The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review

Objective: to investigate variations in the use of specialist palliative care (SPC) services for adult cancer patients, in relation to age.Design: systematic review of studies examining use of or referral to SPC services in adult cancer patients.Search strategy and selection criteria: six electronic databases (Medline, Embase, Web of Science, HMIC, SIGLE and AgeInfo) were searched for studies published between 1966 and March 2005, and references in the articles identified were also examined. Inclusion criteria were all studies which provided data on age in relation to use of or referral to SPC. Two reviewers independently selected studies, extracted data and assessed methodological quality according to defined criteria.Main outcome measures: use of or referral to SPC services, determined from all sources of report (patient, informal carer, health care professional, health care records).Results: 14 studies were identified. All reported a statistically significant lower use of SPC among older cancer patients (65 and above or older) at a univariate level [crude odds ratios ranged from 0.33 (0.15-0.72) to 0.82 (0.80-0.82)]. However, there were important methodological weaknesses in all of the studies identified; most crucially, studies failed to consider variations in use in relation to need for SPC.Conclusions: there is some evidence that older people are less likely to be referred to, or to use, SPC. These findings require confirmation in studies using prospectively collected data which control for patient's need for SPC

The future direction of on-farm irrigation technologies and practice research

The Cooperative Research Centre for Irrigation Futures mission is to facilitate cooperative research and training networks and programs which continuously improve irrigation policy, tools, practices and processes. This paper provides an introduction to the current and planned research activities within the CRCIF with a particular focus on the tools and practices of relevance to improving on-farm water use efficiency. A key focus of this research is the delivery of research outcomes via toolkits which enhance the irrigation sector's ability to measure, monitor and manage the water balance at the field and farm scales, improve the precision of in-field irrigation applications and maximize agronomic responses to irrigation

Mapping and analysis of changes in the riparian landscape structure of the Lockyer Valley Catchment, Queensland, Australia

[Abstract]: A case study of the Lockyer Valley catchment in Queensland, Australia, was conducted to develop appropriate mapping and assessment techniques to quantify the nature and magnitude of riparian landscape structural changes within a catchment. The study employed digital image processing techniques to produce land cover maps from the 1973 and 1997 Landsat imagery. Fixed and variable width buffering of streams were implemented using a geographic information system (GIS) to estimate the riparian zone and to subsequently calculate the landscape patterns using the Patch Analyst (Grid) program (a FRAGSTATS interface). The nature of vegetation clearing was characterised based on land tenure, slope and stream order. Using the Pearson chi-square test and Cramer’s V statistic, the relationships between the vegetation clearing and land tenure were further assessed. The results show the significant decrease in woody vegetation areas mainly due to conversion to pasture. Riparian vegetation corridors have become more fragmented, isolated and of much smaller patches. Land tenure was found to be significantly associated with the vegetation clearing, although the strength of association was weak. The large proportion of deforested riparian zones within steep slopes or first-order streams raises serious questions about the catchment health and the longer term potential for land degradation by upland clearing. This study highlights the use of satellite imagery and geographic information systems in mapping and analysis of landscape structural change, as well as the identification of key issues related to sensor spatial resolution, stream buffering widths, and the quantification of land transformation processes

Factors that Influence the Way Communities Respond to Proposals for Major Changes to Local Emergency Services: A Qualitative Study

According to policy commentators, decisions about how best to organise care involve trade-offs between factors relating to care quality, workforce, cost, and patient access. In England, proposed changes such as Emergency Department closures often face public opposition. This study examined the way communities respond to plans aimed at reorganising emergency services, including the trade-offs inherent in such decisions