Challenges and Facilitators for Psychosocial Support when Aging and Dying in Place: A Rapid Review of the Literature.

Most seniors in Canada live at home and consistently indicate that they prefer to stay there for as long as possible. Consequently, this desire places increasing pressure on supports such as informal caregivers and community services. The current rapid review set out to examine the psychosocial aspects of aging and dying in place that point to gaps in programs and services to support this preference. We searched PubMed, PsycInfo, and Google Scholar for peer-reviewed entries, and identified 42 articles for analysis, which we charted on a form we created and tested. Lack of attention to the whole person, lack of preparation for the journey ahead, and difficulties establishing collaborative and trusting relationships were, broadly, the challenges identified. A blend of initiatives in the community combined with an integrated palliative approach to care may mitigate some of the challenges that limit options for aging and dying in place.

Enhancing the scoping study methodology: a large, inter-professional team's experience with Arksey and O'Malley's framework.

BACKGROUND: Scoping studies are increasingly common for broadly searching the literature on a specific topic, yet researchers lack an agreed-upon definition of and framework for the methodology. In 2005, Arksey and O'Malley offered a methodological framework for conducting scoping studies. In their subsequent work, Levac et al. responded to Arksey and O'Malley's call for advances to their framework. Our paper builds on this collective work to further enhance the methodology. DISCUSSION: This paper begins with a background on what constitutes a scoping study, followed by a discussion about four primary subjects: (1) the types of questions for which Arksey and O'Malley's framework is most appropriate, (2) a contribution to the discussion aimed at enhancing the six steps of Arskey and O'Malley's framework, (3) the strengths and challenges of our experience working with Arksey and O'Malley's framework as a large, inter-professional team, and (4) lessons learned. Our goal in this paper is to add to the discussion encouraged by Arksey and O'Malley to further enhance this methodology. SUMMARY: Performing a scoping study using Arksey and O'Malley's framework was a valuable process for our research team even if how it was useful was unexpected. Based on our experience, we recommend researchers be aware of their expectations for how Arksey and O'Malley's framework might be useful in relation to their research question, and remain flexible to clarify concepts and to revise the research question as the team becomes familiar with the literature. Questions portraying comparisons such as between interventions, programs, or approaches seem to be the most suitable to scoping studies. We also suggest assessing the quality of studies and conducting a trial of the method before fully embarking on the charting process in order to ensure consistency. The benefits of engaging a large, inter-professional team such as ours throughout every stage of Arksey and O'Malley's framework far exceed the challenges and we recommend researchers consider the value of such a team. The strengths include breadth and depth of knowledge each team member brings to the study and time efficiencies. In our experience, the most significant challenges presented to our team were those related to consensus and resource limitations. Effective communication is key to the success of a large group. We propose that by clarifying the framework, the purposes of scoping studies are attainable and the definition is enriched.

Cadmium chloride-induced disruption of testicular steroidogenesis in rainbow trout, Oncorhynchus mykiss.

Cadmium (Cd) is a known endocrine disruptor with the ability to affect the production of hormones involved in the regulation of reproductive processes. In the present study, the effects of CdCl(2) on unstimulated and stimulated testicular steroidogenesis were examined with the intention of furthering the understanding of the potential site(s) of action in the signaling pathway for 11-KT synthesis in teleosts. In short-term (2-h) exposures, CdCl(2 )stimulated 11-KT production (29% and 28% over controls) in minced testicular tissues at concentrations of 10 and 100 microM, respectively. However, 11-KT production was significantly lower than in controls (54%, 62%, and 54%) when tissues were incubated for 18 h with 1, 10, and 100 microM Cd. Incubation of testicular tissues with 100 IU/ml human chorionic gonadotropin (hCG) and 5 mM dibutyryl-cAMP (dbcAMP), which activate rate-limiting steps in steroid synthesis, or 1.3 microM 25-hydroxycholesterol (25-OHC), which augments production, resulted in significant increases in steroidogenesis over controls. hCG-stimulated steroidogenesis was reduced to 54% and 62% that of stimulated controls when tissues were incubated with CdCl(2) at 1 and 10 microM, respectively. 11-KT production in dbcAMP-stimulated and 25-OHC-augmented tissues was not affected by Cd exposure. The results of this study indicate that one site of action of Cd in the signaling steroidogenic pathway is located prior to cAMP formation. This impairment could be overcome when higher concentrations of Cd were used in hCG-stimulated cells, suggesting the presence of a stimulatory site at, or following, hCG receptor binding.