Patient demands,lack of reciprocity,and burnout: a five‐year longitudinal study among general practitioners

This study among a sample of 207 general practitioners (GPs) uses a five‐year longitudinal design to test a process model of burnout. On the basis of social exchange and equity theory, it is hypothesized and found that demanding patient contacts produce a lack of reciprocity in the GP–patient relationship, which, in turn, depletes GPs' emotional resources and initiates the burnout syndrome. More specifically, structural equation analyses confirmed that—both at T1 and T2—lack of reciprocity mediates the impact of patient demands on emotional exhaustion. Emotional exhaustion, in turn, evokes negative attitudes toward patients (depersonalization), and toward oneself in relation to the job (reduced personal accomplishment). Moreover, this process model of burnout was confirmed at T2, even after controlling for T1‐scores on each of the model components. Finally, T1 depersonalization predicted the intensity and frequency of T2 patient demands, after controlling for T1 patient demands. This major finding suggests that GPs who attempt to gain emotional distance from their patients as a way of coping with their exhaustion, evoke demanding and threatening patient behaviors themselves. The theoretical and practical implications of these findings are discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Environmental interactions of Sulphlex pavement

Sulphlex, a mixture of elemental sulfur and plasticizers, has been considered for use as an asphalt substitute in road construction. Because this material contains substantial quantities of elemental sulfur, it is a potential substrate for growth of sulfur-oxidising bacteria. Experiments, performed to determine the susceptibility of Sulphlex in Sulphlex-containing media to degradation by Thiobacillus thiooxidans, resulted in breakdown of the Sulphlex material and concomitant production of acid. In concurrent studies, plants were grown in Sulphlex-amended soils. These plants exhibited higher sulfur content and reduced productivity as compared with plants grown in unamended soils, indicating that Sulphlex was being broken down in the soil and that the breakdown products were apparently having a detrimental effect on plant productivity. These experiments indicate that naturally occurring sulfur-oxidising bacteria have the potential to break down Sulphlex paving material, resulting in adverse effects on both the structural integrity of the pavement and the local environment.     

Prenatal ultrasonographic diagnosis of radial-ray reduction malformations

Radial-ray reduction malformations (RRRMs) may occur isolated or in association with other anomalies. The data of seven fetuses born with RRRMs were collected. Six fetuses had associated lethal abnormalities of the central nervous system, urogenital system, and/or heart, detected by ultrasound. In five cases, it was possible to establish the precise diagnosis, enabling an informed prognosis and subsequent genetic counselling. The diagnoses were: Edwards syndrome (n=3), VACTERL association (n=1), and Poland-Moebius-like complex (n= 1). In two cases, a complete diagnosis was not possible because of inadequate evaluation of these fetuses before and/or after birth. A proposal is given for the diagnostic approach for infants with RRRMs detected in the antenatal period by means of ultrasonography.     

Method verification for determination of tetrachlorodibenzodioxin in soil

Methods for the determination of tetrachlorodibenzodioxin (TCDD) in surface and subsurface soil have been verified by spiking experiments conducted at a nominal level of twice the limit of detection. The methods involve Soxhlet extraction, silica and alumina clean-up and analysis by high resolution gas chromatography/ high resolution mass spectrometry. Mass Spectrometry done under profile data control is described. The precision (accuracy) found for surface and subsurface soils were 10.8% (85%) and 10.8% (95%) respectively. Application of the surface soil procedure is illustrated by analysis of soils from the Northeast United States.     

Assessment of the sustainability of technology by means of a thermodynamically based life cycle analysis

Life cycle analysis is one of the tools in the assessment of the sustainability of technological options. It takes into account all effects on the ecosystem and the population which may endanger the possibilities of current and future generations. However, the main bottleneck in current LCA methodologies is the balancing of different effects, being all quantified on different scales. In this work, a methodology is proposed, which allows one to quantify different effects of the production, consumption and disposal of goods, and services on a single scale. The basis of the methodology is the second law of thermodynamics. All production, consumption and disposal processes affecting the ecosystem and the population, are quantified in terms of loss of exergy. The exergy content of a material is the maximum amount of energy which can be transformed into work at given environmental conditions. Next to the elaboration of the methodology, the new approach is illustrated by examples of the production of synthetic organic polymers, inorganic building insulation materials and different waste gas treatment options.     

Investigations of nitrogen fluxes and pools on a limestone site in the Alps

In the North Tyrolean Limestone Alps a site was investigated over a four-year period (1998–2001) in order to assess the nitrogen saturation status, the nitrogen budget (quantification of the net uptake of nitrogen by the canopy and of the nitrogen mineralization, nitrogen uptake from roots and N₂O emission rates, proof of the origin of nitrate in the soil water with stable isotope analyses), and the effects of the actual nitrogen input on ground water quality. The main goals were to quantify the nitrogen input rate, the nitrogen pools in above-ground and below-ground compartments, nitrogen turnover processes in the soil as well as the output into the groundwater and into the atmosphere. The findings are based on continuous and discontinuous field measurements as well as on model results.While nitrogen input exceeded the Critical Loads of the WHO (1995), nitrogen deficiency and nutrient imbalances were verified by needle analyses. The atmospheric input of inorganic nitrogen was higher than the nitrogen output in 50 cm soil depth. A tracer experiment with¹⁵N helped to prove that not more than half of the applied nitrate could be discharged. This allows the conclusion that nitrogen is stored in the system and that the site cannot yet be said to be saturated with nitrogen. The same result was also obtained by modelling. In addition, it was proved that the nitrogen discharge did not stem from deposition but from processes within the system.