Enhancing End-of-Life Care with Home-Based Palliative Interventions: A Systematic Review.

CONTEXT: Home-Based Palliative Care (HPC) interventions have emerged as a promising approach to deliver patient-centered care in familiar surroundings, aligning with patients' preferences and improving quality of life (QOL). OBJECTIVES: This review aimed to systematically assess the impact of HPC interventions on symptom management, QOL, healthcare resource utilization and place of death among patients with severe, progressive illnesses requiring end-of-life care. METHODS: A comprehensive search was conducted across PubMed, Cochrane, and Scopus databases to identify relevant studies published between January 1, 2013, and December 31, 2023. Eligible studies included randomized controlled trials and clinical studies evaluating the effectiveness of HPC interventions compared to usual care. Risk of bias assessment was performed using Cochrane tools. RESULTS: Nine publications meeting inclusion criteria were identified. Findings indicate that HPC interventions, delivered by specialized teams or integrated care approaches, significantly improve QOL and increase the likelihood of patients dying at home. Moreover, HPC is associated with reduced healthcare utilization, including fewer hospital admissions, emergency department visits, and shorter hospital stays. No significant differences were observed in symptom management. CONCLUSION: HPC interventions demonstrate significant benefits in addressing the complex needs of patients with advanced illnesses. These findings underscore the importance of integrating HPC into healthcare systems to optimize outcomes and promote quality end-of-life care. Future research should focus on expanding access to HPC services, enhancing interdisciplinary collaboration, and incorporating patient preferences to further improve care delivery in this vulnerable population.

Environmental, social and economic perceptions of local food production: a case study of Aberdeenshire farmers' markets.

Sustainable food systems are an important aspect of curbing the impacts of climate change and meeting targets of global food security. It is increasingly recognised that a wider suite of indicators is required to assess sustainability beyond the traditional environmental factors. This study focuses on Aberdeenshire, an atypical area of the UK where soils, climate and topography are not conducive to diverse or large-scale fruit and vegetable production, which in other areas, are a dominant feature of farmers' markets. Nevertheless, Aberdeenshire needs economic diversification to offset some of the impacts of the decline in the oil and gas industry. Face-to-face questionnaires were conducted across Aberdeenshire farmers' markets in summer 2022 to assess buyer and seller perceptions of the environmental, social and economic benefits of local food products. There was a positive attitude to local products with the majority of buyers perceiving the quality, nutrition, organic status and use of sustainable farming practices to be high. Conversely, the main products bought, baked goods and meat, are associated with negative impacts on the environment and/or human health. We discuss why, despite these shortfalls, farmers' markets provide a valuable opportunity to distribute and promote high quality wares to support the local economy.

A global, empirical, harmonised dataset of soil organic carbon changes under perennial crops.

A global, unified dataset on Soil Organic Carbon (SOC) changes under perennial crops has not existed till now. We present a global, harmonised database on SOC change resulting from perennial crop cultivation. It contains information about 1605 paired-comparison empirical values (some of which are aggregated data) from 180 different peer-reviewed studies, 709 sites, on 58 different perennial crop types, from 32 countries in temperate, tropical and boreal areas; including species used for food, bioenergy and bio-products. The database also contains information on climate, soil characteristics, management and topography. This is the first such global compilation and will act as a baseline for SOC changes in perennial crops. It will be key to supporting global modelling of land use and carbon cycle feedbacks, and supporting agricultural policy development.

Selecting land-based mitigation practices to reduce GHG emissions from the rural land use sector: a case study of North East Scotland.

The Climate Change (Scotland) Act 2009 commits Scotland to reduce GHG emissions by at least 42% by 2020 and 80% by 2050, from 1990 levels. According to the Climate Change Delivery Plan, the desired emission reduction for the rural land use sector (agriculture and other land uses) is 21% compared to 1990, or 10% compared to 2006 levels. In 2006, in North East Scotland, gross greenhouse gas (GHG) emissions from rural land uses were about 1599 ktCO2e. Thus, to achieve a 10% reduction in 2020 relative to 2006, emissions would have to decrease to about 1440 ktCO2e. This study developed a methodology to help selecting land-based practices to mitigate GHG emissions at the regional level. The main criterion used was the "full" mitigation potential of each practice. A mix of methods was used to undertake this study, namely a literature review and quantitative estimates. The mitigation practice that offered greatest "full" mitigation potential (≈66% reduction by 2020 relative to 2006) was woodland planting with Sitka spruce. Several barriers, such as economic, social, political and institutional, affect the uptake of mitigation practices in the region. Consequently the achieved mitigation potential of a practice may be lower than its "full" mitigation potential. Surveys and focus groups, with relevant stakeholders, need to be undertaken to assess the real area where mitigation practices can be implemented and the best way to overcome the barriers for their implementation.

Systems approaches in global change and biogeochemistry research.

Systems approaches have great potential for application in predictive ecology. In this paper, we present a range of examples, where systems approaches are being developed and applied at a range of scales in the field of global change and biogeochemical cycling. Systems approaches range from Bayesian calibration techniques at plot scale, through data assimilation methods at regional to continental scales, to multi-disciplinary numerical model applications at country to global scales. We provide examples from a range of studies and show how these approaches are being used to address current topics in global change and biogeochemical research, such as the interaction between carbon and nitrogen cycles, terrestrial carbon feedbacks to climate change and the attribution of observed global changes to various drivers of change. We examine how transferable the methods and techniques might be to other areas of ecosystem science and ecology.