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Researchers and research funders aiming to improve diagnosis seek to identify if, when, where, and how earlier diagnosis is possible. This has led to the propagation of research studies using a wide range of methodologies and data sources to explore diagnostic processes. Many such studies use electronic health record data and focus on cancer diagnosis. Based on this literature, we propose a taxonomy to guide the design and support the synthesis of early diagnosis research, focusing on five key questions: Do healthcare use patterns suggest earlier diagnosis could be possible? How does the diagnostic process begin? How do patients progress from presentation to diagnosis? How long does the diagnostic process take? Could anything have been done differently to reach the correct diagnosis sooner? We define families of diagnostic research study designs addressing each of these questions and appraise their unique or complementary contributions and limitations. We identify three further questions on relationships between the families and their relevance for examining patient group inequalities, supported with examples from the cancer literature. Although exemplified through cancer as a disease model, we recognise the framework is also applicable to non-neoplastic disease. The proposed framework can guide future study design and research funding prioritisation. [ABSTRACT FROM AUTHOR]

Many cancer referral guidelines use patient's age as a key criterium to decide who should be referred urgently. A recent rise in the incidence of colorectal cancer in younger adults has been described in high-income countries worldwide. Information on other cancers is more limited. The aim of this rapid review was to determine whether other cancers are also increasing in younger age groups, as this may have important implications for prioritising patients for investigation and referral. We searched MEDLINE, Embase and Web of Science for studies describing age-related incidence trends for colorectal, bladder, lung, oesophagus, pancreas, stomach, breast, ovarian, uterine, kidney and laryngeal cancer and myeloma. 'Younger' patients were defined based on NICE guidelines for cancer referral. Ninety-eight studies met the inclusion criteria. Findings show that the incidence of colorectal, breast, kidney, pancreas, uterine cancer is increasing in younger age groups, whilst the incidence of lung, laryngeal and bladder cancer is decreasing. Data for oesophageal, stomach, ovarian cancer and myeloma were inconclusive. Overall, this review provides evidence that some cancers are increasingly being diagnosed in younger age groups, although the mechanisms remain unclear. Cancer investigation and referral guidelines may need updating in light of these trends. [ABSTRACT FROM AUTHOR]

Background: Cancer patients often have pre-existing comorbidities, which can influence timeliness of cancer diagnosis. We examined symptoms, investigations and emergency presentation (EP) risk among colorectal cancer (CRC) patients by comorbidity status.Methods: Using linked cancer registration, primary care and hospital records of 4836 CRC patients (2011-2015), and multivariate quantile and logistic regression, we examined variations in specialist investigations, diagnostic intervals and EP risk.Results: Among colon cancer patients, 46% had at least one pre-existing hospital-recorded comorbidity, most frequently cardiovascular disease (CVD, 18%). Comorbid versus non-comorbid cancer patients more frequently had records of anaemia (43% vs 38%), less frequently rectal bleeding/change in bowel habit (20% vs 27%), and longer intervals from symptom-to-first relevant test (median 136 vs 74 days). Comorbid patients were less likely investigated with colonoscopy/sigmoidoscopy, independently of symptoms (adjusted OR = 0.7[0.6, 0.9] for Charlson comorbidity score 1-2 and OR = 0.5 [0.4-0.7] for score 3+ versus 0. EP risk increased with comorbidity score 0, 1, 2, 3+: 23%, 35%, 33%, 47%; adjusted OR = 1.8 [1.4, 2.2]; 1.7 [1.3, 2.3]; 3.0 [2.3, 4.0]) and for patients with CVD (adjusted OR = 2.0 [1.5, 2.5]).Conclusions: Comorbid individuals with as-yet-undiagnosed CRC often present with general rather than localising symptoms and are less likely promptly investigated with colonoscopy/sigmoidoscopy. Comorbidity is a risk factor for diagnostic delay and has potential, additionally to symptoms, as risk-stratifier for prioritising patients needing prompt assessment to reduce EP. [ABSTRACT FROM AUTHOR]

Welding is a widely accepted process used in the assembly of aluminum chassis structures in the automotive industry. Finite element analysis (FEA) is usually adopted to predict distortions caused in the welding process. However, only nominal distortions result from FEA simulations. Welding distortions could be more accurately predicted by introducing the prediction of tolerances due to a modification of the input parameters. The aim of this work is therefore to introduce the tolerance evaluation in the FEA model, by varying the welding input parameters (geometrical and dimensional tolerances on the parts, heat input…). To find the most suitable FEA model to investigate welding process tolerance, three FEA models are compared: one is the thermo-elastic-plastic (TEP) model, and two are based on the inherent strain method. The case study uses a thin (2 mm) aluminum T-joint, which is commonly used in automotive chassis assembly. Results deriving from FEA simulations were compared with experimental data. Among the various input parameters affecting the welding process, the authors combined the dimensional tolerance on the plate thickness with the variability of the heat input. The results provided a tolerance range value for the angular distortion of the T-joint. [ABSTRACT FROM AUTHOR]

The systematic integration of user needs in the product design is a key issue in industry, especially for small- and medium-sized enterprises (SMEs), which suffer a lack of engineering methods and resources. Moreover, most of the approaches described in the literature are not flexible enough to be tailored on the SMEs' needs, involve users only in the early design phases and are not fully accessible due to the high cost in their implementation. The present paper proposes a user-centred design methodological framework specifically focused on SMEs, which supports the designer from both design and manufacturing aspects along the engineering product design process. The framework integrates engineering methods with Web-based software tools, which enable the communication and the concurrent work of the design team, and supports direct participation of users. Beside state-of-the-art methods, the framework allows the integration of specifically tailored techniques. The framework is successfully validated through an industrial case study developed in collaboration with an Italian SME. As a result, the design of an injection-moulded housing and the related interfaces of a biomedical electronic device are achieved with a reduction of uncertainty and development time, by involving users throughout the design phases and suggesting methods and tools on the basis of the designers' know-how and SME's specific resources. [ABSTRACT FROM AUTHOR]

The enhancement of the early design stages, in the production of aeronautical engines, has been shown decisive, for developing efficient and reliable final products. Nevertheless, in most of industrial engineering design problems, the amount of design variables is large. Moreover, several nonlinearities characterize the behaviour of the physical phenomena involved and the derivatives are seldom known for all the functions. Besides, objective functions exhibit several local extremes, whereas the designer as well as the practitioner is usually interested in the global one. In this context, stochastic and evolutionary optimization have been shown capable to provide reliable solutions while keeping the computational cost at a reasonable level. Existing tools for the design and optimization of engine components deal with the optimal and detailed design of specific engine components, thus requiring several computational time and efforts to gain optimized design parameters. Hence, existing tools fit for later design phases. Conversely, this paper proposes an integrated design and optimization environment, for automatically designing optimal aeronautical piston engine configuration, still in the conceptual design stage. The optimization is performed using the MATLAB genetic algorithm (GA) toolbox®, while the automatic design of the optimized components is carried out in cascade to the optimization phase. In particular, a single-objective GA is used to evaluate the optimal dimensions of engine components related to motion, namely: crankshaft, connecting rods and screws, flywheel, propeller shaft and torsional vibration damper. For testing the efficiency of the integrated environment, the conceptual design of components of a 4-in-line Diesel aeronautical piston engine is proposed, starting from an existing similar engine. Results show a reduction of the 20 % of weight of the crankshaft in comparison to the original configuration. The proposed environment seems to be a promising tool for a fast and reliable conceptual design of piston engines for aeronautical purposes. [ABSTRACT FROM AUTHOR]

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