As US hospitals make the necessary shuffle to accommodate the current wave, I would like to remind leadership about the study done on the psychological status of frontline hospital workers during NYC's spring Covid surge (thread).

As expected, many participants reported stress, anxiety, and depression. But the study also looked into *what* exactly made participants feel distressed. https://t.co/ZHCbh10pBG
This graph is showing % of participants who found these factors "highly distressing." Note in the work environment section (blue) the number of things that rank higher than patient deaths.
These include:
- Perceptions of a lack of control and/or uncertainty
- Performing clinical work that is outside of your specialty
- The need/expectation for healthcare providers to provide social support to patients in lieu of their families (due to visitation restrictions)
- Difficult triage decisions or rationing of care (potential or actual) due to resource scarcity
- And also fears related to getting/transmitting Covid within the work environment - in particular, the uncertain Covid status of other healthcare providers
I bring this up because I think there are some good lessons here from Wave 1 for hospital leaders facing Wave 3.
First, if the #1 source of distress is loss of control and uncertainty, than people need as much control and certainty as possible. Transparency, minimal bullshit, problems stated clearly and promptly. More information is better.
Whenever possible, decisions should be made after engagement of multiple stakeholders, and with opportunity for feedback and changing course. We didn't always have time for that in Wave 1. But we had intervening months to learn better approaches in the period since.
Examples of pediatricians seeing adults, radiologists deployed to the ICU have been thrown out there as a signal for hospital system overload. I don't think we have really stopped to acknowledge how distressing it is to be asked to practice outside of your usual scope of work.
Hospital leadership needs to treat this like the very big deal it is, and provide concrete support for rapid skill development and psychological distress beyond "please watch these YouTube videos, phone a friend, you'll be fine."
HCWs at this point should know the range of resources they have to support patients who are isolated from their loved ones and also the processes and bodies that support triage / ethical decision-making in the setting of scarce resources.
But if they do not exist, if they are not sufficient, or if they are not sufficiently communicated, this needs to happen ASAP.
There are two other things I'd point out from the study. First, note how low the clinical hours worked was on the "highly distressed" chart. It's a concern, for sure, but not the main thing. I suspect it's more of an issue at this point in the pandemic...
...when people are exhausted in every sense. But I also think that this is something we amply talk about, because it's familiar and we know how to talk about it. I've gotten my share of "we know this sucks but it's what we gotta do for x reasons, here comes second back-up" ...
And I wonder if there's less severe distress because leadership tends to talk about it clearly and plainly and without the vagueness, avoidance, or insincerity that seems to be used around other topics (like PPE use, or practicing out of specialty, or triage decisions).
The other thing from the study is >60% of participants reported feeling a high level of purpose and meaning. I think of this a lot. Because that's something HCWs bring to the table, an asset that is in some ways hospitals' to keep or lose.
And I think the way you eff that up is actually related to all of the above. When employees are treated like children rather than trusted and respected partners in the work, when they are subjected to unsafe situations without a good faith effort to fix them...
Cheery declarations of "remember, we're all in this together" or wellness Zooms or downloadable apps have no hope to sustain morale.
Once again, I have spoken.

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#ज्योतिष_विज्ञान #मंत्र_विज्ञान

ज्योतिषाचार्य अक्सर ग्रहों के दुष्प्रभाव के समाधान के लिए मंत्र जप, अनुष्ठान इत्यादि बताते हैं।

व्यक्ति के जन्म के समय ग्रहों की स्थिति ही उसकी कुंडली बन जाती है जैसे कि फ़ोटो खींच लिया हो और एडिट करना सम्भव नही है। इसे ही "लग्न" कुंडली कहते हैं।


लग्न के समय ग्रहों की इस स्थिति से ही जीवन भर आपको किस ग्रह की ऊर्जा कैसे प्रभावित करेगी का निर्धारिण होता है। साथ साथ दशाएँ, गोचर इत्यादि चलते हैं पर लग्न कुंडली का रोल सबसे महत्वपूर्ण है।


पृथ्वी से अरबों खरबों दूर ये ग्रह अपनी ऊर्जा से पृथ्वी/व्यक्ति को प्रभावित करते हैं जैसे हमारे सबसे निकट ग्रह चंद्रमा जोकि जल का कारक है पृथ्वी और शरीर के जलतत्व पर पूर्ण प्रभाव रखता है।
पूर्णिमा में उछाल मारता समुद्र का जल इसकी ऊर्जा के प्रभाव को दिखाता है।


अमावस्या में ऊर्जा का स्तर कम होने पर वही समुद्र शांत होकर पीछे चला जाता है। जिसे ज्वार-भाटा कहते हैं। इसी तरह अन्य ग्रहों की ऊर्जा के प्रभाव होते हैं जिन्हें यहां समझाना संभव नहीं।
चंद्रमा की ये ऊर्जा शरीर को (अगर खराब है) water retention, बैचेनी, नींद न आना आदि लक्षण दिखाती है


मंत्र क्या हैं-
मंत्र इन ऊर्जाओं के सटीक प्रयोग करने के पासवर्ड हैं। जिनके जप से संबंधित ग्रह की ऊर्जा को जातक की ऊर्जा से कनेक्ट करके उन ग्रहों के दुष्प्रभाव को कम किया और शुभ प्रभाव को बढ़ाया जाता है।
1/ Some initial thoughts on personal moats:

Like company moats, your personal moat should be a competitive advantage that is not only durable—it should also compound over time.

Characteristics of a personal moat below:


2/ Like a company moat, you want to build career capital while you sleep.

As Andrew Chen noted:


3/ You don’t want to build a competitive advantage that is fleeting or that will get commoditized

Things that might get commoditized over time (some longer than


4/ Before the arrival of recorded music, what used to be scarce was the actual music itself — required an in-person artist.

After recorded music, the music itself became abundant and what became scarce was curation, distribution, and self space.

5/ Similarly, in careers, what used to be (more) scarce were things like ideas, money, and exclusive relationships.

In the internet economy, what has become scarce are things like specific knowledge, rare & valuable skills, and great reputations.