Do diagnostic delays in cancer matter?

background: The United Kingdom has poorer cancer outcomes than many other countries due partly to delays in diagnosing symptomatic cancer, leading to more advanced stage at diagnosis. Delays can occur at the level of patients, primary care, systems and secondary care. There is considerable potential for interventions to minimise delays and lead to earlier-stage diagnosis. methods: Scoping review of the published studies, with a focus on methodological issues. results: Trial data in this area are lacking and observational studies often show no association or negative ones. This review offers methodological explanations for these counter-intuitive findings. conclusion: While diagnostic delays do matter, their importance is uncertain and must be determined through more sophisticated methods

The role of war in deep transitions: exploring mechanisms, imprints and rules in sociotechnical systems

This paper explores in what ways the two world wars influenced the development of sociotechnical systems underpinning the culmination of the first deep transition. The role of war is an underexplored aspect in both the Techno-Economic Paradigms (TEP) approach and the Multi-level perspective (MLP) which form the two key conceptual building blocks of the Deep Transitions (DT) framework. Thus, we develop a conceptual approach tailored to this particular topic which integrates accounts of total war and mechanisms of war from historical studies and imprinting from organisational studies with the DT framework’s attention towards rules and meta-rules. We explore in what ways the three sociotechnical systems of energy, food, and transport were affected by the emergence of new demand pressures and logistical challenges during conditions of total war; how war impacted the directionality of sociotechnical systems; the extent to which new national and international policy capacities emerged during wartime in the energy, food, and transport systems; and the extent to which these systems were influenced by cooperation and shared sacrifice under wartime conditions. We then explore what lasting changes were influenced by the two wars in the energy, food, and transport systems across the transatlantic zone. This paper seeks to open up a hitherto neglected area in analysis on sociotechnical transitions and we discuss the importance of further research that is attentive towards entanglements of warfare and the military particularly in the field of sustainability transitions

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes?:Systematic review

background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. methods: Systematic review of the literature and narrative synthesis. results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers

Assessment of tidal range changes in the North Sea from 1958 to 2014

We document an exceptional large‐spatial scale case of changes in tidal range in the North Sea, featuring pronounced trends between ‐2.3 mm/yr at tide gauges in the UK and up to 7 mm/yr in the German Bight between 1958 and 2014. These changes are spatially heterogeneous and driven by a superposition of local and large‐scale processes within the basin. We use principal component analysis to separate large‐scale signals appearing coherently over multiple stations from rather localized changes. We identify two leading principal components (PCs) that explain about 69% of tidal range changes in the entire North Sea including the divergent trend pattern along UK and German coastlines that reflects movement of the region's semidiurnal amphidromic areas. By applying numerical and statistical analyses, we can assign a baroclinic (PC1) and a barotropic large‐scale signal (PC2), explaining a large part of the overall variance. A comparison between PC2 and tide gauge records along the European Atlantic coast, Iceland and Canada shows significant correlations on time scales of less than 2 years, which points to an external and basin‐wide forcing mechanism. By contrast, PC1 dominates in the southern North Sea and originates, at least in part, from stratification changes in nearby shallow waters. In particular, from an analysis of observed density profiles, we suggest that an increased strength and duration of the summer pycnocline has stabilized the water column against turbulent dissipation and allowed for higher tidal elevations at the coast