Diagnosis of cancer as an emergency: a critical review of current evidence

Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis

Development of a Chemical Source Apportionment Decision Support Framework for Catchment Management

EU legislation, including the Water Framework Directive, has led to the application of increasingly stringent quality standards for a wide range of chemical contaminants in surface waters. This has raised the question of how to determine and to quantify the sources of such substances so that measures can be taken to address breaches of these quality standards using the polluter pays principle. Contaminants enter surface waters via a number of diffuse and point sources. Decision support tools are required to assess the relative magnitudes of these sources and to estimate the impacts of any programmes of measures. This work describes the development and testing of a modeling framework, the Source Apportionment Geographical Information System (SAGIS). The model uses readily available national data sets to estimate contributions of a number of nutrients (nitrogen and phosphorus), metals (copper, zinc, cadmium, lead, mercury, and nickel) and organic chemicals (a phthalate and a number of polynuclear aromatic hydrocarbons) from multiple sector sources. Such a tool has not previously been available on a national scale for such a wide range of chemicals. It is intended to provide a common platform to assist stakeholders in future catchment management