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The building sector accounts for approx. 40% of total energy consumption and approx. 36% of all greenhouse gas emissions in Europe. As the EU climate targets for 2030 call for a reduction of greenhouse gas emissions by more than half compared to the emissions of 1990 and also aim for climate neutrality by 2050, there is an urgent need to achieve a significant decrease in the energy use in buildings towards Nearly Zero-Energy Buildings (nZEBs). As the energy footprint of buildings includes the energy and greenhouse gas consumption both in the construction phase and during service life, nZEB solutions have to provide energy-efficient and less carbon-intensive building materials, specific thermal insulation solutions, and a corresponding design of the nZEB. Carbon reinforced concrete (CRC) materials have proven to be excellent candidate materials for concrete-based nZEBs since they are characterized by a significantly lower CO 2 consumption during component production and much a longer lifecycle. The corresponding CRC technology has been successively implemented in the last two decades and first pure CRC-based buildings are currently being built. This article presents a novel material system that combines CRC technology and suitable multifunctional insulation materials as a sandwich system in order to meet future nZEB requirements. Because of its importance for the life cycle stage of production, cost-efficient carbon fibers (CF) from renewable resources like lignin are used as reinforcing material, and reinforcement systems based on such CF are developed. Cutting edge approaches to produce ultra-thin lightweight CF reinforced concrete panels are discussed with regard to their nZEB relevance. For the life cycle stage of the utilization phase, the thermal insulation properties of core materials are optimized. In this context, novel sandwich composites with thin CRC layers and a cellular lightweight concrete core are proposed as a promising solution for façade elements as the sandwich core can additionally be combined with an aerogel-based insulation. The concepts to realize such sandwich façade elements will be described here along with a fully automated manufacturing process to produce such structures. The findings of this study provide clear evidence on the promising capabilities of the CRC technology for nZEBs on the one hand and on the necessity for further research on optimizing the energy footprint of CRC-based structural elements on the other hand.

When the COVID-19 pandemic forced university campuses and healthcare agencies to temporarily suspend both undergraduate and graduate direct care educational experiences, nursing programs had to formulate alternative plans to facilitate clinical learning. Texas Woman's University used this opportunity to assemble a faculty group tasked with creating a set of college-wide guidelines for virtual simulation use as a substitution for traditional face-to-face clinical. The process included completing a needs assessment of both undergraduate and graduate level programs across three campuses and identifying regulatory requirements and limitations for clinical experiences. The task force utilized the information gathered to develop evidence-based recommendations for simulation hour equivalence ratios and compiled a list of virtual activities and products faculty could use to complete clinical experiences. Undergraduate and graduate student surveys were conducted to determine the effectiveness of the transition to virtual clinical experiences. Overall, the majority of survey results were positive regarding virtual simulation experiences providing students with valuable opportunities to enhance their learning. Negative comments regarding the impact of COVID-19 on a personal level included issues involving internet access and web conferencing logistics, lack of motivation to study, family difficulties, and faculty inexperience teaching in an online environment. Undergraduate pre-licensure students were provided with opportunities to successfully complete all remaining required clinical hours virtually, while graduate students were allowed to complete non-direct care hours as applicable using virtual clinical experiences., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom.

Occupational therapy (OT) services provided in the home to a person with dementia can decrease caregiver burden by targeting home modifications, functional performance, and safety. One method to deliver these services is through telehealth. The use of telehealth is expanding rapidly, but there is a current lack of evidence to support the use of telehealth to deliver OT services to persons with dementia. The purpose of this study was to identify the perceptions of persons with dementia and their caregivers about the use of telehealth to receive OT services. A qualitative descriptive design was used. Results provided themes in three domains: dementia journey, skills for technology use, and perceptions of OT. Each participant identified a unique journey through awareness, challenges, and adaptive strategies as they adjusted to a life with dementia. The skills for technology focused on current usage and perceptions about technology. Participants had limited knowledge of OT but did appreciate the role it has in dementia care. The themes identified in the study provide support for further exploration of the use of telehealth in OT for persons with dementia and their caregivers.

Defining students' academic success can be challenging when perceptions about the qualities that define it differ. Little is known about these perceptions when it comes to nursing students and particularly when English is a second language (ESL). Larger numbers of international and ESL students are gaining entrance into nursing education programs. The study purpose was to identify ways undergraduate nursing students and particularly ESL students self-report academic success. Study findings showed statistically significant findings for perceived student success when students had a prior degree, they were at a higher academic course level in their program, and believed they communicated adequately. Faculty roles that affect students' perceptions of their academic success are described and areas where actions can be taken are suggested., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The biogas technology is a promising approach for the recovery of energy and fertilizer from municipal organic waste (MOW). However, only scarce information on the development of initial nutrient and heavy metal loads during processing is available. Therefore, this study investigates properties of source-separated MOW during treatment in a semi-industrial scale two-stage biogas plant and subsequent digestate composting including impurities removal. Data from 15 batch experiments was investigated by material and substance flow analysis. Results of this study have shown that about 40% of nutrients contained in the MOW inflow are mineralized during anaerobic and subsequent aerobic treatment. A higher nutrient release was observed during the anaerobic treatment step. Additionally, impurities removal causes a significant reduction of final nutrient content. Heavy metal analysis confirmed a high heterogeneity of contamination levels. However, digestion and composting do not seem to significantly impact on total heavy metal loads in the substrate flow., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The Institute of Medicine (IOM) Future of Nursing report, identified eight recommendations for nursing to improve health care for all Americans., Aim: The Texas Team for Advancing Health Through Nursing embraced the challenge of implementing the recommendations through two diverse projects., Method: One group conducted a broad, online survey of leadership, practice, and academia, focusing on the IOM recommendations. The other focused specifically on academic progression through the use of CABNET (Consortium for Advancing Baccalaureate Nursing Education in Texas) articulation agreements., Results: The survey revealed a lack of knowledge and understanding of the IOM recommendations, prompting development of an online IOM toolkit. The articulation agreements provide a clear pathway for students to the RN-to-BSN degree students., Conclusion: The toolkit and articulation agreements provide rich resources for implementation of the IOM recommendations.

Nursing professionals are at the frontline of the health information technology revolution. The Texas Nurses Association and Texas Organization of Nurse Executives partnered to evaluate the changing health technology environment in Texas, in particular the nurses' satisfaction with the use of clinical information systems. A descriptive exploratory study using the Clinical Information System Implementation Evaluation Scale and a newly developed Demographic Survey and the Meaningful Use Maturity-Sensitive Index, with a narrative component, was conducted in 2014 and 2015. Nurses across Texas received an electronic invitation to participate in the survey, resulting in 1177 respondents. Exploratory factor analysis revealed that variables of the Meaningful Use Maturity-Sensitive Index and Clinical Information System Implementation Evaluation Scale show strong interrater reliability, with Cronbach's α scores of .889 and .881, respectively, and thereby inform the survey analysis, indicating and explaining variations in regional and institutional trends with respect to satisfaction. For example, the maturity of a clinical information system within an organization and age of the nurse significantly influence the probability of nurse satisfaction (P < .05). Qualitative analysis of nurses' narratives further explained the nurses' experiences. Recommendations for future research and educational were identified.

We have developed a new bioinformatics framework for the analysis of rearranged bovine heavy chain immunoglobulin (Ig) variable regions by combining and refining widely used alignment algorithms. This bioinformatics framework allowed us to investigate alignments of heavy chain framework regions (FRHs) and the separate alignments of FRHs and heavy chain complementarity determining regions (CDRHs) to determine their germline origin in the four cattle breeds Aubrac, German Black Pied, German Simmental, and Holstein Friesian. Now it is also possible to specifically analyze Ig heavy chains possessing exceptionally long CDR3Hs. In order to gain more insight into breed specific differences in Ig combinatorial diversity, somatic hypermutations and putative gene conversions of IgG, we compared the dominantly transcribed variable (IGHV), diversity (IGHD), and joining (IGHJ) segments and their recombination in the four cattle breeds. The analysis revealed the use of 15 different IGHV segments, 21 IGHD segments, and two IGHJ segments with significant different transcription levels within the breeds. Furthermore, there are preferred rearrangements within the three groups of CDR3H lengths. In the sequences of group 2 (CDR3H lengths (L) of 11-47 amino acid residues (aa)) a higher number of recombination was observed than in sequences of group 1 (L≤10 aa) and 3 (L≥48 aa). The combinatorial diversity of germline IGHV, IGHD, and IGHJ-segments revealed 162 rearrangements that were significantly different. The few preferably rearranged gene segments within group 3 CDR3H regions may indicate specialized antibodies because this length is unique in cattle. The most important finding of this study, which was enabled by using the bioinformatics framework, is the discovery of strong evidence for gene conversion as a rare event using pseudogenes fulfilling all definitions for this particular diversification mechanism., Competing Interests: The authors have declared that no competing interests exist.

Structural order in organic solar cells is paramount: it reduces energetic disorder, boosts charge and exciton mobilities, and assists exciton splitting. Owing to spatial localization of electronic states, microscopic descriptions of photovoltaic processes tend to overlook the influence of structural features at the mesoscale. Long-range electrostatic interactions nevertheless probe this ordering, making local properties depend on the mesoscopic order. Using a technique developed to address spatially aperiodic excitations in thin films and in bulk, we show how inclusion of mesoscale order resolves the controversy between experimental and theoretical results for the energy-level profile and alignment in a variety of photovoltaic systems, with direct experimental validation. Optimal use of long-range ordering also rationalizes the acceptor-donor-acceptor paradigm for molecular design of donor dyes. We predict open-circuit voltages of planar heterojunction solar cells in excellent agreement with experimental data, based only on crystal structures and interfacial orientation.

Venous thromboembolism (VTE), including the combined diseases of deep vein thrombosis and pulmonary embolism, is a significant health problem that affects mortality, morbidity, and resource expenditure. Multiple guidelines have been formulated to address this condition, but broad implementation in health care is lacking. Nurses have a pivotal role in VTE prevention through increased knowledge, patient advocacy, and implementation/development of institutional VTE protocols.

The American College of Obstetricians and Gynecologists guidelines discourage elective deliveries before 39 weeks gestation, but clinicians continue to schedule elective inductions and cesareans resulting in births at 37 0/7 to 38 6/7 weeks gestation. These "early term" (ET) infants incur more morbidity and mortality than their 39-to-41-week counterparts. Using the Quality Health Outcomes Model, four hypotheses were tested: Among hospitals in one southwestern U.S. county, there are different rates of ET births, ET births preceded by elective labor induction, ET births preceded by elective cesarean section, and Neonatal Intensive Care Unit (NICU) admissions of ET infants. Analyses of 75,625 birth certificates involved 26,199 ET and 49,426 full term births in 16 hospitals. Chi-square analyses revealed significant differences in rates among hospitals for ET births, ET births preceded by elective labor induction, and ET births preceded by elective cesarean section, but no significant differences in NICU admissions. Wide variance across hospitals demonstrated practice patterns amenable to improvements.

Rapid development of doctor of nursing practice (DNP) programs requires that nursing faculty and students become competent and proficient in the discipline of informatics. The authors describe the steps used to develop an applied informatics course in a post-master's DNP program using content organizing and pedagogical frameworks and its positive learning outcomes.

Overview: Health information technology (HIT) is a central aspect of current U.S. government efforts to reduce costs and improve the efficiency and safety of the health care system. A federal push to implement and enhance electronic health records (EHRs) has been supported by billions of dollars earmarked in the Health Information Technology for Economic and Clinical Health Act, passed as part of the 2009 American Recovery and Reinvestment Act. The goal has been to lay the groundwork for a HIT system that enables a more reliable exchange of information among practitioners and patients and significant improvements in the way care is delivered.But what does this really mean for nurses? This article is the first in a series on HIT and nursing and will examine the federal policies behind efforts to expand the use of this technology as well as the implications for nurses. Subsequent articles will take a closer look at the use of EHRs to improve patient safety and quality of care, and the important role nurses are playing-and could play-in this system-wide initiative.

The study design for this hospital-randomized controlled trial of an educational quality improvement intervention in rural and small community hospitals, following the implementation of a Web-based quality benchmarking and case review tool, specified a control group and a rapid-cycle quality improvement education group of >or= 30 hospitals each. Of the 64 hospitals initially interested in participating, 7 could not produce the required quality data and 10 refused consent to randomization. Of the 23 hospitals randomized to the educational intervention, 16 completed the educational program, 1 attended the didactic sessions but did not complete the required quality improvement project, 3 enrolled in "make-up" sessions, and 3 were unable to attend. Of the 42 individuals who attended educational sessions, 5 (12%) have left their positions. Quality improvement interventions require several different approaches to engage participating organizations and should include plans to train new staff given the high turnover of health care quality improvement personnel.

Rural and small community hospitals typically have few resources and little experience with quality improvement (QI) and, on average, demonstrate poorer quality of care than larger facilities. Formalized QI education shows promise in improving quality, but little is known about its effect in rural and small community hospitals. The authors describe a randomized controlled trial assigning 47 rural and small community Texas hospitals to such a program (n = 23) or to the control group (n = 24), following provision of a Web-based quality benchmarking and case review tool. Centers for Medicare and Medicaid Services Core Measures composite scores for congestive heart failure (CHF) and community-acquired pneumonia (CAP), using Texas Medical Foundation data collected via the QualityNet Exchange system, are compared for the groups, for 2 years postintervention. Given the estimated baseline rates for the CHF (68%) and CAP (66%) composites, the cohort enables the detection of 14% and 11% differences (alpha = .05; power = 0.8), respectively.

Introduction: Colonic pouches have been used for 20 years to provide reservoir function after reconstructive proctectomy for rectal cancer. More recently coloplasty has been advocated as an alternative to a colonic pouch. However there have been no long-term randomized, controlled trials to compare functional outcomes of coloplasty, colonic J-Pouch (JP), or a straight anastomosis (SA) after the treatment of low rectal cancer., Aim: : To compare the complications, long-term functional outcome, and quality of life (QOL) of patients undergoing a coloplasty, JP, or an SA in reconstruction of the lower gastrointestinal tract after proctectomy for low rectal cancer., Methods: A multicenter study enrolled patients with low rectal cancer, who were randomized intraoperatively to coloplasty (CP-1) or SA if JP was not feasible, or JP or coloplasty (CP-2) if a JP was feasible. Patients were followed for 24 months with SF-36 surveys to evaluate the QOL. Bowel function was measured quantitatively and using Fecal Incontinence Severity Index (FISI). Urinary function and sexual function were also assessed., Results: Three hundred sixty-four patients were randomized. All patients were evaluated for complications and recurrence. Mean age was 60 +/-12 years, 71% were male. Twenty-three (7.4%) died within 24 months of surgery. No significant difference was observed in the complications among the 4 groups. Two hundred ninety-seven of 364 were evaluated for functional outcome at 24 months. There was no difference in bowel function between the CP-1 and SA groups. JP patients had fewer bowel movements, less clustering, used fewer pads and had a lower FISI than the CP-2 group. Other parameters were not statistically different. QOL scores at 24 months were similar for each of the 4 groups., Conclusions: In patients undergoing a restorative resection for low rectal cancer, a colonic JP offers significant advantages in function over an SA or a coloplasty. In patients who cannot have a pouch, coloplasty seems not to improve the bowel function of patients over that with an SA.

The subunit GluR2 of the alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) subfamily of ionotropic glutamate receptors (GluRs) features a single amino acid at the narrow constriction of the pore loop that is altered from glutamine to arginine by RNA editing. This so-called Q/R site has been shown to play an important role in the determination of the electrophysiological properties of AMPA receptor complexes as well as of trafficking to the plasma membrane. The protein stargazin has also been shown to modulate electrophysiological properties and trafficking to the plasma membrane of AMPA receptors. In this study we examined via a series of mutants of the Q/R site of the AMPA receptor GluR1 whether the amino acid at this position has any influence on the modulatory effects mediated by stargazin. To this end, we analyzed current responses of Q/R site mutants upon application of glutamate and kainate and determined the amount of mutant receptor protein in the plasma membrane in Xenopus oocytes. Desensitization kinetics of several mutants were analyzed in HEK293 cells. We found that the stargazin-mediated decrease in receptor desensitization, the slowing of desensitization kinetics, and the kainate efficacy were all dependent on the amino acid at the Q/R site, whereas the stargazin-mediated increase in trafficking toward the plasma membrane remained independent of this amino acid. We propose that the Q/R site modulates the interaction of stargazin with the transmembrane domains of AMPA receptors via an allosteric mechanism and that this modulation leads to the observed differences in the electrophysiological properties of the receptor.

Background/aims: Patients with advanced unresectable hepatobiliary carcinomas have a dismal prognosis. The efficacy of systemic chemotherapy in these patients is negligible and often, in particular in patients with hepatocellular carcinomas, the toxicity of chemotherapy outweighs the potential palliative effect of antineoplastic agents. Gemcitabine is a new anticancer agent with a mild toxicity profile, which has demonstrated antineoplastic activity in many solid tumors. Therefore we investigated the effect of gemcitabine in patients with advanced nonresectable hepatocellular and cholangiocellular carcinomas in a phase II study., Methodology: Twenty-three patients with cholangiocellular carcinoma and 20 patients with hepatocellular carcinoma were enrolled into the study. Eighteen of the 20 patients with hepatocellular carcinomas had liver cirrhosis. Gemcitabine was administered once weekly over 30 min for 3 consecutive weeks out of every 4 weeks. Patients with cholangiocellular carcinomas received gemcitabine also in the forth week of the first cycle with no rest to the following cycle. Disease status was assessed every 4 weeks., Results: Overall the regimen was well tolerated. The median number of gemcitabine administration was 15 (range, 3-37) in the group of patients with cholangiocellular carcinomas and 7.6 (range, 3-21) in the group of patients with hepatocellular carcinomas. In the group of patients with hepatocellular carcinomas thrombocytopenia was the most frequent side effect (30% grade 3/4). Among the patients with cholangiocellular carcinomas nausea and neutropenia were the most commonly observed side effects. The overall response rate of hepatocellular carcinomas was only 5% and chemotherapy generally did not improve the tumor symptoms of the patients in this group. In contrast, in the group of cholangiocellular carcinomas, seven patients achieved a partial response (overall response rate 30%). Eleven patients with cholangiocellular carcinomas revealed tumor symptoms before the onset of gemcitabine treatment. Seven of these patients developed a treatment related clinical benefit as defined as a relief of tumor symptoms or gain of weight., Conclusions: Our results indicate that the treatment of cholangiocarcinomas with gemcitabine is effective and should be further evaluated in phase III studies. In contrast, palliative chemotherapy with gemcitabine cannot be recommended in patients with hepatocellular carcinoma and liver cirrhosis.

The purpose of this study was to isolate fungi from the quarter milk of cow udders in 9 dairy farms. The samples were collected between May 1996 and April 2000 in the Lublin region. Six hundred and four milk samples collected from the quarters of 172 cows with clinical and subclinical mastitis were examined. Milk samples were plated as soon as possible on blood agar (BA), Mac Conkey agar, aesculin-tallium acetate-crystal violet blood agar, and Sabouraud agar with chloramphenicol and gentamicin. Fifty eight (9.6%) of the samples were positive for fungi. All of the fungal isolates were yeasts of the genera Candida, Rhodotorula and Trichosporon. We also isolated Streptococcus agalactiae (4.9%), Str. spp.(6.4%), Staphylococcus aureus (10.4%), coagulase-negative staphylococci-CNS (36.6%), Escherichia coli (3.5%), other microorganisms (2.6%) and no growth (25.8%).

The transcription factor nuclear factor kappaB (NFkappaB) is an essential antagonist of apoptosis during liver regeneration and embryonal development of hepatocytes. Several reports have indicated that NFkappaB may also inhibit the programmed cell death induced by cytokines, ionizing radiation, or cytotoxic drugs in some cancer cell lines. Because hepatocellular carcinomas (HCCs) are one of the most resistant tumors to systemic chemotherapy, we investigated the activation of NFkappaB and the consequence of its inhibition by an IkappaBalpha-super repressor during tumor necrosis factor alpha (TNFalpha)- and chemotherapy-induced apoptosis in HCC cell lines. We demonstrate that both TNFalpha and adriamycin activate NFkappaB in hepatoma cells. Activation of NFkappaB could be blocked through an adenoviral vector expressing the IkappaBalpha super repressor, regardless of the activating agent. Inhibition of NFkappaB enhanced the apoptosis induced by TNFalpha, whereas IkappaBalpha had an anti-apoptotic effect on chemotherapy-induced programmed cell death. A strong inhibition of chemotherapy- and TNFalpha-induced apoptosis by dominant-negative Fas-associated death domain indicated an essential contribution of death receptor-mediated apoptosis. To elucidate the different role of NFkappaB in chemotherapy-induced apoptosis, we investigated the expression of Fas (CD95) and Fas ligand (CD95 ligand), which have been described as important mediators of chemotherapy-induced cell death and as target genes of NFkappaB. However, our investigations demonstrated that in hepatoma cells, the chemotherapy-induced up-regulation of Fas (CD95) and Fas ligand (CD95 ligand) is not transcriptionally mediated through NFkappaB. Thus, other molecular mechanisms must account for the anti-apoptotic effect of IkappaBalpha in adriamycin-induced death of hepatoma cells. In summary, our investigations indicate that the activation of NFkappaB in response to cytotoxic drugs, in contrast to TNFalpha, exerts a pro-apoptotic stimulus rather than an anti-apoptotic function, which has implications for therapy of HCCs.

Aims/background: This study was undertaken in order to assess the main features of hepatocellular carcinoma in Germany, a country with low incidences of this tumor., Methods: Two hundred and eighty consecutive patients with hepatocellular carcinomas admitted to the Medical School Hannover between 1993-1997 were retrospectively studied., Results: Reliable data for the assessment of the etiology and the tumor stage of HCC were available for 268 patients. The female/male ratio was 1/4. In 51.9% of the patients, HCC was associated with hepatitis virus B or C (HBV, HCV) infection: 35.1% with HBV, 26.9%) with HCV and 10% coinfection with HBV/HCV This result emphasizes the major impact of HBV and HCV infection in liver cancer in Germany. Of all patients with HCC 74.6%) had liver cirrhosis. The predominant majority of the HCC (87%) were restricted to the liver: in only 5.9% could regional lymph node metastases as well as 8.5%) metastases in other organs be clinically diagnosed by chest X-ray, computed tomography scan or sonography. Data to asses the Okuda tumor stage were available for 166 patients: 47% were classified as stage I, 47% as stage II and only 6% as stage III. Serum AFP were determined in 195 patients. In 66% of the patients, the AFP value was elevated, but only in 30% did the AFP level reach the value of 500 microg/l, which is considered to be significant for HCC diagnosis in patients with liver cirrhosis. The proportion of liver cirrhosis was higher in HCV (97.8%) versus HBV (80.6%) associated HCC, which was the only significant (p<0.05) difference in the characteristics of HCC according to the etiology., Conclusion: Our study shows that liver cirrhosis is the prime risk factor for hepatocarcinogenesis in Germany. However, the very high proportion of hepatitis virus related HCC, in particular the high proportion of HBV infections, contradicts the common view that alcohol is by far the most important etiological factor for hepatocarcinogenesis in low hepatitis virus endemic areas such as Germany.

A hydrophobic, redox-active component with a molecular mass of 538 Da was isolated from lyophilized membranes of Methanosarcina mazei Gö1 by extraction with isooctane. After purification on a high-performance liquid chromatography column, the chemical structure was analyzed by mass spectroscopy and nuclear magnetic resonance studies. The component was called methanophenazine and represents a 2-hydroxyphenazine derivative which is connected via an ether bridge to a polyisoprenoid side chain. Since methanophenazine was almost insoluble in aqueous buffers, water-soluble phenazine derivatives were tested for their ability to interact with membrane-bound enzymes involved in electron transport and energy conservation. The purified F42OH2 dehydrogenase from M. mazei Gö1 showed highest activity with 2-hydroxyphenazine and 2-bromophenazine as electron acceptors when F420H2 was added. Phenazine-1-carboxylic acid and phenazine proved to be less effective. The Km values for 2-hydroxyphenazine and phenazine were 35 and 250 microM, respectively. 2-Hydroxyphenazine was also reduced by molecular hydrogen catalyzed by an F420-nonreactive hydrogenase which is present in washed membrane preparations. Furthermore, the membrane-bound heterodisulfide reductase was able to use reduced 2-hydroxyphenazine as an electron donor for the reduction of CoB-S-S-CoM. Considering all these results, it is reasonable to assume that methanophenazine plays an important role in vivo in membrane-bound electron transport of M. mazei Gö1.

Electronic information networks are explored in terms of the political and economic impact of such concepts as the National Information Infrastructure. The relevancy of electronic information retrieval to nursing is discussed as it applies to current health-care information management. Electronic information sources applicable to nursing are described along with examples of how they may be utilized. Network functions, such as bulletin boards, Freenets and literature searches, are explained and the implications for evolution of health-care delivery are summarized.

The age of the molecular organization of life as expressed in the genetic code can be estimated from experimental data. Comparative sequence analysis of transfer RNA by the method of statistical geometry in sequence space suggests that about one-third of the present transfer RNA sequence divergence was present at the urkingdom level about the time when archaebacteria separated from eubacteria. It is concluded that the genetic code is not older than, but almost as old as our planet. While this result may not be unexpected, it was not clear until now that interpretable data exist that permit inferences about such early stages of life as the establishment of the genetic code.