[Improve the Integrity Rate of Response and Teaching for Tube Care Administered by the Primary Caregiver].

BACKGROUND & PROBLEM: The need to use an indwelling nasogastric tube, urinary catheter, or tracheostomy tube (the so-called "three tubes") because of illness or prolonged bedrest is increasing. The functions and effectiveness of these tubes may be maintained only with correct care. Improper care, slippage, obstruction, or infection may in severe cases cause septic shock or even death. PURPOSE: To increase the completeness of the reverse demonstration of three tubes care instructions by primary caregivers to further improve related care quality. RESOLUTION: Between February 10th and March 31st, 2019, the completeness rates of reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers participating in this study were shown to be low, at 42.5%, 38%, and 58.3%, respectively. The plausible causes were: 1. Human: Poor communication, forgetting the care steps, having no time for learning, and fear of performing nasogastric tube rotation; 2. Instrument: Lack of graphic demonstrations in health education materials; 3. Policy: Lack of standards and auditing. The implemented intervention involved creating innovative health-education instruments, videos and flash cards about three tubes care in multiple languages, and straps for holding the urinary catheter and developing standards and an auditing system for the reverse demonstration of three tube care instructions by primary caregivers. RESULTS: The completeness rates for the reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers improved to 97.3%, 96.3%, and 95%, respectively. CONCLUSIONS: Using the innovative health-education aids and improvements introduced in this study, the ability of primary caregivers to correctly perform the care steps should improve significantly.

Morphologic improvement of the PBDTTT-C and PC71BM blend film with mixed solvent for high-performance inverted polymer solar cells.

Tracing the evolution of the bulk heterojunction structure, a dramatic promotion in the efficiency of polymer solar cells has been obtained in recent years. The active layer morphology of low-bandgap polymer solar cells is one of the critical factors for high-efficiency performance. In the past, the relationship between morphology improvement and the device's characteristics (such as efficiency, fill factor and short-circuit current) in low-bandgap polymer solar cells has been studied intensively with regards to the conventional structure. Here we demonstrate the morphologic improvement of the poly[(4,8-bis-(2-ethylhexyloxy)-benzo[1,2-b;4,5-b']dithiophene)-2,6-diyl-alt-(4-(2-ethylhexanoyl)-thieno[3,4-b]thiopene)-2,6-diyl]/[6,6]-phenyl C71 butyric acid methyl ester (PBDTTT-C/PC71BM) blend film for inverted solar cells. By utilizing a mixed solvent of dichlorobenzene/chlorobenzene with (1,8-diiodooctane) additives, the device efficiency can be significantly enhanced, from 0.92% to 4.43%. This enhancement is attributed to active layer morphologic improvement promoting carrier transport. Furthermore, the thickness optimization of the active layer and the electron blocking layer MoO3 further contributes to efficiency. The device performance could be achieved with an efficiency as high as 5.35%, an open-circuit voltage of 0.70 V, a short-circuit current density of 13.5 mA cm(-2), and a fill factor of 57%.

Toward Clean and Economic Production of Highly Efficient Perovskite Solar Module Using a Cost-Effective and Low Toxic Aqueous Lead-Nitrate Precursor.

Toxic substance usage remains one of the major concerns that must be addressed toward the commercialization of perovskite photovoltaics. Herein, we report a highly efficient perovskite solar module (>13%) fabricated via a wet process that uses a unique aqueous Pb(NO3)2 precursor, eliminating the use of toxic organic solvents during perovskite film preparation. In addition, we demonstrate a unique pattern in a monolithically interconnected module structure to check the uniformity of perovskite film and the quality of laser scribing. Finally, we highlight that this aqueous Pb(NO3)2 precursor protocol could achieve an enormous cost reduction over conventional PbI2 organic solutions whether in the laboratory research stage or at mass production scale, strengthening the core competitiveness of perovskite solar cells in the Darwinian ocean of photovoltaic technologies.

Negative associations between PBDE levels and thyroid hormones in cord blood.

Polybrominated diphenyl ethers (PBDEs) causing thyroidal effects have been demonstrated in in vivo and in vitro studies. PBDEs with structural similarities to thyroid hormones have increased recently, but the health effects for thyroid hormones have not been well studied. The study aimed to determine PBDE levels in cord blood and further to explore associations between prenatal PBDE exposures and thyroid hormones in cord blood. Fifty-four cord blood samples were collected after delivery. Cord-blood levels of BDE-15, 28, 47, 99, 100, 153, 154, and 183 were analyzed using a high resolution gas chromatograph with a high resolution mass spectrometer. Thyroid hormones were determined by an automated chemiluminescence analyzer. The mean, median, and standard deviation of ΣPBDEs were 4.72, 3.49, and 6.36 ng/g lipid, respectively. To adjust for confounding by maternal age, pre-pregnant BMI and gestational age, stepwise multiple linear regression was used after log(2) transformation of the exposure variables. A doubling of BDE-154 was associated with 0.043 ng/mL lower triiodothyronine (T3) values (adjusted r=-0.245, p=0.043). Likewise a doubling of BDE-153 was associated with 0.143 ng/mL lower free T3 (FT3) values and a doubling of BDE-183 with 0.084 ng/mL lower FT3 values (adjusted r=-0.487, p=0.023). In contrast, the T4 (thyroxine)/T3 ratio increased by 4.93 (adjusted r=0.277, p=0.017) when doubling BDE-100 exposure. No significant associations with BDE-47 or any other of the PBDEs was found. Our findings of an inverse relationship between BDE-153, BDE-154 or BDE-184 and thyroid hormones confirm the results of animal experiments but are in contrast to most epidemiological studies.

Antigenic diversity of Neisseria meningitidis isolated in Taiwan between 1995 and 2002.

The geographic distribution of N. meningitidis is diverse. Information on the antigenic variation of N. meningitidis is important for the development of an outer membrane protein-based vaccine. As a first step towards vaccine development, serological typing was performed to determine the antigenic properties of 127 invasive N. meningitidis isolates collected in Taiwan between 1995 and 2002. With 31.5% non-serotypeable and 32.3% non-serosubtypeable, the 127 isolates fell into 51 phenotypes, with W135:NT:P1.5,2:L3,7,9, Y:14P1.5,2, and B:1:NST:L3,7,9 being the 3 most prevalent. Among the 37 serogroup B isolates, 15 serosubtypes were found, with P1.5,2 and P1.12,13 being the most prevalent. The high diversity of Por A among serogroup B isolates circulating in Taiwan poses a great challenge for the development of a PorA-based vaccine. Because 85% of the serogroup B isolates had the L3,7,9 immunotype, inclusion of L3,7,9 lipooligosaccharides in a PorA-based vaccine may be a promising approach. In addition, based on the phenotypic characterization, we suggest that both serogroup B and W135 isolates were endemic and that serogroup A, C, and Y isolates were imported, which may reflect increased international travel.