Impacts of industrial actions, protests, strikes and lockouts by health and care workers during COVID-19 and other pandemic contexts: a systematic review.

BACKGROUND: Public health emergencies of international concern (PHEICs) as the COVID-19 pandemic and others that have occurred since the early 2000s put enormous pressure on health and care systems. This is being a context for protests by health and care workers (HCWs) because of additional workload, working conditions and effects on mental and physical health. In this paper, we intended to analyze the demands of HCWs associated with industrial actions, protests, strikes and lockouts (IAPSLs) which occurred during COVID-19 pandemic and other PHEICs; to identify the impact of these grievances; and describe the relevant interventions to address these IAPSLs. METHODS: We included studies published between January 2000 and March 2022 in PubMed, Embase, Scopus, BVS/LILACS, WHO's COVID-19 Research Database, ILO, OECD, HSRM, and Google Scholar for grey literature. Eligibility criteria were HCWs as participants, IAPSLs as phenomenon of interest occurring in the context of COVID-19 and other PHEICs. GRADE CERQual was used to assess risk of bias and confidence of evidence. RESULTS: 1656 records were retrieved, and 91 were selected for full-text screening. We included 18 publications. A system-wide approach, rather than a limited approach to institutions on strike, makes it possible to understand the full impact of the strike on health and care services. PHEICs tend to aggravate already adverse working conditions of HCWs, acting as drivers for HCWs strikes, leading to staff shortages, and financial issues, both in the North and in the Global South, particularly evident in Asia and Africa. In addition, issues related to deficiencies in leadership and governance in heath sector and lack of medical products and technologies (e.g., lack of personal protective equipment) were the main drivers of strikes, each contributing 25% of the total drivers identified. CONCLUSIONS: It is necessary to focus on the preparedness of health and care systems to respond adequately to PHEICs, and this includes being prepared for HCWs' IAPSLs, talked much in the context of COVID-19 pandemic. Evidence to assist policymakers in defining strategies to respond adequately to the health and care needs of the population during IAPSLs is crucial. The main impact of strikes is on the disruption of health care services' provision. Gender inequality being a major issue among HCWs, a proper understanding of the full impact of the strike on health and care services will only be possible if gender lens is combined with a systemic approach, rather than gender-undifferentiated approaches limited to the institutions on strike.

Strikes of physicians and other health care workers in sub-Saharan African countries: a systematic review.

Introduction: Strikes in the health sector have been of growing concern, given their disruptive nature, negatively impacting the provision of health care and jeopardizing the well-being of patients. This study aims to identify the main actors, the reasons behind industrial actions protests, strikes and lockouts (IAPSL) in sub-Saharan African countries and their impact on health care workers (specifically doctors) and health services, as well as to identify the main strategies adopted to reduce their impact on healthcare services. Methods: Studies published between January 2000 and December 2021 and archived in MEDLINE, Google Scholar, Scopus, ProQuest, and Science Direct were included. Quantitative, observational (i.e., cohort, case-control, cross-sectional, and ecological) and experimental studies, as well as mixed methods, quasi-experimental, and qualitative studies were eligible. Results: A total of 5521 studies were identified and after eliminating duplicates, applying the inclusion criteria, and assessing the risk of bias, a total of 11 studies were included in the review. Nurses and doctors are the actors most commonly involved in strikes. The main causes of strikes were salary claims and poor working conditions. The main strategies adopted to mitigate the strike consequences were to restrict services and prioritize emergency and chronic care, greater cooperation with the private sector and rearrange tasks of the available staff. The strikes led to a reduction in hospitalizations and in the number of women giving birth in health units, an increase in maternal and child morbidities and delays in the immunization process. Increased mortality was only reported in faith-based hospitals. Discussion: This evidence can assist decision-makers in developing strategies and interventions to address IAPSL by health care workers, contributing to strengthen the health system. Strikes in the health sector disrupt healthcare services provision and compromise the well-being of patients, especially the most disadvantaged, with consequences that may be difficult to overcome ever. The potential health impacts of strikes highlights the importance of their prevention or timely resolution through regulation and negotiations to balance the rights of health care workers and the rights of patients. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334173, identifier CRD42022334173.

The Silent Threat of Hypokalemia after High Voltage Electrical Injuries: A Case Study and Review of the Literature.

High-voltage electrical injuries, especially from lightning strikes, can cause life-threatening complications due to extreme temperature and voltage exposure. While burns and cardiac complications have been widely described, the documentation of metabolic imbalances, particularly hypokalemia, has not been as prevalent. This report focuses on a patient with profound transient hypokalemia following a lightning strike, alongside a review of three similar cases of transient hypokalemia from the literature. Our patient, a previously healthy young man, was struck by lightning and subsequently suffered transient hypokalemia with lower extremity sensory changes, which resolved after the normalization of serum potassium levels. While the exact underlying mechanisms of transient hypokalemia following high-voltage electrical injuries are unknown, we propose a multifactorial mechanism, which includes massive intracellular shifts of potassium due to elevated epinephrine levels and the prevention of potassium efflux through the electrical disruption of voltage-gated potassium channels. Our report underscores the importance of recognizing hypokalemia in patients with high-voltage electrical injuries and contributes to the understanding of the complex mechanisms involved. Further research is necessary to understand the connection between cellular changes induced by high-voltage exposure and their effects on metabolism, particularly in relation to hypokalemia.

Evaluating drivers of recent large whale strandings on the East Coast of the United States.

Anthropogenic stressors threaten large whales globally. Effective management requires an understanding of where, when, and why threats are occurring. Strandings data provide key information on geographic hotspots of risk and the relative importance of various threats. There is currently considerable public interest in the increased frequency of large whale strandings occurring along the US East Coast of the United States since 2016. Interest is accentuated due to a purported link with offshore wind energy development. We reviewed spatiotemporal patterns of strandings, mortalities, and serious injuries of humpback whales (Megaptera novaeangliae), the species most frequently involved, for which the US government has declared an "unusual mortality event" (UME). Our analysis highlights the role of vessel strikes, exacerbated by recent changes in humpback whale distribution and vessel traffic.  Humpback whales have expanded into new foraging grounds in recent years. Mortalities due to vessel strikes have increased significantly in these newly occupied regions, which show high vessel traffic that also increased markedly during the UME. Surface feeding and feeding in shallow waters may have been contributing factors. We found no evidence that offshore wind development contributed to strandings or mortalities. This work highlights the need to consider behavioral, ecological, and anthropogenic factors to determine the drivers of mortality and serious injury in large whales and to provide informed guidance to decision-makers.

Análisis de las causantes de los recientes varamientos de ballenas en la costa este de los Estados Unidos Resumen El estrés antropogénico amenaza a las ballenas en todo el mundo. El manejo efectivo requiere comprender en dónde, cuándo y por qué ocurren las amenazas. Los datos de varamientos proporcionan información clave sobre los puntos críticos geográficos de riesgo y la importancia relativa de varias amenazas. Actualmente existe un interés público considerable por el incremento en la frecuencia de varamientos de ballenas que ocurren en la costa este de los Estados Unidos desde 2016, al cual el gobierno nacional ha denominado un "evento inusual de mortalidad" (EIM). El interés se acentúa debido a la supuesta conexión con el desarrollo de la energía eólica marina. Revisamos los patrones espaciotemporales de los varamientos, mortandad y lesiones graves de las ballenas jorobadas (Megaptera novaeangliae), la especie involucrada con mayor frecuencia. Nuestro análisis resalta el papel de las colisiones con navíos, agudizados por los cambios recientes en la distribución de la especie, y el tráfico de navíos. Las ballenas jorobadas se han expandido hacia nuevas áreas de forrajeo y los años recientes. La mortandad causada por las colisiones con navíos ha incrementado significativamente en estas regiones ocupadas recientemente, las cuales también muestran un tráfico elevado de navíos que también incrementó durante el EIM. La alimentación superficial y en áreas someras podrían ser factores contribuyentes. No encontramos evidencia de que la energía eólica marina contribuya a los varamientos o a la mortandad. Este trabajo resalta la necesidad de considerar los factores ecológicos, antropogénicos y de comportamiento para determinar las causas de la mortalidad y las lesiones graves en las ballenas y de proporcionar orientación informada para quienes toman las decisiones.

State of Physician Unionization.

OBJECTIVES: To provide an overview of the current state of physician unionization, potential factors surrounding increased unionization, and the ethical and financial issues that may arise. DESIGN: Review article. SETTING: Not applicable. PARTICIPANTS: Not applicable. RESULTS: Over the last few years, there has been a recent surge in physician unionization. Union membership among residents and fellows is also at an all-time high and continues to increase, as seven residency programs voted to unionize in 2023. The resulting threat of strikes has grown considerably over the last year as residents across 6 hospitals have threatened to strike, resulting in New York's first physician strike in over three decades. As physician practice continues to shift from private to corporate health system-based employment, more opportunities for unionization will arise. Globally, these trends have been comparable, with thousands of physicians striking across the United Kingdom, Germany, Italy, Nigeria, and New Zealand in the last year. CONCLUSION: The current state of physician unionization is of increasing significance as more physicians are presented with opportunities for unionization. Physicians perceive a lack of autonomy, and the demand to deliver high level outcomes with diminishing resources is becoming an insurmountable challenge. Additionally, physician satisfaction with their workplace has decreased with increased burnout rates. Thus, it is important to understand the current state of unionization, potential reasons for unionization among physicians and residents, and its future impact on the field of medicine.

'Enough is enough': a mixed methods study on the key factors driving UK NHS nurses' decision to strike.

BACKGROUND: The UK National Health Service (NHS) is one of the largest employers in the world and employs around 360,000 registered nurses. Following a protracted pay dispute in December 2022 NHS nurses engaged in industrial action resulting in the largest nurse strikes in the 74-year history of the NHS. Initially it appeared these strikes were a direct consequence of pay disputes but evidence suggests that the situation was more complex. This study aimed to explore what the key factors were in driving UK NHS nurses' decision to strike. METHODS: A convergent parallel mixed methods design was used. The study was conducted throughout the UK and involved participants who were nurses working for the NHS who voted in favour of strike action. Data collection involved the use of an online survey completed by 468 nurses and 13 semi-structured interviews. Descriptive and inferential statistics were used for quantitative data analysis and a process of inductive thematic analysis for the qualitative data. The quantitative and qualitative data were analysed separately and then integrated to generate mixed methods inferences. RESULTS: The quantitative findings showed that patient safety, followed by staff shortages, pay, and unmanageable work demands were the most important factors encouraging nurses' decision to strike. The qualitative findings served to further the understanding of these factors particularly in relation to participants' perception of the NHS and the consequences of inadequate pay and staff shortages. Three overarching and overlapping themes represented the qualitative findings: Save our NHS, Money talks, and It's untenable. Integration of the findings showed a high level of concordance between the two data sets and suggest that the factors involved are interconnected and inextricably linked. CONCLUSIONS: The UK NHS is a challenging and demanding work environment in which the well-being of its patients is dependent on the well-being of those who care for them. Concerns relating to patient welfare, the nursing profession and the NHS played a large part in driving UK NHS nurses' decision to strike. In order to address these concerns a focus on recruitment and retention of nurses in the NHS is needed.

From plaster casts to picket lines: Public support for industrial action in the National Health Service in England.

This paper explores public sentiment towards strike action among healthcare workers, as a result of their perceived inadequate pay. By analysing survey data collected in England between 2022 and 2023, the study focuses on NHS nurses and junior doctors, due to their critical role in delivering essential public services. Results indicate higher public support for strikes by nurses and junior doctors compared to other professions such as postal workers, teachers, rail workers, airport workers, civil servants and university lecturers. However, variation in support for strikes by healthcare workers is observed across societal segments. Significant disparities in support are linked to individual political affiliations, left-right ideological positions and trust in the NHS. In short, nonconservative voters, individuals leaning towards left-wing politics and those with greater trust in the NHS demonstrate higher likelihoods of supporting strikes by health workers. These findings carry implications for future strike decisions and highlight specific target groups for enhanced communication efforts to garner increased public support.

Disentangling the biotic and abiotic drivers of bird-building collisions in a tropical Asian city with ecological niche modeling.

Bird collisions with buildings are responsible for a large number of bird deaths in cities around the world, yet they remain poorly studied outside North America. We conducted one of the first citywide fine-scale and landscape-scale analyses of bird-building collisions in Asia and used maximum entropy modeling (as commonly applied to species distribution modeling) in a novel way to assess the drivers of bird-building collisions in the tropical city-state of Singapore. We combined 7 years of community science observations with publicly available building and remote sensing data. Drivers of bird-building collisions varied among taxa. Some migratory taxa had a higher relative collision risk that was linked to areas with high building densities and high levels of nocturnal blue light pollution. Nonmigratory taxa had a higher collision risk in areas near forest cover. Projecting our results onto official long-term land-use plans, we predicted that future increases in bird-building collision risk stemmed from increases in blue light pollution and encroachment of buildings into forested areas and identified 6 potential collision hotspots linked to future developments. Our results suggest that bird-building collision mitigation measures need to account for the different drivers of collision for resident and migratory species and show that combining community science and ecological modeling can be a powerful approach for analyzing bird-building collision data.

Modelos de nicho ecológico para esclarecer los causantes bióticos y abióticos de las colisiones entre aves y edificios en una ciudad tropical asiática Resumen Las colisiones entre aves y edificios son causa de un gran número de muertes en todas las ciudades del mundo, y aun así se estudian muy poco fuera de América del Norte. Realizamos uno de los primeros análisis a escala fina y a escala de paisaje en una ciudad asiática y usamos el modelo de entropía máxima (como se aplica con frecuencia a los modelos de distribución de especies) de manera novedosa para analizar los causantes de estas colisiones en Singapur, una ciudad­estado tropical. Combinamos siete años de observaciones de ciencia comunitaria con los datos públicos de teledetección y construcción. Los causantes de las colisiones entre aves y edificios variaron entre taxones. Algunos taxones migratorios tuvieron un riesgo de colisión relativamente más alto relacionado con áreas de alta densidad de edificios y niveles elevados de contaminación lumínica de luz azul nocturna. Los taxones no migratorios tuvieron un riesgo de colisión más elevado en las áreas cercanas a la cobertura forestal. Con la proyección de nuestros resultados sobre los planes oficiales de uso de suelo a largo plazo, pronosticamos que el incremento en el futuro de colisiones entre aves y edificios vendrá del incremento en la contaminación de luz azul y la invasión de edificios en las áreas forestales; también identificamos seis potenciales puntos calientes de colisión relacionados a futuros desarrollos inmobiliarios. Nuestros resultados sugieren que para mitigar estas colisiones se necesita considerar los diferentes causantes de dichas colisiones para las especies migratorias y residentes y también muestran que la combinación de la ciencia comunitaria y los modelos ecológicos puede ser una estrategia poderosa para analizar los datos de colisiones entre aves y edificios.

Social media opposition to the 2022/2023 UK nurse strikes.

Previous research has established that the success of strikes, and social movements more broadly, depends on their ability to garner support from the public. However, there is scant published research investigating the response of the public to strike action by healthcare workers. In this study, we address this gap through a study of public responses to UK nursing strikes in 2022-2023, using a data set drawn from Twitter of more than 2300 publicly available tweets. We focus on negative tweets, investigating which societal discourses social media users draw on to oppose strike action by nurses. Using a combination of corpus-based approaches and discourse analysis, we identified five categories of opposition: (i) discourse discrediting nurses; (ii) discourse discrediting strikes by nurses; (iii) discourse on the National Health System; (iv) discourse about the fairness of strikers' demands and (v) discourse about potential harmful impact. Our findings show how social media users operationalise wider societal discourses about the nursing profession (e.g., associations with care, gender, vocation and sacrifice) as well as recent crises such as the Covid-19 pandemic to justify their opposition. The results also provide valuable insights into misconceptions about nursing, strike action and patient harm, which can inform strategies for public communication.

Examining the recent strike wave in the UK: The problem with official statistics.

In the UK, there has been a significant increase in strike activity since the summer of 2022. Due to these increased levels of strike activity, it is logical for academics and policy makers to turn to the official data on labour disputes to help us understand what has been happening. Strikes remain of core sociological interest, yet are under researched in this journal. This research note briefly examines the recent strike wave in the UK drawing on data from the Office for National Statistics. The limitations of these data are outlined before consideration is given to other potential sources of data on labour disputes.

A Low Cost Real-Time Transient Recorder for High Voltage Systems.

Large-scale incorporation of new energy generation units based on renewable sources, such as wind and photovoltaic power, drastically alters the structure of the power system. Because of the intermittent nature of these sources, switching in grids (connection and disconnection) occurs much more frequently than with conventional sources. As a result, the power system will inevitably experience a large number of transients, which raises questions about the stability of the system and the quality of the electrical energy. Therefore, measuring various types of transients in power system is crucial for stability, power quality, fault analysis, protection design, and insulation design. Transient recorders that are currently used are generally expensive and only suitable for particular locations in power systems. The number of installed transient recorders is insufficient for a comprehensive analysis of problems that may occur. Hence, it is important to have inexpensive and efficient transient recorders that can be installed at multiple points in the power system on various types of objects. It is also essential to have a transient record database with open access, which can be used by researchers to develop new analysis techniques based on artificial intelligence. This paper proposes an inexpensive measurement and acquisition system designed to record transient phenomena on different objects within the power system. The system is designed to use autonomous power, a standardized data acquisition module, a low-budget system for transmitting recorded transient events to the server via mobile network, and a sensor system adapted to the object where transients are recorded. The proposed system is designed to be used for all types of objects in the power system where transients may occur, such as power lines, transmission towers, surge arresters, and transformers. All components of the system are described, and the system is tested under laboratory conditions. The modular nature of the system allows customization to the specifics of the location in power system by choosing appropriate components. The calibration method of the custom designed Rogowski coil is described. The cost analysis of the proposed system and power consumption analysis are performed. The results show that the system's performance meets application requirements at a low cost.

Investigation of bionic composite laminates inspired by the natural impact-resistant helicoidal structure in the mandibles of trap-jaw ants.

Many living organisms exhibit exceptional capabilities and have evolved effective strategies to synthesize impact-resistant and damage-tolerant structures. One such example can be observed in the rapid mandible strikes ofOdontomachus monticola, a species of trap-jaw ants from the ponerine subfamily. During trap-jaw strikes, the mandibles can achieve peak speeds of 35.42 m s-1, and the maximum acceleration can reach 71 729 g within an average duration of 0.18 ms. The extreme acceleration results in instantaneous mandible strike forces that can exceed 330 times the ant's body weight, withstanding thousands of impacts. A natural impact-resistant fibrous helicoidal structure is found in the mandibles of trap-jaw ants. This microstructure is characterized by periodic modulus oscillations that increase energy absorption and improve stress redistribution, offering added protection against damage from impact loading. A carbon fiber reinforced helicoidal composite is fabricated based on the microstructure of the trap-jaw ant's mandibles. The results show that the helicoidal composite with a 12° helical-fiber exhibits higher residual strength, making it more capable of withstanding strong collisions. The catastrophic propagation of damage along the thickness direction is prevented by in-plane spreading and redirection of cracks. This research provides useful references for fabricating bionic impact-resistant composites.

Fin Whale (Balaenoptera physalus) Mortality along the Italian Coast between 1624 and 2021.

The Mediterranean Sea hosts a population of fin whale (Balaenoptera physalus), the only species of Mysticete regularly occurring in the basin. Observed and inferred mortality suggests that the population is likely declining. Accordingly, understanding the causes of mortality and assessing the health status is pivotal to the survival of this endangered population. While such studies are inherently difficult for a highly roaming species with a pelagic distribution, mortality events provide the opportunity to investigate biological and epidemiological traits linked to these events, and evaluate the footprint of human activity, especially when long-term data series exist. We present a comprehensive spatial-temporal overview of fin whale mortality events along the Italian coast encompassing four centuries (1624-2021). Time series analysis was used to highlight structural changes in the evolution of mortality through time, while spatial-temporal patterns in the distribution of mortality events were assessed through emerging hot spot analysis methods. Recent mortality events (1964-2021) were further explored to evaluate, where possible, the primary causes of mortality and to identify anthropogenic threats of conservation concerns. This long-term survey offers the basis for an understanding of the health status of this B. physalus population and provides much-needed information for developing an effective management and conservation plan for the species in the region.

Exploring the impact of health worker strikes on maternal and child health in a Kenyan county.

BACKGROUND: Studies of the impact of health care workers' strikes tend to look at facility-level activity rather than populations, with evidence from low and middle-income countries relatively sparse. This study explored the effect of national strikes on maternal and child health. It looked at the impact on health system activity in both public and non-public sectors (e.g. private, faith-based), on health promotion investments like immunisation, and on disease detection like post-partum haemorrhage (PPH). A 100 day doctors' strike started in December 2016, a 150 day nurses strike from June 2017 and then the clinical officers for 21 days that September. METHODS: Time series descriptive analysis of attendance data from the Kenyan Health Management Information System (public, non-public sector facilities). The setting was Kilifi, a coastal county in Kenya with a population of about 1.5 million. RESULTS: Along the care pathway from antenatal, postnatal and out-patient child health clinics, activity levels dropped markedly in the public sector with only partial compensatory increases in non-public sector activity. The number of fully immunised children fell during the nurses strike as did women seen with PPH during all strikes. These health care strikes caused significant adverse health impacts at the time and potentially inter-generationally as exemplified by the fall in antenatal haematinics supplementation and syphilis testing. Some post-strike ''catch-up" activity occurred, however this may have been too late in some instances. CONCLUSIONS: Policy-makers at national and county level need to ensure population health is protected at times of strikes and ideally resolve disputes without such action. Not to do so risks major negative effects on maternal and child health. Increased use of the non-public health sector could be done by the authorities in mitigation should strikes occur again.

The unintended consequences of hospital strikes on patient outcomes evidence from multiple strikes in the Portuguese National Health Service.

Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent. This paper analyses the effect of different health professionals' strikes (physicians, nurses, and diagnostic and therapeutic technicians (DTT) - DTT) on patient outcomes and hospital activity. Patient-level data, comprising all NHS hospital admissions in mainland Portugal from 2012 to 2018, is used together with a comprehensive strike dataset with almost 130 protests. Data suggests that hospital operations are partially disrupted during strikes, with sharp reductions in surgical admissions (up to 54%) and a decline on both inpatient and outpatient care admissions. The model controls for hospital characteristics, time and regional fixed effects, and case-mix changes. Results suggest a modest increase in hospital mortality limited for patients admitted during physicians' strikes, and a slight reduction in mortality for patients already at the hospital when a strike takes place. Increases in readmission rates and length of stay are also found. Results suggest that hospitals and legal minimum staffing levels defined during strikes are not flexible enough to accommodate sudden disruptions in staffing, regardless of hospital quality in periods without strikes.

Moomins Take the Floor. Finnish Trolls in Contemporary Mass Social (Media) Events.

Tove Jansson (1914-2001) was an outstandingly talented Finnish-Swedish artist, recognized worldwide mostly as the creator of the Moomins. Although the last of the nine-volume series (1945-1970) about the internationally popular Finnish trolls, Moominvalley in November, was published over fifty years ago, the Moomins' and Jansson's popularity is still rising, which testifies to the universality and timelessness of the books as well as the thoughtful marketing strategies of Moomin Characters Ltd, the company responsible for copyright supervision. In this article I discuss the Moomin characters' representation in three events set in contemporary (2017-2021), extratextual societal contexts, both strategically planned and co-organized by Moomin Characters Ltd and spontaneously organized by ordinary people. The motifs and figures from Moominvalley which have been applied in (1) the Invisible Child campaign, (2) the #OURSEA campaign, and/ (3) the women's strike protests in Poland are exemplified and juxtaposed with their literary images in the nine Moomin books by Jansson. My conclusion is that the references are based on a selective reading and focus on beneficial-in specific contexts-facets. On the one hand, it proves the Moomin books' versatility and topicality, while on the other, it is not inclusive and disregards the holistic message of the saga, which is an evolving continuum. Furthermore, this way of reading reinforces a single address of the unequivocally double-addressed series.

Hockey Puck Strike Rates and Injuries at National Hockey League Games: A Retrospective Analysis of Data from Six Seasons.

IMPORTANCE: This paper provides a large-scale, per-National Hockey League (NHL) season analysis of hockey puck strike (HPS) injury data and also provides estimates of injury frequency and severity. OBJECTIVE: The study's goal was to quantify and describe the rate and type of spectator HPS injuries at NHL games. DESIGN: This was a retrospective review of summary data reports for patients evaluated by on-site health care providers over six seasons (2013-2018). Data were obtained from a single Emergency Medical Service (EMS) agency. SETTING: Location of study was one US-based NHL venue. RESULTS: There were 51 HPS recorded. This accounted for 0.93% of total patient contacts translating to a patient per 10,000 (PPTT) of 0.116. This was compared to a PPTT of 12.6 for all patient contacts. The average age of a patron with a HPS was 31 years old. There was an even split between male and female patrons with HPS. The most common location for a HPS was the head or face (75%) followed by upper extremity injuries. Laceration was most frequently diagnosed followed by contusions and pain. Approximately one-quarter of people struck by hockey pucks were transported to the hospital, with the transport to hospital rate (TTHR) being 0.027, compared to the total TTHR of 2.7. CONCLUSIONS AND RELEVANCE: Hockey is a safe sport to watch, although HPS are the spectator hazard of concern given that pucks can travel into the stands at 100mph. Most injuries are minor and occur only one percent of the time; but when they do occur, these fans tend to need transport to the hospital. Finally, HPS tend to occur along the lateral sides of the rink where the glass level is lower and there is no protective netting.

Cases of Lightning Strikes during Mountain-Sports Activities: An Analysis of Emergencies from the Swiss Alps.

BACKGROUND: Lightning strikes are a risk during mountain-sport activities. Yet little is known about the prevalence of injuries related to lightning strikes during mountain hiking, backcountry skiing, or high-altitude mountaineering. This study therefore examined the occurrence and characteristics of lightning-strike-related emergencies during mountain-sport activities in the Swiss Alps. METHODS: We analyzed 11,221 alpine emergencies during mountain hiking, 4687 during high-altitude mountaineering, and 3044 during backcountry skiing in the observational period from 2009 to 2020. Identified cases were analyzed in detail regarding age, sex, the time of occurrence, altitude, location, the severity of the injury as quantified by its NACA Score (National Advisory Committee for Aeronautics Score), and injury pattern. RESULTS: We found no cases related to backcountry skiing. Eight cases of lightning strikes during mountain hiking (four female and four male) were identified. The mean age was 32.5 ± 17.5 years, the mean NACA Score was 2.5 ± 1.9, and the mean altitude was 1883.8 ± 425.7 m. None of these cases were fatal, and only one victim was seriously injured. Fifteen cases were identified during high-altitude mountaineering (four female and 11 male). The mean age was 38.7 ± 5.2 years, the mean NACA Score was 3.1 ± 2.5, and the mean altitude was 3486.4 ± 614.3 m. Two lightning strikes were fatal. In these two cases, rope partners were injured by a lightning strike (NACA Score = 4). Most cases were on relatively exposed terrain, such as the Matterhorn Hörnligrat or the Eiger Mittellegigrat. DISCUSSION: The typical victims were 30-40-year-old men. It is possible that the lightning strikes are a consequence of a lower risk aversion among these alpinists, which is be supported by the fact that most of the events occurred on famous mountains such as the Matterhorn or Eiger. Furthermore, since most of the locations were on relatively exposed terrain where one could not quickly find shelter, we recommend careful tour planning with serious consultation of the weather forecast and the likelihood of thunderstorms before climbing exposed sections to prevent emergencies related to lightning strikes.

A Semi-Analytical Solution for Shock Wave Pressure and Radius of Soil Plastic Zone Induced by Lightning Strikes.

A semi-analytical solution for forecasting the soil behavior induced by lightning strikes is of great engineering significance to calculate the radius of the soil plastic zone. In this paper, a simplified two-stage method is employed to solve the shock wave pressure and the radius of the soil plastic zone. The solution is verified against experimental data. Using the present model, the major factors dominating the shock wave pressure and the radius of the soil plastic zone are investigated. The results show that (1) the radius of the soil plastic zone (rp) induced by lightning decreases monotonically with cohesion (c) and internal friction angle (φ), while c has a better effect on soil properties than φ does; (2) increasing the initial radius of the plasma channel (ri0) can reduce the pressure (P) and increasing ri0 has a nonnegligible effect on rp; with ri0 increasing by 100%, the radius of the soil plastic zone increases by 47.9-59.7%; (3) the plasma channel length (L) has a significant influence on P and rp, especially when L is at a relatively low level; (4) the rp induced by lightning decreases exponentially with attenuation coefficient (a); (5) the wavefront time is a major factor while the half-value time is a minor factor for the shock wave pressure induced by plasma explosives.

(Re)shaping Amazon labour struggles on both sides of the Atlantic: the power dynamics in Germany and the US amidst the pandemic.

With the initial context of COVID-19 fuelling Amazon's exponential growth, this article investigates how the pandemic (re)defined labour struggles, i.e., cultivating labour's structural, associational and institutional powers in two case study countries, Germany and the US. By analysing these power resources in its two largest markets, I argue that Amazon's structural conditions by which it organises its warehouse labour, which predate the pandemic, have continued to act as obstacles to collective labour action. While in Germany, ver.di continues to mobilise its workplace power but has been unable to get Amazon to sign a collective agreement, the pandemic triggered unprecedented workplace mobilisations and the pursuit of associational power in the US, albeit with varying outcomes. Despite their different industrial relations systems and labour struggles, these two cases highlight the key role of shop-floor organising to put pressure on Amazon, while Amazon's continued rejection of unions as negotiating partners further underlines the importance of regulating Amazon's union-busting tactics.

Dans un contexte où la COVID-19 a alimenté la croissance exponentielle d'Amazon, cet article examine comment la pandémie a (re)défini les luttes syndicales, en soulignant son impact sur les pouvoirs structurels, associatifs et institutionnels des travailleurs dans les deux pays étudiés, à savoir l'Allemagne et les États-Unis. En analysant ces ressources de pouvoir sur les deux plus importants marchés d'Amazon, l'auteur fait valoir que les modalités structurelles de l'organisation de sa main-d'œuvre par Amazon dans les entrepôts d'Amazon, qui sont antérieures à la pandémie, ont continué à faire obstacle à l'action collective des travailleurs. En Allemagne, le syndicat unifié des services (ver.di) continue de mobiliser ses forces sur le lieu de travail sans parvenir à faire signer une convention collective à Amazon. Aux États-Unis, la pandémie a entraîné des mouvements de mobilisation sans précédent sur les lieux de travail, à la recherche d'un pouvoir associatif, mais avec des résultats inégaux. Malgré leurs différences en termes de systèmes de relations industrielles et de luttes syndicales, ces deux cas mettent en évidence le rôle clé de la mobilisation des travailleurs à la base pour faire pression sur Amazon ; quant au fait qu'Amazon continue de récuser les syndicats en tant que partenaires de négociation, il souligne l'importance de réglementer les tactiques antisyndicales de cette entreprise.