Implementation and evaluation of a pain assessment app and novel community platform for long-term care health professionals.

OBJECTIVE: A tablet app, based on the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II), has been shown to have clinical utility and unique advantages. We aimed to replicate and extend the previous validation of the app through the implementation and evaluation of a new community platform involving a quality indicator (QI) monitoring feature and a resource community portal (CP) that work in conjunction with an updated version of the app. METHODS: We employed a mixed-methods multiple-baseline design across 11 long-term care (LTC) units. Units were randomly assigned to conditions which varied in number of app features available. Data included unit-level QIs as well as questionnaires and semi-structured interviews with health professionals. RESULTS: Following use of the app, we found improvements in unit-level QIs regardless of availability of the QI/CP features. During interviews, participants expressed a preference for the app over a paper version of the PACSLAC-II due to reasons such as the app's ability to summarize information. Utilization of the community portal websites was unrelated to staff questionnaire-assessed stress/burnout. CONCLUSIONS: Despite the positive effects on the care of residents, the COVID-19 pandemic presented challenges and interfered with the long-term maintenance of the QI results.

TrmB Family Transcription Factor as a Thiol-Based Regulator of Oxidative Stress Response.

Oxidative stress causes cellular damage, including DNA mutations, protein dysfunction, and loss of membrane integrity. Here, we discovered that a TrmB (transcription regulator of mal operon) family protein (Pfam PF01978) composed of a single winged-helix DNA binding domain (InterPro IPR002831) can function as thiol-based transcriptional regulator of oxidative stress response. Using the archaeon Haloferax volcanii as a model system, we demonstrate that the TrmB-like OxsR is important for recovery of cells from hypochlorite stress. OxsR is shown to bind specific regions of genomic DNA, particularly during hypochlorite stress. OxsR-bound intergenic regions were found proximal to oxidative stress operons, including genes associated with thiol relay and low molecular weight thiol biosynthesis. Further analysis of a subset of these sites revealed OxsR to function during hypochlorite stress as a transcriptional activator and repressor. OxsR was shown to require a conserved cysteine (C24) for function and to use a CG-rich motif upstream of conserved BRE/TATA box promoter elements for transcriptional activation. Protein modeling suggested the C24 is located at a homodimer interface formed by antiparallel α helices, and that oxidation of this cysteine would result in the formation of an intersubunit disulfide bond. This covalent linkage may promote stabilization of an OxsR homodimer with the enhanced DNA binding properties observed in the presence of hypochlorite stress. The phylogenetic distribution TrmB family proteins, like OxsR, that have a single winged-helix DNA binding domain and conserved cysteine residue suggests this type of redox signaling mechanism is widespread in Archaea. IMPORTANCE TrmB-like proteins, while not yet associated with redox stress, are found in bacteria and widespread in archaea. Here, we expand annotation of a large group of TrmB-like single winged-helix DNA binding domain proteins from diverse archaea to function as thiol-based transcriptional regulators of oxidative stress response. Using Haloferax volcanii as a model, we reveal that the TrmB-like OxsR functions during hypochlorite stress as a transcriptional activator and repressor of an extensive gene coexpression network associated with thiol relay and other related activities. A conserved cysteine residue of OxsR serves as the thiol-based sensor for this function and likely forms an intersubunit disulfide bond during hypochlorite stress that stabilizes a homodimeric configuration with enhanced DNA binding properties. A CG-rich DNA motif in the promoter region of a subset of sites identified to be OxsR-bound is required for regulation; however, not all sites have this motif, suggesting added complexity to the regulatory network.

Development, evaluation, and implementation of an online pain assessment training program for staff in rural long-term care facilities: a case series approach.

BACKGROUND: Pain among long-term care (LTC) residents, and especially residents with dementia, is often underassessed and this underassessment has been attributed, in part, to gaps in front-line staff education. Furthermore, although evidence-based clinical guidelines for pain assessment in LTC are available, pain assessment protocols are often inconsistently implemented and, when they are implemented, it is usually within urban LTC facilities located in large metropolitan centers. Implementation science methodologies are needed so that changes in pain assessment practices can be integrated in rural facilities. Thus, our purpose was to evaluate an online pain assessment training program and implement a standardized pain assessment protocol in rural LTC environments. METHODS: During the baseline and implementation periods, we obtained facility-wide pain-related quality indicators from seven rural LTC homes. Prior to implementing the protocol, front-line staff completed the online training program. Front-line staff also completed a set of self-report questionnaires and semi-structured interviews prior to and following completion of the online training program. RESULTS: Results indicated that knowledge about pain assessment significantly increased following completion of the online training program. Implementation of the standardized protocol resulted in more frequent pain assessments on admission and on a weekly basis, although improvements in the timeliness of follow-up assessments for those identified as having moderate to severe pain were not as consistent. Directed content analysis of semi-structured interviews revealed that the online training program and standardized protocol were well-received despite a few barriers to effective implementation. CONCLUSIONS: In conclusion, we demonstrated the feasibility of the remote delivery of an online training program and implementation of a standardized protocol to address the underassessment of pain in rural LTC facilities.

Gibberellic acid maintains postharvest quality of Agaricus bisporus mushroom by enhancing antioxidative system and hydrogen sulfide synthesis.

The application of gibberellic acid (GA3 ) treatment to the postharvest quality maintenance of white button mushroom (Agaricus bisporus) was investigated. The optimum concentration of exogenous GA3 was 100 mg/L. At this concentration, the color change was inhibited, the firmness was maintained, and the weight loss and respiratory rates were reduced. The GA3 group had significantly lower malonaldehyde (MDA) content and membrane permeability. Reactive oxygen species accumulation was reduced due to the regulation of polyphenol oxidase (PPO), peroxidase (POD), and superoxide dismutase (SOD) enzyme activities. Moreover, the production of endogenous gaseous signaling molecule hydrogen sulfide (H2 S) was triggered by GA3 treatment, which enhanced cystathionine γ-lyase (AbCSE) and cystathionine ß-synthase (AbCBS) activities alongside the corresponding gene expressions. The preservation of button mushroom postharvest storage quality by GA3 was most likely due to the regulation of reactive oxygen species metabolism and hydrogen sulfide biosynthesis. PRACTICAL APPLICATIONS: Mushroom is rich in nutrients and functional substances. However, due to the lack of cuticle, high respiration rate, and moisture content, mushroom's postharvest quality deteriorates rapidly. A safe and effective reagent that prevents the senescence and quality deterioration of harvested mushroom is urgently needed. The effects of plant hormone GA3 on the postharvest quality of edible fungi remain unclear. The present study provided convincing evidence that 100 mg L-1 of GA3 effectively maintained postharvest button mushroom quality by regulating reactive oxygen species metabolism and hydrogen sulfide biosynthesis.

Improved Expansion and In Vivo Function of Patient T Cells by a Serum-free Medium.

Improvements to T cell culture systems that promote long-term engraftment and function of adoptively transferred T cells will likely result in superior clinical benefit to more individuals. To this end, we recently developed a chemically defined cell culture medium that robustly expands all T cell subsets in the absence of human serum. Using a humanized mouse model, we observed that T cells expanded in the absence of human serum provided durable control of tumors, whereas T cells expanded in medium supplemented with human serum only mediated transient control of tumor growth. Importantly, our new medium effectively expanded more differentiated T cells from multiple myeloma patients in the absence of serum. These patient-derived T cells were also able to provide durable control of B cell tumors in vivo, and this long-term control of cancer was lost when T cells were expanded in the presence of serum. Thus, engineered T cells expanded in an optimized medium in the absence of serum may have improved therapeutic potential.