Abstract Introduction When the SARS-Cov2 virus hit the New York and New Jersey metropolitan area in Spring 2020, hospitals and hospital workers were hit hard with a new unknown pathogen that either killed people or made them very ill. There were large numbers of severely ill patients that strained resources. Hospital workers had extraordinary stress with multiple additional patients, the need to use personal protective equipment (PPE) in short supply, and faced with a pathogen that had no treatments beyond care and support initially. Methods We surveyed our hospital workers in late Spring 2020 to identify the main stressors and find out what measures were helpful. An online anonymous survey included questionnaires about sleep, mood, outside stressors, helpful measures, and how they coped generally. All levels of hospital workers were surveyed. Resources were provided to all respondents. Results Over 240 individuals responded to the survey; most respondents were women (76%). ‘Workplace stressors’ topped the chart for 98 of our respondents. The worst workplace stressor that was cited was ‘irritable workforce,’ but ‘lack of ‘protocols’ and ‘shortage of PPE’ were also cited as stressors. ‘Other’ (not described) and ‘taking care of an ill relative’ were rated highly. Those who had ‘symptoms everyday:’ Anhedonia (loss of pleasure or interest), 13%; feeling down and hopeless, 12%; sleep disturbance, 41%; low energy, feeling tired, 29%; appetite disturbance, 26%; poor concentration and attention, 15%. Respondents told us what resources they used and what was most helpful; exercise was most frequently cited as helpful. Lessons Learned and Discussion Various resources for formal and informal mental health support were provided to all respondents at the time of survey. Our hospital mounted its own response with support services, as did our medical school and university. A "warm line" was available through the Department of Psychiatry from late March 2020; tip sheets and online groups were widely circulated; State Department of Health provided resources. There were formal peer support sessions and workers helped each other. Medical students provided child care, shopping, and transport. We learned that extra support for workers and more frequent rest and recharge time are important. A weekly "town hall" was instituted and a weekly update about the hospital and support in healthy activities are widely circulated to employees. Those with active PTSD (some were very disturbed by the number of deceased patients) were referred to professional providers. Hospitals need to be ready to deal with epidemics and pandemics more effectively in order to mitigate stress and support workers. Being prepared, not just with equipment, but with protocols in how to proceed should another pandemic come. We learned that listening to workers is important. Workers also need to know how valued they are. Funding Department of Psychiatry, New Jersey Medical School
AbstractIntroduction: Barefoot running is not a new concept, but relatively few people choose to engage in barefoot running on a regular basis. Despite the technological developments in modern running footwear, as many as 79% of runners are injured every year. Although benefits of barefoot running have been proposed, there are also potential risks associated with it. Objective: To review the evidence-based literature concerning barefoot/minimal footwear running and the implications for the practicing physician. Materials and Methods: Multiple publications were reviewed using an electronic search of databases such as Medline, Cinahl, Embase, PubMed, and Cochrane Database from inception until August 30, 2013 using the search terms barefoot running, barefoot running biomechanics, and shoe vs. barefoot running. Results: Ninety-six relevant articles were found. Most were reviews of biomechanical and kinematic studies. Analysis: There are notable differences in gait and other parameters between barefoot running and shoe running. Based on these findings and much anecdotal evidence, one could conclude that barefoot runners should have fewer injuries, better performance, or both. Several athletic shoe companies have designed running shoes that attempt to mimic the barefoot condition, and thus garner the purported benefits of barefoot running. Conclusion: Although there is no evidence that confirms or refutes improved performance and reduced injuries in barefoot runners, many of the claimed disadvantages to barefoot running are not supported by the literature. Nonetheless, it seems that barefoot running may be an acceptable training method for athletes and coaches, as it may minimize the risks of injury.Keywords: barefoot runningshoe runningbiomechanicsminimalistic shoesrunningView correction statement:Erratum
Background As younger,healthier patients are having THA, a greater emphasis is being placed on postoperative function, activity, and exercise. With recent advances in implant technology and surgical technique, the survival rates for modern prosthetic designs and patients with these high demands are promising. There is no current consensus on the safety of resuming to sport. The main concerns nevertheless are remaining instability, wear, loosening, and fracture. Objective To provide a narrative literature review relating to returning to sporting activity following a THA. Design An electronic search was conducted up to October 2013, using medical subject headings and free-text words. Subject-specific search was based on the terms “total hip arthroplasty”, “return to sport” and “exercise”. Results 10 articles were found to be suitable. Only one was a prospective randomized study, comparing the type, intensity and frequency of sports activities performed after resurfacing hip arthroplasty vs. THA using a metal-on-metal bearing. All the rest were narrative reviews and expert opinion. One guideline consensus paper was published. Substantial limitations were observed in most of the publications, including small sample size, patient selection, trial quality, heterogeneity of outcome assessments, and potential sources of confounding variables not investigated. Conclusion Each sport should be evaluated on its potential risk to a joint replacement, whether from the force of repetitive injury or the possibility of catastrophic failure. Likewise, a surgeon can use techniques, biomaterials, and implants that will maximize an athlete's chance of success over time. There is a need for a long-term, high-quality, prospective randomized control trial that will compare low vs. high impact sports and their effect on the prostheses. Until then, definitive recommendations should be made based on each patient's expectations, goals and the surgeon's past experience.
Any smooth spatial disturbance of a degenerate Fermi gas inevitably becomes sharp. This phenomenon, called the gradient catastrophe, causes the breakdown of a Fermi sea to multiconnected components characterized by multiple Fermi points. We argue that the gradient catastrophe can be probed through a Fermi-edge singularity measurement. In the regime of the gradient catastrophe the Fermi-edge singularity problem becomes a nonequilibrium and nonstationary phenomenon. We show that the gradient catastrophe transforms the single-peaked Fermi-edge singularity of the tunneling (or absorption) spectrum to a sequence of multiple asymmetric singular resonances. An extension of the bosonic representation of the electronic operator to nonequilibrium states captures the singular behavior of the resonances.
