Self-Trapped, Thermally Equilibrated Delayed Fluorescence Enables Low-Reabsorption Luminescent Solar Concentrators Based on Gold-Doped Silver Nanoclusters.

Reabsorption-free luminescent solar concentrators (LSCs) are crucial ingredients for photovoltaic windows. Atomically precise metal nanoclusters (NCs) with large Stokes-shifted photoluminescence (PL) hold great promise for applications in LSCs. However, a fundamental understanding of the PL mechanism, particularly on the excited-state interaction and exciton kinetics, is still lacking. Herein, we studied the exciton-phonon coupling and singlet/triplet exciton dynamics for gold-doped silver NCs in a solid matrix. Following photoexcitation, the excitons can be self-trapped via strong exciton-phonon coupling. Subsequently, rapid thermal equilibration between the singlet and triplet states occurs due to the coexistence of small energy splitting and spin-orbit coupling. Finally, broadband delayed fluorescence with a large Stokes shift can be generated, namely, self-trapped, thermally equilibrated delayed fluorescence (ST-TEDF). Benefiting from superior ST-TEDF, we demonstrated efficient LSCs with minimized reabsorption.

Taiwanese Older Adults Prefer to Use Antibiotics and Intravenous Infusion at the End of Life based on a Cartoon Version of the Life Support Preferences Questionnaire.

Asians believe discussing death-related topics is inauspicious and may bring bad luck. It is critical to explore the end-of-life care preferences of the Asian elderly with less-threatening tools. The study examined older adults' preferences regarding end-of-life treatments by applying a cartoon version of the Life Support Preferences Questionnaire (LSPQ). A cross-sectional survey was conducted to understand older adults' preferences for end-of-life treatments. A total of 342 older adults participated in the study, comprising 268 elderly patients from a veterans hospital located in northern Taiwan and 74 elderly family members of the patients. Regardless of scenario, cardiopulmonary resuscitation (CPR) had the lowest score, indicating that older adults considered it a less desirable medical treatment. By contrast, antibiotics and intravenous infusions had the highest scores, indicating that older adults tended to prefer them. End-of-life care preferences were significantly different in genders. CPR and surgical preferences of older adults differed significantly with education level. Different demographic characteristics had different end-of-life treatment preferences, and future research may develop advance care planning programs for different attributes. This cartoon version of the LSPQ can help healthcare professionals to understand older adults' preferences for end-of-life care and warrants further empirical research.

Older Adults' Behavioral Intentions Toward Advance Care Planning Based on Theory of Reasoned Action.

This study aimed to explore the factors affecting the behavioral intentions of older adults toward advance care planning (ACP). A questionnaire survey was conducted at 2 medical wards and a senior activity center in northern Taiwan. Four hundred one participants were older adults aged over 65 years, comprising hospitalized patients, their caregivers, and members of a senior activity center. The regression model revealed that participant type (patient, caregiver, or community resident); financial support; discussion of ACP with family; and knowledge, attitudes, and subjective norms accounted for 46.3% of the variance in behavioral intentions. The behavioral intention of caregivers was higher than that of patients. The behavioral intention of participants who were financially dependent on the family was lower than that of pensioners. Regarding discussing ACP with family, older adults in the contemplation and preparation stages score higher on behavioral intention than those in the precontemplation stage. This study supports the theory of reasoned action. Older adults' ACP knowledge and attitudes need to be enhanced through education. Caregivers' behavioral intentions tend to perform ACP. Sharing their caring experiences may be a strategy for promoting ACP. Older adults' financial status affects their behavioral intentions. Therefore, financial planning should be performed early and should incorporate ACP.

Knowledge, attitudes, and behavioral intentions of elderly individuals regarding advance care planning: Questionnaire development and testing.

BACKGROUND: Studies have indicated that the advance care planning knowledge and attitudes of elderly individuals strongly affect their implementation of advance care planning. A measurement with a theoretical base for evaluating elderly individuals' knowledge, attitudes, and behavioral intentions regarding advance care planning is lacking. OBJECTIVES: To develop a questionnaire and understand elderly individuals' knowledge, attitudes, and behavioral intentions regarding implementing advance care planning. METHODS: A cross-sectional questionnaire survey was conducted. The content validity index, and statistical methods, including discrimination, factor, and reliability analysis, were adopted for psychometric testing. Descriptive statistics mainly presented data analysis. RESULTS: 401 elderly individuals were recruited from a medical center and one senior activity center. The content validity index was approximately 0.71-0.92 for the developed questionnaires, the Kuder-Richardson formula 20 was 0.84 for advance care planning knowledge, and the Cronbach's alpha was 0.86, 0.94, 0.76, and 0.92 for attitudes, behavioral intentions, influencing factors, and subjective norms, respectively. The average score for advance care planning knowledge for elderly individuals was 4.42, with a correct answer rate of 49.1%. They lacked knowledge of advance care planning-related legislation. The mean score for attitudes and behavioral intentions was 14.32 and 3.48, respectively. Elderly individuals agreed that advance care planning has benefits but were worried about the emotional distress caused by advance care planning discussions. Elderly individuals with positive behavioral intentions tend to implement advance care planning. Spouses, children, doctors, and nurses are significant reference people for elderly individuals. CONCLUSIONS: The developed questionnaire exhibits good validity and reliability for understanding elderly individuals' knowledge, attitudes, and behavioral intentions concerning advance care planning. Advance care planning materials or decision aids suitable for elderly individuals must be developed to increase their understanding of advance care planning. Additionally, the role of nurses is indispensable in promoting advance care planning among elderly individuals.

Two-Dimensional Self-Assembly of Boric Acid-Functionalized Graphene Quantum Dots: Tunable and Superior Optical Properties for Efficient Eco-Friendly Luminescent Solar Concentrators.

Carbon-based nanomaterials hold promise for eco-friendly alternatives to heavy-metal-containing quantum dots (QDs) in optoelectronic applications. Here, boric acid-functionalized graphene quantum dots (B-GQDs) were prepared using bottom-up molecular fusion based on nitrated pyrenes and boric acid. Such B-GQDs with crystalline graphitic structures and hydrogen-bonding functionalities would be suitable model systems for unraveling the photoluminescence (PL) mechanism, while serving as versatile building blocks for supramolecular self-assembly. Unlike conventional GQDs with multiple emissive states, the B-GQDs exhibited excitation-wavelength-independent, vibronic-coupled excitonic emission. Interestingly, their PL spectra can be tuned without largely sacrificing the quantum yield (QY) due to two-dimensional self-assembly. In addition, such B-GQDs in a polystyrene matrix possessed an ultrahigh QY (∼90%) and large exciton binding energy (∼300 meV). Benefiting from broadband absorption, ultrahigh QY, and long-wavelength emission, efficient laminated luminescent solar concentrators (100 × 100 × 6.3 mm3) were fabricated, yielding a high power conversion efficiency (1.4%).

Utilizing host-guest interaction enables the simultaneous enhancement of the quantum yield and Stokes shift in organosilane-functionalized, nitrogen-containing carbon dots for laminated luminescent solar concentrators.

Solar energy can be harvested using luminescent solar concentrators (LSCs) incorporated with edge-mounted solar cells without sacrificing their see-through visibility, thus facilitating the development of solar windows. Eco-friendly carbon dots (CDs) are promising alternatives to heavy-metal-containing quantum dots in LSC applications. Unfortunately, their solid-state quantum yield (QY) at high optical density (required by laminated LSCs) is still low (<30%) and the Stokes shift is only moderate (<100 nm). Here, we studied the host-guest interaction between aminosilane-functionalized, nitrogen-containing CDs (Si-NCDs) and a silica matrix for preparing efficient laminated LSCs. We found that a sol-gel-derived silica matrix with vacuum treatment can efficiently suppress the direct nonradiative transition of the absorbing states and selectively enhance the long-wavelength-emitting surface states. Therefore, the formed Si-NCDs@silica composites simultaneously exhibited high QYs (>60%) and large Stokes shifts (>200 nm) even at a high loading content (∼10 wt%), while still exhibiting high optical transparency. Moreover, unlike conventional QY reduction upon increasing the excitation wavelengths, such high QY values can be maintained over all excitation wavelengths in the absorption region. Benefiting from these photophysical properties, efficient laminated LSCs were simply prepared, yielding a high optical efficiency of ∼4.4%.

Electronically Coupled Gold Nanoclusters Render Deep-Red Emission with High Quantum Yields.

Electronic coupling can be used to tailor electronic states and optical properties of the luminophores. Therefore, electronically coupled systems would provide unique properties, which cannot be achieved by individual constituents. Here, electronically coupled gold nanoclusters (AuNCs) were prepared on the basis of organosilane grafting and a sol-gel-derived porous silica template. After prolonged drying, the formed AuNCs@silica composites exhibited red-shifted, line-width-narrowed, deep-red emission with high quantum yields (QYs) of ∼66% due to electronic-coupling-enhanced radiative rates and covalent-bonding-suppressed nonradiative relaxation. Meanwhile, the absorption maximum was slightly blue-shifted, leading to a large Stokes shift. All experimental findings revealed the formation of electronically coupled AuNC aggregates confined inside the nanopores and bonded to silica matrix. The mechanism is distinctly different from conventional aggregation-enhanced emission. Our work would provide great potential to engineer photophysical properties by controlling the packing modes.

Highly transparent and luminescent gel glass based on reabsorption-free gold nanoclusters.

Luminescent and transparent composites formed by embedding luminophores in a solid matrix are essential components for several photonic applications, such as luminescent solar concentrators (LSCs) and luminescent down-shifting/conversion layers. For these applications, the optical losses, including reabsorption and scattering need to be minimized, while the photoluminescence (PL) emission must be stable against outdoor environments. Here, highly transparent and luminescent aluminosilicate glass doped with surface-engineered gold nanoclusters (AuNCs) was prepared without involving toxic elements and hazardous solvents. Such an AuNC@glass composite with a high loading (∼14 wt%) exhibits a unique absorption profile; near-unity absorptance in the absorption range but near-zero reabsorption in the emission region, and thus generates bright PL emission with negligible reabsorption losses. Meanwhile, the PL quantum yield was enhanced (from ∼1% to ∼14%) without sacrificing the Stokes shift, while still maintaining high optical transparency. In addition, they have high stability due to the effective protection of rigid inorganic matrices, and thus would be eco-friendly candidates for further preparation of efficient and reabsorption-free LSCs.

Visible-Transparent Luminescent Solar Concentrators Based on Carbon Nanodots in the Siloxane Matrix with Ultrahigh Quantum Yields and Optical Transparency at High-Loading Contents.

Visible-transparent luminescent solar concentrators (VT-LSCs) can be integrated with solar cells for designing solar glasses. Recently, rare-earth complexes, semiconductor nanocrystals, and carbon nanodots (CNDs) have been applied in developing VT-LSCs. However, several challenges still existed, such as quantum yields (QYs) at high-loading contents, scattering/reabsorption losses, and stability. Here, highly luminescent and visible-transparent composites based on organosilane-functionalized CNDs (Si-CNDs) cross-linked in the siloxane matrix were prepared. The composites with a high-loading content (∼10 wt %) possess ultrahigh QYs of ∼94% due to surface passivation, cross-linking-enhanced emission, and negligible inter-CND energy transfer. Moreover, they still appear exceptionally transparent and, thus, are suitable for VT-LSCs. Eco-friendly VT-LSCs without colored tinting were fabricated, yielding high internal and external quantum efficiencies of ∼66% and ∼3.9%. Our demonstration would pave a bright way for the utilization of eco-friendly VT-LSCs in solar glasses.

Coordination-induced emission enhancement in gold-nanoclusters with solid-state quantum yields up to 40% for eco-friendly, low-reabsorption nano-phosphors.

Colloidal quantum dots (CQDs) have gained much attention as light-emitting materials for light-conversion nano-phosphors and luminescent solar concentrators. Unfortunately, those CQDs involve toxic heavy metals and frequently need to be synthesized in the hazardous organic solvent. In addition, they suffer from severe solid-state aggregation-induced self-quenching and reabsorption losses. To address these issues, here we prepare Zn-coordinated glutathione-stabilized gold-nanocluster (Zn-GSH-AuNCs) assemblies without involving heavy metals and organic solvent. Unlike GSH-AuNCs dispersed in an aqueous solution with poor photoluminescence quantum yields (PL-QYs, typically ~1%), those Zn-GSH-AuNCs powders hold high solid-state PL-QYs up to 40 ± 5% in the aggregated state. Such Zn-induced coordination-enhanced emission (CEE) is attributed to the combined effects of suppressed non-radiative relaxation and enhanced charge-transfer interaction. In addition, they also exhibit a large Stokes shift, thus mitigating both aggregation-induced self-quenching and reabsorption losses. Motivated by these photophysical properties, we demonstrated white-light emission from all non-toxic, aqueous-synthesis nano-materials.

Greener Luminescent Solar Concentrators with High Loading Contents Based on in Situ Cross-Linked Carbon Nanodots for Enhancing Solar Energy Harvesting and Resisting Concentration-Induced Quenching.

A luminescent solar concentrator (LSC) is composed of loaded luminophores and a waveguide that can be employed to harvest and concentrate both direct and diffused sunlight for promising applications in solar windows. Thus far, most of efficient LSCs still relied on the heavy-metal-containing colloidal quantum dots (CQDs) dispersed into a polymer matrix with a very low loading (typically <1 wt %). Such low-loading constraint is required to mitigate the concentration-induced quenching (CIQ) and maintain high optical quality and film uniformity, but this would strongly reduce the light-absorbing efficiency. To address all issues, greener LSCs with high loading concentration were prepared by in situ cross-linking organosilane-functionalized carbon nanodots (Si-CNDs), and their photophysical properties relevant to LSC operation were studied. The PL emission is stable and does not suffer from the severe CIQ effect for cross-linked Si-CNDs even with 25 wt % loadings, thus exhibiting high solid-state quantum yields (QYs) up to 45 ± 5% after the calibration of the reabsorption losses. Furthermore, such LSCs can still hold high optical quality and film uniformity, leading to low scattering losses and high internal quantum efficiency of ∼22%. However, the reabsorption losses need to be further addressed to realize large-area LSCs based on earth-abundant, cost-effective CNDs.

The Psychometric Properties and the Development of the Indicators of Quality Nursing Work Environments in Taiwan.

BACKGROUND: The nursing shortage in medical institutions in Taiwan averaged 9% in 2012, considerably higher than the 5% indicated in the literature. As a result, many hospitals have been forced to close wards or reduce beds. Despite the acute need, the percentage of registered nurses who are employed as nurses in Taiwan (60.4%) is considerably lower than those in Canada or the United States. This low rate may be because of the poor working environment for nurses in Taiwan. PURPOSE: This study aimed to develop a set of nursing work environment quality indicators for Taiwan and to test the reliability and validity of the resulting survey tool. METHODS: Multiple methods were used in this study. In Phase 1, we organized an expert panel, reviewed the literature, and conducted seven rounds of expert panel discussion and six focus group discussions with nursing directors. The goal was to draft indicators representing a quality nursing work environment to fit current conditions in Taiwan. In Phase 2, we conducted an expert review for content validity, held three public hearings, and conducted a survey. Four hundred twenty-seven questionnaires were sent out, with 381 returned. The goal was to test the content validity, construct validity, and internal consistency reliability. RESULTS: The study produced a set of indicators of a quality nursing work environment with eight dimensions and 65 items. The content validity index for importance and suitability dimensions were 1.0, whereas the internal consistency was 0.91. The eight dimensions were safe practice environment (16 items), quality and quantity of staff (four items), salary and welfare (seven items), professional specialization and teamwork (seven items), work simplification (five items), informatics (five items), career development (nine items), and support and caring (12 items). The overall load for the indicators was 77.57%. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The developed indicators may be used to evaluate the quality of nursing work environments. Furthermore, the indicators may be used in hospital surveys to establish baseline conditions and for outcome research that measures improvement in nursing work environments after interventions.

Jejunal Cancer with WRN Mutation Identified from Next-Generation Sequencing: A Case Study and Minireview.

Small bowel cancer is a rare, gastrointestinal cancer originating from the small intestines. Carcinogenesis in the jejunum, the middle segment of the small intestines, occurs less commonly than in the duodenum and ileum. Despite the increasing incidences globally, the cancer is still poorly understood, which includes lack of pathological understanding and etiological reasoning, as it seems to exhibit both similarities and differences with other types of cancers. A 76-year-old Asian man was presented with abdominal pain, which was later attributed to an adenocarcinoma in the jejunum. Initial immunoreactive staining results found no connections to colorectal cancer. The microsatellite instability test was further examined by immunohistochemistry which revealed them to be wild-type. From our exome-capture sequencing results, mutations of WRN may be important as they represent the only genetic defect in this jejunal cancer. The patient has since undergone surgical resection of his cancer and is currently being treated with chemotherapy. The pathology, genomic markers, and treatments are described along with literature review.

The development of nursing workforce allocation standards for acute care general wards in Taiwan.

BACKGROUND: Adequate nursing workforce is critical to ensure patient safety and reduce the incidence of adverse events. PURPOSE: This study explores and compares the nursing workforce allocation situation in the acute care general wards of Taiwan's three hospital tiers and, based on findings, develops standards for adequate nursing workforce allocation and nurse-to-patient ratios in acute care general wards at each tier. METHODS: This study uses multiple research methods, including literature review, questionnaire survey, and expert focus group discussion. Final consensus is achieved using a public hearing and questionnaire survey. RESULTS: The severity of patient conditions differs among hospital tiers. Therefore, each tier requires a nursing workforce allocation standard appropriate to its situation. Study findings indicate that nurse-to-bed ratios and nursing hours are valid indicators of nursing workforce allocation needs. The results of expert discussions and public hearings recommend 0.53 nurses per bed and 2.8 nursing hours for academic medical centers, 0.49 nurses per bed and 2.6 nursing hours for metropolitan hospitals, and 0.40 nurses per bed and 2.1 nursing hours for local community hospitals for the current stage of healthcare development; 0.57 nurses per bed and 3.0 nursing hours for academic medical centers, 0.53 nurses per bed and 2.8 nursing hours for metropolitan hospitals, and 0.44 nurses per bed and 2.3 nursing hours for local community hospitals in 3 years; and 0.61 nurses per bed and 3.2 nursing hours for academic medical centers, 0.57 nurses per bed and 3.0 nursing hours for metropolitan hospitals, and 0.48 nurses per bed and 2.5 nursing hours for local community hospitals in 5 years. CONCLUSIONS: Study results may provide a basis for better allocating nursing workforce in hospitals, setting formal standards for minimum nurse-to-patient ratios, and assessing nursing workforce needs at the national level.

ResearchTracking: Monitoring gender and ethnic minority recruitment and retention in cancer symptom studies.

BACKGROUND: Recruiting and retaining participants for clinical trials, particularly women and ethnic minorities, are challenging. Few studies, however, examine gender and ethnic differences in research processes. Such information is important for findings to adequately represent the available population. OBJECTIVE: The study aim was to examine study recruitment processes (referral, eligibility, consent/enrollment) and study retention (completion) for gender and ethnic differences. METHODS: A descriptive comparative analysis of data from 2 randomized clinical trials focused on cancer outpatients with pain and/or fatigue. A computerized ResearchTracking software allowed documentation of recruitment and retention effort outcomes. RESULTS: Among the 1464 referred patients, 612 (42%) were eligible for study participation. Lack of ongoing care at the study settings and lack of English skills were the main reasons for ineligibility. There were no gender differences in consent/enrollment or completion rates. Ethnic minority patients were represented proportionally to the available population (13%) and were equally willing to consent/enroll and complete both studies as their white counterparts, if they were eligible. CONCLUSIONS: Specific strategies to target language eligibility barriers are necessary to increase minority participation. IMPLICATIONS FOR PRACTICE: Future studies could include audio-aided tools in their native language to help recruit patients with limited English skills, if the study tools can be validly translated into other languages and are equivalent to English versions. Efforts to educate and garner support of providers could improve enrollment of patients in cancer studies, especially in studies of audio- or video-recorded patient-provider interaction.

Effects of coaching patients with lung cancer to report cancer pain.

The authors have examined the effects of coaching sensory self-monitoring and reporting on pain-related variables in patients with lung cancer. Randomly assigned to coached or not-coached groups, 215 patients have their interactions with their providers audiotaped and complete study measures pre- and postintervention. Of the 151 patients who complete the 4-week study, those coached are more likely than those not coached to give their providers unsolicited sensory pain information and to mention it before their providers ask for it. The mean number of pain parameters discussed during the audiotaped clinic visit is statistically larger at study end for the coached group. Scores for analgesic adequacy, all pain indices except one, anxiety, depression, and catastrophizing coping are not significantly different. Although coaching increases the amount of pain data communicated to providers by patients with lung cancer, the magnitude is small and does not lead to improved adequacy of analgesics prescribed for each patient's pain level.

Effects of a full-body massage on pain intensity, anxiety, and physiological relaxation in Taiwanese patients with metastatic bone pain: a pilot study.

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%-45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29)=16.5, P=0.000; t(29)=8.9, P=0.000], short-term (20-30 minutes) [t(29)=9.3, P=0.000; t(29)=10.1, P=0.000], intermediate (1-2.5 hours) [t(29)=7.9, P=0.000; t(29)=8.9, P=0.000], and long-term benefits (16-18 hours) [t(29)=4.0, P=0.000; t(29)=5.7, P=0.000] on PPI and anxiety. The most significant impact occurred 15 [F=11.5(1,29), P<0.002] or 20 [F=20.4(1,29), P<0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.

Developing a computerized data collection and decision support system for cancer pain management.

Contemporary nursing practice needs reengineering to deliver its service effectively and efficiently. Using computer technology to support clinicians' decision making may be a parsimonious way to provide high-quality, patient-centered, efficient care. The process of developing the PAINReportIt and PAINConsultN system is described, and the results of two pilot studies in which the system was tested are summarized. The feasibility of using the system to assess pain and provide decision support for clinicians is demonstrated. The findings show PAINReportIt to be promising as an effective, efficient way for patients to report their pain. Whether PAINConsultN is an effective answer to cancer pain management barriers warrants further evaluation with larger samples. The advantages of using the system, as compared with use of the traditional pain management process, are discussed.

Pain trajectory of Taiwanese with nasopharyngeal carcinoma over the course of radiation therapy.

The purpose of this study was to describe the characteristics and management of pain among patients with nasopharyngeal carcinoma (NPC) prior to and during the 7-week course of radiation therapy (RT) in Taiwan. Twenty-nine men and 11 women with NPC participated in this prospective, longitudinal study. A modified Brief Pain Inventory was used to assess pain and its interference with daily activities weekly. Medical records were reviewed to abstract pain management and disease data. Findings showed that the pain intensity and pain interference scores escalated prominently at Week 3 and peaked at Week 5, representing the time course of RT complications. Pain prior to RT exacerbated the RT-induced mucositis pain. The pain related to RT for NPC was often severe and undertreated, and affected swallowing and talking more than sleeping or other general activities. We recommend interventions to control pain be instituted prior to Week 3 to minimize the potentiation of subsequent pain.