Cancerbackup, the cancer information and support charity, has launched what it hopes will be the biggest ever survey of people affected by cancer. The aim is to increase understanding of how the provision of the right information, to the right people, at the right time helps them make the right choices about their treatment and care.

“Information for people affected by cancer has long been recognised as vital”, says Derryn Borley, Head of Cancer Services, Cancerbackup. “Therefore Cancerbackup is undertaking this study to find out ways in which having clear and trustworthy information about cancer can affect people’s lives, from the first visit to the GP through all stages of treatment and care.”

By knowing how and when people would like to receive the information, and what best serves their needs, Cancerbackup will aim to shape its service and influence healthcare providers to deliver relevant information in the most useful way.

Today, leading organizations from across the healthcare spectrum joined together to ensure that the United States is prepared to deliver on a major women’s health breakthrough - the elimination of most forms of cervical cancer through access to new vaccines and screening. The Partnership to End Cervical Cancer’s goal is to ensure the immediate inclusion of cervical cancer vaccines as part of routine preventive healthcare for American women. Cervical cancer, caused by persistent infection with oncogenic human papillomavirus (HPV), is the second most prevalent cancer among women today, taking the lives of more than 270,000 women worldwide every year.

“This Partnership is inspired by the enormous opportunity a vaccination will offer to help eliminate most forms of cervical cancer, but we are concerned that the public health landscape is not primed to ensure broad access to vaccines,” said Phyllis Greenberger, M.S.W., president and chief executive officer of the Society for Women’s Health Research and chair of the Partnership to End Cervical Cancer. “Our goal is to educate women about cervical cancer and to encourage the public health network, physicians and policymakers to take action to ensure that women have access to medical breakthroughs, such as new vaccines.”

The more than 20 member organizations of the Partnership have formed four key committees to address the major policy and public health challenges to ensuring access to vaccines for women.

– The Cervical Cancer and HPV Education Committee will increase awareness among women of the human papillomavirus (HPV) as the necessary cause of cervical cancer and the benefits of vaccination in women. — The Access/Coverage for Vaccines Committee will educate policymakers on the value of universal access to these vaccines and the requisite coverage of the cost.

– The Medical Home Committee for Adult Women Vaccination will develop and implement recommendations to inform medical practice guidelines that include routine screening and vaccination.

– The Health Disparities Committee will strive to ensure that women in communities with higher incidence and mortality rates of cervical cancer have equal opportunities to receive the vaccines.

“All women are at risk for cervical cancer. From a women’s health perspective, a cervical cancer vaccine is as revolutionary as the birth control pill,” said Stanley Gall, M.D., American College of Obstetricians and Gynecologists’ (ACOG’s) representative to the Advisory Committee on Immunization Practices; professor of Obstetrics, Gynecology and Women’s Health, and Public Health and Information Science, University of Louisville; and Steering Committee member and chair, Medical Home for Adult Women Vaccination Committee, Partnership to End Cervical Cancer. “That we can potentially eliminate most forms of a cancer through a series of vaccinations is a significant milestone in healthcare history.”

Said Ciro de Quadros, M.D., M.P.H., president and chief executive officer of the Sabin Vaccine Institute and Partnership Steering Committee member, “Comprehensive vaccination programs work - as we’ve seen with the significant reduction or elimination of smallpox worldwide and measles in the Western Hemisphere. Today, the Partnership is making the commitment to play a leadership role in the campaign to end as much of cervical cancer as can be prevented with these vaccines and screening in this country.”

Partnership member organizations:

American College Health Association
American College of Obstetricians and Gynecologists
American Medical Women’s Association
American Social Health Association
Association of Women’s Health, Obstetric and Neonatal Nurses
The Balm In Gilead, Inc.
Cancer Research and Prevention Foundation
Coalition of Labor Union Women
Digene Corporation
GlaxoSmithKline
National Association of County and City Health Officials
National Association of Nurse Practitioners in Women’s Health
The National Black Nurses Association, Inc.
National Cervical Cancer Coalition
National Council of La Raza
National Family Planning and Reproductive Health Association
National Healthy Mothers, Healthy Babies Coalition
National Hispanic Medical Association
National Medical Association
Partnership for Prevention
Planned Parenthood Federation of America
Sabin Vaccine Institute
Marie Savard, M.D.
Society for Women’s Health Research

About cervical cancer:

Cervical cancer is caused by persistent infection with a common and contagious virus, HPV. HPV types 16, 18, 45 and 31 are responsible for 80 percent of all cervical cancers worldwide. Approximately 10,000 cases of cervical cancer will be diagnosed and nearly 4,000 women will die from it in the United States this year.

Cervical cancer deaths disproportionately occur in women of certain populations and geographic regions (e.g., African-American women in the South, Hispanic women along the Texas-Mexico border, white women in Appalachia, American Indians of the Northern Plains, Vietnamese American women, Alaska Natives) in the United States. Of the women in the United States who develop cervical cancer, about half have never had a Pap test and an additional 10 percent have not had a Pap in the last five years.

This issue, which has suddenly become headline news, has never been the subject of a full national debate in the profession, writes general practitioner, Richard Lehman.

Over the past 15 years there has been much talk of centralising services, and many local campaigns over individual threatened local hospitals, but little systematic collection of evidence to inform decision making, he says. Instead the process has been driven largely by financial pressures, by the European Working Time Directive and its effects on junior doctors’ staffing, and recommendations from the royal colleges.

Inevitably these pressures have driven hospitals to amalgamate services, at some cost to local accessibility. Equally inevitably such moves are deeply unpopular with patients, who may have to travel considerable distances for acute care that used to be on their doorstep.

The services most likely to be cut or merged throughout Britain are paediatrics, obstetrics, and emergency services - the very ones that patients particularly want to be near.

This presents a dilemma for trusts seeking to maintain a lower level of service, for example by substituting a midwife led birth unit for a consultant led obstetric service. Such units only accept “low risk” births, but emergencies inevitably occur, requiring transit to the nearest consultant led facility. If considerations of cost are allowed to predominate that may be a very long distance, he warns.

This issue is one of several that need to be debated urgently before a further wave of such changes sweeps the country, he writes. It cannot be timed or located to suit electoral convenience.

We need clearer guidance on issues such as safe transit times for paediatric and obstetric emergencies, and we need more creative thinking on shared site working and flexible training rotas.

It is time for GPs to reassert their role as patients’ advocates, defending the principle of local care for local people, he says. If doctors do not take an active role in questioning the present direction of policy then the public will rightly see us as more interested in our own career structures and hours of working than in providing a safe and accessible service.

The American Medical Student Association at American River College (AMSA ARC), part of nation’s largest, independent medical student organization, today announces the 2006 AMSA ARC Pre-Medical Conference, an annual event designed to educate and prepare California pre-medical students for entrance into medical school. This conference takes place in Sacramento, CA on the main campus of the American River College.

The theme of this year’s AMSA ARC Pre-Med Conference is “Your Passion in Action: Discover Your Path to Medicine,” and will take place Saturday, September 23 and Sunday, September 24. The conference is sponsored by the American Medical Student Association (AMSA) in conjunction with the Stanford Center of Excellence, and will feature informative speakers, workshops, and presentations to give attendees the opportunity to network with others, explore opportunities and learn tips and procedures for the medical school application process.

Keynote speakers of the conference are Dr. Charles Terrell, Vice President of the American Association of Medical Colleges (AAMC), David Carlisle, Director of California Office of Statewide Health Planning & Development, and Jay Bhatt, National President of the American Medical Student Association (AMSA). The conference will also exhibit discussion panels featuring Deans of Admissions from Harvard, Stanford, Duke, Cornell, University of Chicago, and many California schools including UC Davis, UC Irvine, UC San Diego, UCLA and UCSF.

The conference will showcase over forty-five workshops covering important topics such as paying for medical school, preparing for the MCAT, mock interviewing, M.D./PhD programs, and Women in Medicine. Program highlights include a medical school fair, community service fair, counselor/advisor round table, and an appearance by Steve Barkley, Director of the Medical College Admission Test.

“AMSA ARC is thrilled to be hosting this year’s AMSA Pre-Medical Conference,” says Joubin Afshar, AMSA ARC’s Premedical Regional Director. “It is a wonderful opportunity to bring together physicians-in-training from all over the state to increase their knowledge of the medical education process and all the amazing opportunities a career in medicine has to offer.”

Last year’s conference attendance of close to 1,000 students from over fifty-five colleges and universities from California established the AMSA ARC Pre-Medical Conference as the largest, most diverse gathering of premedical students in the nation.

“AMSA is proud to recognize and support its premedical members that will be the future of medicine,” says Jay Bhatt, National President. “I’m excited to participate in this incredible event that will highlight how to become involved in our wonderful profession as well as the many resources AMSA offers to support it.”

The American Diabetes Association (ADA) endorsed the Gestational Diabetes (GEDI) Act, which was introduced in the U.S. Senate today by Sens. Hillary Rodham Clinton and Susan Collins. The bill aims to lower the incidence of gestational diabetes and prevent women afflicted with this condition and their children from developing type 2 diabetes. Gestational diabetes develops in 4-8 percent of all pregnancies and affects about 135,000 women in the United States each year. Women who have had gestational diabetes or have given birth to a baby weighing more than 9 pounds are at a dramatically increased risk for developing type 2 diabetes later in life. Gestational diabetes is also associated with more health problems for both the mother and child during pregnancy and childbirth. The Gestational Diabetes Act will allow for better data collection in local communities and will expand the resources available to fight the disease.

“Diabetes has become a health epidemic that the federal government can no longer ignore,” said Lawrence T. Smith, Chair of the American Diabetes Association. “That is why it is vital to have approaches - like this one to address the growing incidence of gestational diabetes - that increase the government’s role in raising awareness and intensifying prevention efforts. We applaud Senators Clinton and Collins for their leadership on this legislation and urge the Senate to pass it quickly.”

The GEDI Act will set up a national grant program, which will enable communities to determine the most efficient and customized approaches to prevent, diagnose and treat gestational diabetes on the local level. Additionally, grants can be used by state-based diabetes prevention and control programs to collect and analyze surveillance data on women with and at risk for gestational diabetes, among other purposes. These components are crucial to stemming the tide of gestational diabetes in America, and lowering the overall incidence of diabetes in the United States.

Diabetes is one of the nation’s most prevalent, debilitating and costly diseases. Nearly 21 million American children and adults have diabetes, up from 18 million when the Centers for Disease Control and Prevention last measured diabetes prevalence in 2003. If present trends continue, one in three Americans, and one in two minorities, born in 2000 will develop diabetes in their lifetime. The cost of diabetes in the U.S. in 2002 was at least $132 billion.

The medical device currently used for intestinal research, the colonsope, causes patients great discomfort. At TU Delft, an alternative method has been developed, inspired by the way in which snails move. On September 18, researcher Dimitra Dodou received her PhD degree from TU Delft based on this research subject.

The intestines are an extremely difficult area to navigate through with a medical device. Yet, many people need to have intestinal examinations done to determine if, for example, they have intestinal cancer. The medical device currently used for this is the colonscope, a long, thin and flexible tube that causes patients great discomfort and pain. For this reason, researchers have been trying to develop alternative medical devices, such as, for example, a small robot that moves independently through the intestinal tract. There is a layer of slime, called mucus, on the inside of the large intestine (colon). The robots, as they move forward under their own power, ignore this layer of mucus and try, if possible, to suck or grab on to the intestinal wall, which results in the walls being stretched and the patient feeling pain and discomfort.

A better method, according to TU Delft researcher Dimitra Dodou, is in fact to use this layer of mucus and allow the robot to imitate the forward movement of a snail. A snail leaves a trail of slime behind it on the ground. This slimy material works simultaneously as a lubricant for gliding on and as a glue which the slug can grip hold of.

An intestinal robot should also have a similar layer to use. To achieve this, an adhesive layer is added to the mucus-like properties, which allows the device to be stuck to the layer of mucus. The ability to be attached to a surface covered with lubricant is a great technological challenge, because most adhesives normally only work on ‘clean’ surfaces. The researchers discovered a group of polymers, so-called muco-adhesives, that are suitable for this. Dodou used a pig’s intestine to evaluate how this material worked. Her findings revealed that muco-adhesives in the form of films provided by far the highest degree of friction.

Despite this, there is nevertheless no possibility of movement. A snail uses the exertions of pressure to change the characteristics of the middle layer, and thus lower the degree of friction, in order to move. In the intestine, however, pressure cannot be exerted, because this would cause the intestine to become deformed. The solution then is found in using smaller and larger surfaces that slide over each other. If a large surface coated with muco-adhesive remains still, and a relatively small surface coated with muco-adhesive begins moving in relation to the larger surface, the smaller surface has less freedom of movement. One by one the small ‘hands’ of the robot move forward. After this, the entire robot can be slide forward incrementally, whereupon the process of small surfaces shifting begins anew.

Additional experiments found that it is not only the size of the film surfaces, but also their shapes, which influence the degree of friction generated. It’s remarkable that the degree of friction increases when the surface size decreases, as a result of holes being made in the structure of the film. It is therefore possible to influence the degree of friction by creating holes in the muco-adhesive or indeed by closing the holes.

Moreover, by selecting different shapes, which owing to their compact size can achieve high degrees of friction, the device can be made smaller.

The researchers are currently building a prototype that will be tested in living pigs. We must however wait a while longer until a fully developed medical device is available.

The Dana Foundation will host a panel discussion titled, “Can Immunology Help Win the War on Cancer?” on Wednesday, September 27, 2006 from 6:00 - 7:15 p.m. The event will feature Dr. LaSalle D. Leffall, Jr., cancer surgeon, professor, and medical advocate, author of the Howard University Press title, No Boundaries: A Cancer Surgeon’s Odyssey (2005).

It will be held at The Dana Foundation’s Washington, D.C. headquarters at 900 15th Street, N.W. Washington, D.C. 20005. A book signing and reception for Dr. Leffall will follow the panel discussion. Seating is limited and by RSVP only. Featured guest speakers for the evening will be:

LaSalle D. Leffall Jr., MD, F.A.C.S., is Charles R. Drew Professor of Surgery at Howard University College of Medicine, chair of the Board of Directors of the Susan G. Komen Breast Cancer Foundation and chair of the President’s Cancer Panel. Dr. Leffall is a surgeon, oncologist, medical educator and leader in professional civic organizations. His significant achievements are chronicled in his recent autobiography, No Boundaries: A Cancer Surgeon’s Odyssey, published by Howard University Press (2005).

Ralph M. Steinman, M.D., is the Henry G. Kunkel Professor at The Rockefeller University, Director of the Chris Browne Center for Immunology and Immune Diseases, and a senior physician at The Rockefeller University Hospital. Dr. Steinman studies the interface of the immune system with several disease states, including research aimed at developing vaccines and immune-based therapies for tumors, infections and autoimmune diseases.

Steven A. Rosenberg, M.D., Ph.D., is Chief of Surgery at the National Cancer Institute and a Professor of Surgery at the Uniformed Services University of Health Sciences and the George Washington University School of Medicine and Health Sciences. His research interests have focused on studies of tumor immunology and the development of effective immunotherapies for the treatment of patients with cancer.

William Safire, Chairman, The Dana Foundation (Moderator).

THE DANA FOUNDATION is a private philanthropic organization with particular interest in brain science, immunology, and arts education. Dana supports brain research through grants and by its outreach to the public. Dana’s research includes popular science and health books and periodicals for the general reader from the Dana Press.

The Dana Alliances in the U.S. and Europe–nonprofit organizations of 390 neuroscientists, including fifteen Nobel laureates–are committed to advancing public awareness about the progress of brain research. Dana has offices in New York, Washington, D.C., and London.

The Starr Foundation today announced that it has made a $100 million grant to create a wide-ranging cancer consortium to coordinate the efforts of five internationally renowned research institutions in the fight against cancer. Joining this ambitious undertaking is The Broad Institute of MIT and Harvard, Cold Spring Harbor Laboratory, Memorial Sloan-Kettering Cancer Center, The Rockefeller University and Weill Cornell Medical College.

The five will collaborate on research aimed at understanding cancer at its most fundamental levels and at developing new approaches to the prevention, diagnosis and treatment of the many forms of the disease that together constitute one of the greatest threats to human health.

The program, to be known as the Starr Cancer Consortium, will provide an innovative framework for research that brings together world-class biomedical investigators with a critical mass of technology. It will build on the complementary strengths of the five institutions, including one-of-a-kind experience in applying the power of genomics to biomedical problems, a proven expertise in the study of cancer genetics in humans and animals, and a strong clinical operation and vast collection of cancer specimens that offer a crucial resource for studying cancer in humans.

“The opening years of the 21st century have brought dramatic advances in understanding cancer and in putting new discoveries to work for the people who need it most,” said Maurice R. Greenberg, Chairman of The Starr Foundation. “Our goal in launching the Starr Cancer Consortium is to bring these exceptional institutions together in a manner that assures maximum efficiency and the greatest firepower in targeting cancer. This will enable us to achieve tangible results more quickly and decisively than any one or two members of the consortium could accomplish working alone.”

The Starr Foundation, with assets today of approximately $3.5 billion, has donated in excess of $2 billion - more than $1 billion in New York City alone - making it one of the largest private foundations in the United States. The Foundation supports education, cultural institutions, medicine and healthcare, human needs, public policy, and the environment.

Each institution taking part in the Starr Cancer Consortium enjoys international distinction as a leader in scientific research and discovery. At the same time, they have each compiled an impressive track record of collaborative work in a variety of partnerships. The Starr Foundation grant of $100 million will be earmarked specifically for joint projects involving two or more institutions, including several highly promising initiatives already underway.

Key areas of focus for the Starr Cancer Consortium will include:

* Creation or accelerated development of powerful technology platforms designed to unravel the genetic and molecular basis of cancers

* Application of these technologies in joint projects aimed at developing new and highly effective approaches to diagnosis and treatment

* Support for basic biological research to provide insights into the fundamental molecular and cellular processes underlying cancer

Activities selected for funding through the Starr Cancer Consortium will be determined by an executive committee including leaders of the five institutions: Eric Lander of the Broad Institute of MIT and Harvard, Bruce Stillman of Cold Spring Harbor Laboratory, Harold Varmus of Memorial Sloan-Kettering Cancer Center, Paul Nurse of The Rockefeller University and Antonio M. Gotto, Jr., of Weill Cornell Medical College.

Inspired by The Starr Foundation’s visionary generosity in establishing the Starr Cancer Consortium, the five collaborating institutions (profiled below) are committed to achieving dramatic progress in addressing the enormous challenges posed by cancer and in seizing one of today’s greatest scientific opportunities.

The Broad Institute of Harvard and MIT - located in Cambridge, Mass., is a new research collaboration among MIT, Harvard University and Harvard’s affiliated hospitals, including the Dana-Farber/Harvard Cancer Center. Already recognized for its accomplishments in applying the power of genomics to important biomedical problems, the Broad Institute of Harvard and MIT is led by Eric S. Lander, Ph.D., a principal leader of the Human Genome Project.

Cold Spring Harbor Laboratory - is a renowned research and educational institution with a rich tradition of studying cancer in animals through the use of cancer viruses and genetically altered mice. It is also highly regarded in the fields of whole-genome-based analysis of DNA, bioinformatics and RNAi methods. Founded in 1890, it is headed by Bruce Stillman, Ph.D., a leading specialist in DNA replication.

Memorial Sloan-Kettering Cancer Center - is the nation’s preeminent center for research, education and patient care focused exclusively on cancer. The Center’s president and CEO is Harold Varmus, M.D., a recipient of the 1989 Nobel Prize for Physiology or Medicine for his groundbreaking research into the genetic basis of cancer. Dr. Varmus is a former Director of the National Institutes of Health and a founder of the Public Library of Science, a model for providing open access to scientific publications.

The Rockefeller University - is an internationally recognized basic research institution that today brings a strong and steadily growing emphasis to addressing fundamental questions about cancer from perspectives that span a wide range of scientific disciplines. It is headed by Paul Nurse, Ph.D., a 2001 recipient of the Nobel Prize in Physiology or Medicine whose research focuses on the molecular machinery that drives cell division and controls cell shape.

Weill Cornell Medical College - is one of the nation’s top-ranked clinical and medical research centers, with an array of twenty academic departments devoted to the scientific disciplines that inform both the study of medicine and investigations into the major human diseases, such as cancer. Antonio M. Gotto, Jr., M.D., D.Phil., a specialist in coronary heart disease risk and lipid disorders, serves as Provost for Medical Affairs and Dean of the Medical College.

Researchers at Virginia Commonwealth University Medical Center have developed and patented a new, noninvasive means of measuring blood pressure inside the heart.

The measurement to determine central venous pressure (CVP) — a reading that gives doctors important information about the volume of blood circulation and how well the heart is pumping — now can be done using a simple blood pressure cuff and special electrodes connected to a computer.

The new technique, developed by researchers in VCU’s Reanimation Engineering Shock Center (VCURES), determines CVP by monitoring blood volume changes in the arm in response to externally applied circumferential pressure to the brachial vein — the large vessel in the arm that carries blood between the elbow and shoulder back to the heart.

Doctors space four monitoring electrodes along the arm and apply a blood pressure cuff on top of two of the electrodes near the shoulder. Over the course of a minute, the cuff is partially inflated and deflated allowing the monitoring electrodes to detect changes in blood volume and send data to a computer that determines the CVP.

Monitoring CVP of a critically ill or injured patient can be essential in determining how well blood is circulating to vital organs and if the heart is failing.

Until now, doctors had to thread a catheter through the neck or chest to a point near the right atrium — the first of the heart’s four pumping chambers — to accurately determine CVP, a time consuming procedure that can lead to complications including infection, punctured lungs, bleeding and arrhythmias.

In a recent study published in the journal Resuscitation, VCU investigators used the method to measure CVP in critically ill or injured patients who already were undergoing CVP measurement using the conventional catheter technique. The investigators found the new noninvasive method was as accurate and precise as directly measuring CVP from the catheter.

“The ability to accurately monitor CVP in a safer, more efficient, noninvasive way will have tremendous patient benefits and enable health care workers to make more rapid treatment decisions,” according to Kevin Ward, M.D., associate professor in the Department of Emergency Medicine at the VCU Medical Center, who co-authored the study and is a co-inventor of the technique. “This should ultimately lead to improved patient outcomes and fewer complications.”

Other members of the VCURES team include Hakam Tiba, M.D., and R. Wayne Barbee, Ph.D., VCU Department of Emergency Medicine; James Arrowood, M.D., Department of Internal Medicine; Rao Ivatury, M.D., and Russell Hummel, Department of Critical Care Surgery; and Bruce Spiess, M.D., Department of Anesthesiology, and E. Kate Proffitt, Department of Biomedical Engineering. VCURES is a multidisciplinary center dedicated to improving survival from critical illness and injury. For more on VCURES visit http://www.vcures.org.

the Virginia Commonwealth University Medical Center

The Virginia Commonwealth University Medical Center is one of the nation’s leading academic medical centers and stands alone as the only academic medical center in Central Virginia. The medical center includes the 780-bed MCV Hospitals and outpatient clinics, MCV Physicians — a 600-physician-faculty group practice, and the health sciences schools of Virginia Commonwealth University. The VCU Medical Center, through its VCU Health System, offers state-of-the art care in more than 200 specialty areas, many of national and international note, including organ transplantation, head and spinal cord trauma, burn healing and cancer treatment. The VCU Medical Center is the site for the region’s only Level 1 Trauma Center. As a leader in healthcare research, the VCU Medical Center offers patients the opportunity to choose to participate in programs that advance evolving treatment, such as those sponsored by the National Cancer Institute through VCU’s Massey Cancer Center, Virginia’s first NCI-designated cancer center. The VCU Medical Center’s academic mission is supported by VCU’s health sciences schools of medicine, allied health, dentistry, pharmacy and nursing.

Radiation Shield Technologies, Inc. (RST) announced today that it was awarded an international tender issued by the International Atomic Energy Agency (IAEA). Under this tender, the IAEA has agreed to purchase Anti-Nuclear Full Body suits from the Miami, FL based Radiation Shield Technologies, Inc. The suits will be used by United Nations Development Program in Belarus under Project 9012 aimed at Strengthening the System of Emergency Preparedness and Response to Radiation Emergencies.

The tender called for, “Radiation shielding coveralls constructed with an integrated hood and heat sealed seams for full body radiation protection.” RST responded to and was awarded this solicitation by offering its full body Demron(TM) suits. Demron(TM) is the first and only proprietary fabric that has been shown to be effective against all forms of radiation. Current Nuclear Biological Chemical (NBC) suits offer no protection against ionizing radiation and with the eminent threat of a dirty bomb or other radiological dispersal device (RDD), agencies are beginning to look for ways to protect their first responders against nuclear radiation.

Initial discussions have begun to provide this garment to other participating IAEA member states within this project. Tex Clark, Director of Business Development, for RST stated, “Belarus is just 1 of 22 member states operating within this project. This is an excellent opportunity to expand the global reach of RST’s operations.” While nations including the United States, France, Germany, and England are purely observers for this project committee, there are 22 actively participating nations within central and Eastern Europe.