Age, burnout and physical and psychological work ability among nurses.

Background: The ageing of the US labour force highlights the need to examine older adults' physical and psychological ability to work, under varying levels of occupational burnout. Aims: To examine how age and burnout interact in predicting physical and psychological work ability. Methods: Using a cohort of actively working nurses, we assessed factors on the Work Ability Index at 12-month follow-up and determined how these were related to age and exhaustion-related burnout at baseline. Results: The study group consisted of 402 nurses aged 25-67 (mean = 41.7). Results indicated age by burnout interactions in which decrements in physical work ability with greater age were observed at all but the lowest level of burnout (1.5 SD below mean: ß = -0.14, 95% CI -0.36, 0.07; 1 SD below: ß = -0.23, 95% CI -0.39, -0.06; mean: ß = -0.39, 95% CI -0.50, -0.29; 1 SD above: ß = -0.56, 95% CI -0.70, -0.42; 1.5 SD above: ß = -0.64, 95% CI -0.83, -0.46). In contrast, we observed decrements in psychological work ability with age at higher levels of burnout only (1 SD above: ß = -0.20, 95% CI -0.35, -0.05; 1.5 SD above: ß = -0.30, 95% CI -0.49, -0.11); at lower levels of burnout, older age was associated with improvements in this (1 SD below: ß = 0.19, 95% CI 0.03, 0.35; 1.5 SD below: ß = 0.29, 95% CI 0.08, 0.50). Conclusions: Findings indicated physical and psychological dimensions of work ability that differed by age and occupational burnout. This emphasizes the need for interventions to reduce burnout and to address age-related strengths and vulnerabilities relating to physical and psychological work ability.

Soil mineral N retention and N(2) O emissions following combined application of (15) N-labelled fertiliser and weed residues.

RATIONALE: The combination of plant residues with inorganic fertiliser-N provides the potential to increase N-use efficiency in agricultural fruit production systems, such as olive orchards. The development of weeds in the inter-canopy area of olive orchards is encouraged as a novel strategy to reduce soil erosion. However, little is known about soil N retention or N(2) O production following the combined application of inorganic-N with the mulched weed residues. METHODS: Emissions of (15) N-N(2) O and soil mineral (15) N retention were measured following combined applications of (15) N-labelled fertiliser and a range of olive crop weed residues to a silty loam soil under controlled conditions. These plant residues differed in their C:N ratios, lignin and polyphenol contents. RESULTS: The magnitude of soil (15) N-NO(3) (-) retention from combining plant residues and fertiliser-N was highly dependent on potential N mineralisation (r = -0.96) and the (lignin + polyphenol)-to-N ratio (r = 0.98) of the residues. Fertiliser-N-derived retention was zero for a legume-based mulch but up to 80% in the treatment containing plant residues with a high (lignin + polyphenol)-to-N ratio. N(2) O emissions increased after the addition of residues, and increased further (up to 128%) following the combined application of inorganic fertiliser and residues. Fertiliser-derived (15) N-N(2) O was <1.4% of the total (14+15) N-N(2) O emission and <0.01% of the applied (15) N-NO(3) (-) . Enhanced N(2) O emissions following the application of residues and the fertiliser-N values were positively correlated with the C:N ratio of the residue. Thus, combining organic- and inorganic-N immobilised a significant proportion of the inorganic N with little increase in N(2) O, especially in low C:N ratio residues. CONCLUSIONS: The results demonstrate that whilst there is potential for N(2) O emissions to be controlled by combining weed residues and inorganic fertilisers, this is not easy to achieve as the magnitude and direction of interactions vary between different species due to their varying substrate qualities.

Gross and net rates of nitrogen mineralisation in soil amended with composted olive mill pomace.

Olive mill pomace is the major waste product in the olive oil industry and composting these by-products for the purpose of recycling nutrients and organic matter is a sound environmental strategy. Yet little is known about the quantity and timing of nitrogen (N) release from composted olive mill pomace. This paper assesses both gross (using the (15)N dilution technique) and net (aerobic incubation) nitrogen (N) mineralisation and N(2)O emissions of soil amended with seven commercially available composts of olive mill pomace (COMP). All are currently produced in Andalusia and differ in the proportions of raw materials co-composted with the pomace. The absence of significant differences in net N or gross mineralisation and nitrification in COMP-amended soil compared with a control, except for COMP combined with poultry manure, highlighted the recalcitrant nature of the COMP-N. Applications of COMP are hence unlikely to supply available N in available forms, at least in the short-term. Furthermore, N(2)O emissions from COMP-amended soil were negligible and, therefore, applications in the field should not result in increased N loss through denitrification.

High rates of nitrogen cycling in volcanic soils from Chilean grasslands.

There are over one million hectares of pasture in Chile, and 80% and 50% of the country's milk and meat comes from 72% of this area, situated in the lake region of southern Chile. The soils are volcanic and a major characteristic is that they have very high organic matter (OM) contents with the potential to support plant growth with only moderate levels of added nitrogen (N). To understand better the potential fertility of these soils in order to maximise production and minimise losses of N, we undertook studies using the stable isotope of N ((15)N) to resolve the rates of the main internal N cycling processes in three soils representing the two main volcanic soil types: Osorno and Chiloé (Andisol) and Cudico (Ultisol). We also assessed the longer-term potential of these soils to sustain N release using anaerobic incubation. Gross rates (µg N g(-1) day(-1)) of mineralisation were 27.9, 27.1 and 15.5 and rates of immobilisation were 5.9, 12.0 and 6.3 for Osorno, Chiloé and Cudico, respectively, implying high rates of net mineralisation in these soils. This was confirmed by anaerobic incubation which gave potential seasonal net mineralisation indices of 1225, 1059 and 450 kg N ha(-1) in the top 10 cm soil layers of the three soils. However, plant production may still benefit from added N, as the release of N from organic sources may not be closely synchronised with crop demand. The low rates of nitrification that we found with these acidic soils suggest that the more mobile N (viz. nitrate-N) would be in limited supply and plants would have to compete for the less mobile ammonium-N with the soil microbial biomass. Nitrogen was mineralised in appreciable amounts even down to 60 cm depth, so that leaching could become significant, particularly if the soils were limed, which could enhance nitrification and N mobility through the soil profile.

Evidence for the production of NO and N2O in two contrasting subsoils following the addition of synthetic cattle urine.

Nitrogenous materials can be transferred out of the topsoil, either vertically to a greater depth, or in lateral pathways to surface waters, and they may also become transformed, with the potential of generating environmentally active agents. We measured the production of NO and N(2)O in two contrasting subsoils (70 to 90 cm): one poorly drained and the other freely drained and compared this with the topsoil (0 to 20 cm) of the corresponding soils. The soils were incubated aerobically in jars with subtreatments of either synthetic cattle urine or deionised water and sampled at intervals up to 34 days. (15)N-NO(3)(-) was used to determine the processes responsible for NO and N(2)O production. The headspace was analysed for the concentrations of N(2)O, NO and CO(2) and (15)N enrichment of N(2)O. The soil samples were extracted and analysed for NO(2)(-), NO(3)(-) and NH(4)(+), and the (15)N enrichment of the extracts was measured after conversion into N(2)O and N(2). The study demonstrated the potential for NO, N(2)O and NO(2)(-) to be generated from subsoils in laboratory incubations. Differences in these N dynamics occurred due to subsoil drainage class. In the freely drained subsoil the rates of NO and NO(2)(-) production were higher than those observed for the corresponding topsoil, with mean maximum production rates of 3.5 microg NO(2)(-)-N g(-1) dry soil on day 16 and 0.12 microg NO-N g(-1) dry soil on day 31. The calculated total losses of N(2)O-N as percentages of the applied synthetic urine N were 0.37% (freely drained subsoil), 0.24% (poorly drained subsoil), 0.43% (freely drained topsoil) and 2.09% (poorly drained topsoil). The calculated total losses of NO-N as percentages of the applied synthetic urine N were 1.53% (freely drained subsoil), 0.02% (poorly drained subsoil), 0.25% (freely drained topsoil) and 0.08% (poorly drained topsoil).

The effect of cutting, mulching and applications of farmyard manure on nitrogen fixation in a red clover/grass sward.

In organic farming, maximising the amount of nitrogen (N) which is fixed and retained within the soil is of paramount importance for the yield of the following crop. The aim of this study was to establish the extent to which increased soil fertility, farmyard manure (FYM) applications and/or mulching, could adversely affect fixation. At two sites, situated in the South West (SW) and North East (NE) of England, N(2) fixation was estimated in 'organically' managed red clover/grass plots, both with and without green manure (i.e. surface mulched) and/or the addition of FYM. The FYM was incorporated into the seedbeds at both sites in autumn 2002 at the rate of 170 kg total Nha(-1), as either well-composted (SW site), or not actively-composted (NE site) manures. The same FYM application rate was repeated as top-dressings to both sites in autumn 2003. The plots were cut three or four times each year over two growing seasons. In the first harvest year (2003), incorporation of FYM had beneficial effects of increasing dry matter and N yields significantly at the first cut, but there were no significant differences in subsequent cuts. The same pattern was found in the second harvest year (2004) after the top dressings of FYM, suggesting that most of the N in both types of FYM was in recalcitrant forms. Over the two growing seasons, mulching did not affect red clover/grass dry matter or N yields, but did reduce the proportion of N(2) fixed, by up to 60 kg Nha(-1) when compared with plots from which the clover/grass herbage was cut and removed. Thus, the gain in N from FYM or green manure tended to be offset by a similar reduction in N(2) fixation. These results demonstrate the close association between the availability of soil N and the feed-back system which operates on N(2) fixation by red clover.

Investigation of platelet-neutrophil interactions in whole blood by flow cytometry.

Evidence is increasing that platelets can initiate and propagate inflammatory processes by interacting with leucocytes and the vascular endothelium. Platelets have been shown to bind to neutrophils, existing as platelet/neutrophil complexes (PNC) within the circulation. We describe a simple flow cytometric method for assessing and investigating platelet interactions with neutrophils in small volumes of whole blood. Twenty-five percent (sd 6%) of circulating neutrophils from healthy adults were associated with platelets. Formation of these platelet-neutrophil complexes was CD62P (P-selectin) and divalent cation dependent. Platelet activation (with ADP or thrombin) caused a rapid and sustained rise in %PNC which differed from the pattern of free platelet activation as assessed by CD62P expression. F-met-leu-phe induced neutrophil activation but did not increase the percentage PNC. Platelet activation also caused increased neutrophil CD11b/CD18 expression which was most marked on neutrophils complexed with platelets. This straightforward technique is simple, reproducible, and allows assessment of platelet-neutrophil interactions and activation of neutrophils. It may also provide a method for estimating platelet activation in whole blood.

Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices.

OBJECTIVE: Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with those who survived. DESIGN: A prospective observational study of 118 consecutive AHRF admissions with data analysis incorporating all blood gases. SETTING: A pediatric intensive care unit in a national children's hospital. INTERVENTIONS: None. RESULTS: Mortality was 26/118, 22% (95 % confidence interval 18-26%). There were no significant differences in the best alveolar-arterial oxygen tension gradient (A-aDO2, torr), oxygenation index (OI), ventilation index (VI), or PaO2/FIO2 during the first 2 days of intensive care between the survivors and non-survivors. Only the mean airway pressure (MAP, cm H2O) used for supportive care was significantly different on days 0 and 1 (p < 0.05) with higher pressure being used in non-survivors. Multiple logistic regression analysis did not identify any gas exchange or ventilator parameter independently associated with mortality. Rather, all deaths were associated with coincident pathology or multi-organ system failure, or perceived treatment futility due to pre-existing diagnoses instead of unsupportable respiratory failure. When using previously published predictors of outcome (VI > 40 and OI > 40; A-aDO2 > 450 for 24 h; A-aDO2 > 470 or MAP > 23; or A-aDO2 > 420) the risk of mortality was overestimated significantly in the current population. CONCLUSION: The original hypothesis was refuted. It appears that the outcome of AHRF in present day pediatric critical care is principally related to the severity of associated pathology and now no longer solely to the severity of respiratory failure. Further studies in larger series are needed to confirm these findings.

Influence of tidal volume on respiratory compliance in anesthetized infants and young children.

Recent studies have suggested a close association between total respiratory compliance (Crs) and tidal volume in anesthetized paralyzed infants who are being artificially ventilated. To investigate this further, the multiple occlusion technique was used to measure Crs in 20 anesthetized infants and young children (aged 1-25 mo) before elective surgery. Measurements were made after intubation 1) during spontaneous breathing (SB), 2) after administration of a non-depolarizing muscle relaxant with tidal volume and frequency mimicking that during SB, and 3) with the child still paralyzed but tidal volume approximately double that during SB. Compared with values obtained during SB, there was no significant change in Crs after paralysis when ventilation matched the child's own pattern (P greater than 0.2). When ventilated with the larger tidal volumes, the infants showed a highly significant increase in Crs (mean 62%, range 14-158%, P less than 0.0001). These results may have implications not only for studies performed during anesthesia but also when infants were monitored in the intensive care setting. Values of Crs obtained in ventilated infants may reflect both the mechanical behavior of the respiratory system and the pattern of ventilation at the time of measurement.

Respiratory compliance during sedation, anesthesia, and paralysis in infants and young children.

Although total respiratory compliance (Crs) has been shown to fall in adults on induction of halothane anesthesia, no successful paired studies have been reported in children. The multiple occlusion technique was used to measure Crs in 17 infants and young children during sedated sleep (CrsS) and shortly after, following induction of halothane anesthesia (CrsA). Crs fell in all but one infant after induction of anesthesia, with a mean fall of 34.7% (range 0-58%). This was accompanied by a reduction in tidal volume and increase in frequency in every case. In 7 of the 17 children, who were to be paralyzed for surgical purposes, Crs was also measured in this anesthetized-paralyzed state. When tidal volume administered during manual ventilation was similar to that observed during measurement of CrsA, Crs during this low-volume ventilation was similar to CrsA. When tidal volume was increased and Crs remeasured, there was a significant increase in every case, with the high-volume Crs within 10% of CrsS in all but one child, in whom there was a 31.4% increase with respect to CrsS. Changes in tidal volume accounted for approximately 50% of the variability in each state. These results demonstrate a highly significant fall in Crs in infants and young children after induction of halothane anesthesia. In addition it appears that this reduction in Crs can be reversed by paralyzing the child and manually ventilating with tidal volumes approximating those seen during sedation.

Maturation of porcine tracheal cholinergic and inhibitory non-adrenergic, non-cholinergic innervation.

It is known that both excitatory cholinergic neural activity and nitric oxide (NO) release from inhibitory non-adrenergic, non-cholinergic (iNANC) nerves are important determinants of adult human airway smooth muscle tone. However, the level of cholinergic and iNANC activity in the newborn is unknown. Therefore, isolated trachealis muscle strips were obtained from neonatal, 10-day-old, and adult pigs. To quantify cholinergic nerve activity, isometric contractions were elicited by stimulating the nicotinic receptors of the cholinergic intramural ganglia with dimethyl-phenyl-piperazinium (DMPP). After ganglionic blockade with hexamethonium, the post-ganglionic cholinergic nerves were subjected to electrical field stimulation (EFS). To assess whether DMPP and EFS were also stimulating nitric oxide release from iNANC nerves, the stimulations were repeated after NO-synthase inhibition with 3 x 10(-5) M NG-monomethyl-L-arginine acetate (LNMMA). All responses were expressed as a percentage of maximal response to 10(-4) M acetylcholine. Although no significant age-related differences in the contractile responses to DMPP were demonstrated between the three age groups, the EFS responses were significantly different. At EFS frequencies of 1 and 2 Hz the responses of all three groups were different (P < 0.05, unpaired t-test). At frequencies of 0.125 and 0.5 Hz the contractile responses in the neonatal and 10-day-old groups were less than in the adult animal tissues (P < 0.05, unpaired t-test). At 4 Hz and above, the responses of the 10-day-old and adult groups became greater than the neonatal (P < 0.05, unpaired t-test). LNMMA did not significantly increase the contractile responses to DMPP at any age. Only in the neonatal rat and 10-day-old groups was a significant increase of the EFS frequency responses by LNMMA demonstrated (140.4 +/- 38.2% and 144.2 +/- 41.2%, respectively, at 0.5 Hz, ANOVA, P < 0.001). In conclusion, the DMPP responses suggest that the neonatal porcine cholinergic innervation is mature at birth. This contrasts with a frequency-dependent increase in EFS responses from birth. This may be due in part to a relative increase in iNANC modulation of post-ganglionic cholinergic activity at birth. This mechanism is not responsible for the increase in higher EFS frequency responses with post-natal maturation. Inhibitory iNANC activity may serve a protective role in the newborn, given the reported hyper-responsiveness of airway smooth muscle, small airway caliber, and high chest wall compliance at this age.

The effect of triclofos sodium sedation on respiratory rate, oxygen saturation, and heart rate in infants and young children.

Chloral hydrate is frequently used to sedate infants for lung function testing. While no effect on respiratory function has been demonstrated, a recent study has reported a fall in oxygen saturation (SaO2) following sedation in wheezy infants. This study was designed to assess the effects of the closely related but less gastrically irritant drug triclofos sodium on respiratory rate (RR), heart rate (HR), and SaO2 in infants without cardiopulmonary disease. Paired measurements using respiratory inductance plethysmography and pulse oximetry were obtained in 10 infants (4-19 months of age) during natural and sedated sleep. Following sedation with triclofos, mean RR rose by 1.9 breaths min-1 (95% confidence intervals [Cl] of the mean difference: 0.13-3.7 min-1). Mean heart rate rose by 5.5 beats min-1 (95% Cl: -0.9-11.9 min-1). Mean SaO2 fell by 0.68% (95% Cl -1.8-0.45%). None of these changes are considered to be of clinical importance, and only the change in RR reached statistical significance at the 5% level.

Total respiratory compliance in infants and young children with congenital heart disease.

The multiple occlusion technique was used to measure total respiratory system compliance (Crs) in 62 infants and young children with congenital heart disease (age range, 2 days to 2 years). Measurements were found to be reproducible in nine infants in whom repeat measurements were possible (maximum deviation between measurements less than 10%). The incidence of failure to obtain accurate results was no greater than when studying infants without cardiopulmonary disease. However, in the presence of severe growth retardation or alinearity of volume-pressure data, results may be difficult to interpret in individuals. Results of Crs were related to non-invasive assessments of cardiac disease severity using chest radiography and echocardiography. After the effects of growth had been taken into account, a significant negative relationship was found between Crs and the right pulmonary artery to aortic ratio, which reflects pulmonary vascular engorgement (P = 0.003, R2 = -0.40). However, no significant relationship was found between Crs and chest X-ray score (P = 0.27).

Measurements of ammonia emission from grazed grassland.

Some of the factors influencing NH(3) emission from grazed grassland were examined. The large day-to-day variation in rates of loss were only partially explained by variation in the measured environmental factors (wind speed, soil and air temperature, soil moisture status, relative humidity, rainfall and potential evapotranspiration). Of the measured variables, wind speed had the largest effect but the best multiple linear regression model of daily NH(3) loss had an adjusted R(2) value of only 0.406. The mechanisms controlling NH(3) flux were therefore unclear. There were marked diurnal rhythms in NH(3) loss and the concentration gradients above the sward were strongest during the period which included the 3 h each side of midday. This pattern of NH(3) release has important implications in relation to atmospheric mixing processes and chemical reactions. A comparison of two means of determining NH(3) concentrations, i.e. a bubbler collection system or denuder tubes, indicated that different forms were collected which could be related to the environmental conditions. Such differences and effects should be considered when models are developed to describe the behaviour of nitrogenous and other species in the atmosphere.

Specialist anaesthetic training and certification process in England.

Specialist accreditation in anaesthesia in the United Kingdom currently requires a minimum of six years recognised training after full medical registration. In future, the training programme will become more structured, with more emphasis on regular in-training assessment, and attempts are being made to reduce the overall training period. The Royal College of Anaesthetists has published a proposed plan for structured training and is evaluating the reliability and validity of traditional and newer methods of examination. It is one of the first postgraduate bodies to introduce the Objective Structured Clinical Examination (OSCE) into its examination structure. A more formal programme of Continuing Medical Education is also being considered.