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Ever since he contracted the coronavirus in mid-March, Jake Elsas, 53, has spent every waking moment feeling like hes had the worst sleep of his life. The kind of sleep where a person fitfully rolls around for hours and, once in temporary slumber, has nothing but anxiety dreams and nightmares. Tired and groggy and lethargic, the cobwebs in my head become an impermeable blanket. And thats on agoodday, said Elsas, who lives in Atlanta.

On anot-so-good day, he experiences a complete meltdown. Elsas says the exhausting crash (also known as a flare or post-exertional malaise) is brutal and terrifying. Hes theexecutive director of a nonprofit art and history center.

This was the sickest I have ever been in my life. My skin was really trashed. I looked gray, pallid and wrinkly, and felt like I had aged about 10 years in less than two weeks,

On top of brain fog, Elsas suffers from what he describes as a perfect storm of coughing, sweating and debilitating fatigue, now accompanied by ringing in his ears, or tinnitus.

And he is one of the lucky ones. As sick as he was with COVID-19, Elsas was never hospitalized, never on a ventilator, had no fever and had no trouble breathing, even at his worst.

Yet six months after falling ill, he still feels terrible.

Elsas is one of the so-called long haulers, also known as having long COVID or post-COVID syndrome. They experience persistent symptoms long after recovering from the acute phase, which often was relatively mild. Their recovery is erratic, with continuing and even new symptoms that fluctuate in intensity.

The Centers for Disease Control and Prevention (CDC) found that about a third of people with milder bouts of COVID-19 who hadnt been hospitalized hadprolonged illness and persistent symptomsfor weeks after contracting the coronavirus. On his nightly cable show, CNNs Chris Cuomo often talks of his own experience as a long hauler.

Related: A lung doctor on what shes learning about coronavirus long haulers

The COVID-19 Long-Hauler SymptomsSurvey Report,conducted by Natalie Lampert at Indiana University School of Medicine, surveyed more than 1,500 people from the online support groupSurvivor Corps.The most common symptoms were severe fatigue, muscle or body aches and respiratory issues, including shortness of breath or chronic cough. Many also reported fever, chills, hair loss, racing heart, palpitations and other symptoms.

A May 2020 patient-ledsurveyof 640 long haulers, done by theBody Politic COVID-19 Support Group,found that at the time of the survey, more than 90% had not yet fully recovered. Most of the respondents had not required hospitalization. The support group was started by journalist Fiona Lowenstein, a long hauler who contracted the virus in March at age 26.

A follow-up three months later found that the majority of individuals had symptoms 20 to 25 weeks after the initial illness. There was a surprising preponderance of neurological issues, with many experiencing brain fog, memory problems, headaches, insomnia and depression/anxiety.

Dr. Joan Bosco, a primary care physician at the Center for Post-COVID Care at Mount Sinai in New York City, found that in the patients she treated during a two-month period, fatigue was the number one presenting symptom, followed by shortness of breath, cognitive impairment, neuropathy (numbness/tingling), anxiety, nightmares and alterations in taste/smell.

Bosco notes that in the patients she has seen, Age hasnt seemed to factor into who will develop residual symptoms. I have seen previously healthy 20-year-olds who still cant get out of bed, and 70-year-olds who are back to their regular workout routines.

David Putrino, a neuroscientist at Mount Sinai Hospital,studied1,400 long haulers and found the majority are women, with an average age of 44.

More: Encouraging news for these long haulers

Early in the pandemic, Mark Smith, 67, a cinematographer in Jersey City, N.J., had COVID-19. This was the sickest I have ever been in my life. My skin was really trashed. I looked gray, pallid and wrinkly, and felt like I had aged about 10 years in less than two weeks, he says. Smith continued to test positive in June, indicating that his viral load was still high.

A racer and cyclist whohad prided himself on his strength and stamina,Smith found his major problems recovering were general weakness and fatigue, along with some COVID-19-related eye, neurological and possible clotting problems. COVID is not a cold, not the flu, not like anything Ive ever experienced, he says.

An August 2020articlepublished in the British Medical Journalstated that COVID-19 tends to affect older people more severely in the acute phase, as well as certain ethnic groups, including people who are Black, South Asian and Jewish.

The article says it is too soon to know if these disparities will persist in long haulers. Many patients, particularly older ones, have co-morbidities (other medical conditions such as diabetes or high blood pressure), which may influence the duration of their post-COVID-19 symptoms.

Cardiac problems such as myocarditis (inflammation of the heart), heart rhythm abnormalities and blood clots are seen more commonly in patients, often older, with pre-existing cardiovascular disease.

Bosco has been struck by how profound some of these COVID-19 residual symptoms are, especially the cognitive impairment and debilitating post-exertional (after activity) malaise.

While I do observe general trends and similarities among the symptomatic post-COVID patients, everyone seems to present with their own unique take or flavor, says Bosco.

She says this post-viral syndrome appears to have many complex factors with inflammation certainly playing a role, as well as physical deconditioning after a severe illness, worsened nutritional status, poor sleep and psychiatric stressors, among others. Given this, there is not a one-size-fits-all explanation or treatment plan.

Because many people did not get tested for the coronavirus, and because of the number of false negatives in those who were, a person can be a long hauler without ever having a positive coronavirus or antibody test.

This has led many patients to complain of medical gaslighting, or minimizing their symptoms. They point out that some health care professionals, and even friends and family, do not comprehend the severity of the post-COVID experience and blame it on anxiety or stress.

Some long haulers are beginning to show signs of a post-viral syndrome known as myalgic encephalomyelitis, also known as chronic fatigue syndrome. Its main feature is complete exhaustion after physical activity or cognitive overload, often worsening 24 hours after the triggering event.

Also read: Pandemic sets record case numbers across the U.S. as White House suggests the crisis is over

Because symptoms must be present for six months, doctors are just beginning to acknowledge that a cohort of patients may end up with this long-term, debilitating disorder.

Yet the news is not all bad. Bosco says one method that is persistently helpful to post-COVID patients is supervised exercise programs that include breathing and chest exercises as well as those that improve physical strength and stamina.

Smith recently ran past the Statue of Liberty from his home. While I still dont feel as good running as I did seven months ago, Iwasable to get out for that run, he says. I have done some hard races over the years and I have the mental framework to persevere. I am continuing to improve and to get my endurance and strength back. For that, I am thankful.

Barbra Williams Cosentino RN, LCSW, is a psychotherapist in Queens, N.Y., and a freelance writer whose essays and articles on health, parenting and mental health have appeared in the New York Times, Medscape, BabyCenter and many other national and online publications.

This article is reprinted by permission fromNextAvenue.org, 2020 Twin Cities Public Television, Inc. All rights reserved.

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'Brutal and terrifying,' and 'the sickest I've ever been in my life.' More COVID patients report symptoms that won't go away - MarketWatch

Dr. Alejandro Badia

MIAMI (PRWEB) November 04, 2020

Recent studies suggest injuries to the ulnar collateral ligament (UCL) in the elbow are rising, particularly among teenage baseball athletes 15-19 years old, and orthopedic surgeons, like noted hand-and-upper-limb-specialist Alejandro Badia MD, are sounding an alarm. They blame the increase on continued participation in year-round sports programs, heightened competitiveness, insufficient injury-prevention programs, and failure to teach proper body mechanics.

Even more concerning, the documented success of Tommy John surgery as the gold standard for reconstructing a ruptured elbow UCL in adults is often not appropriate for treating less severe UCL injuries in children, including those whose bones are still growing and developing. Yet, we have no long-term research showing what conservative, nonoperative approaches to UCL injuries can help young athletes maintain healthy, functional elbows now and in the future, especially if they intend moving on to professional sports careers, says Dr. Badia, founder and chief medical officer of the Florida-based Badia Hand to Shoulder Center and OrthoNOW and author of the new book Healthcare from the Trenches.

Experts agree. In a study published in the Journal of the American Academy of Orthopaedic Surgeons, authors write that the intensity of training and competition among young athletes can place them at increased risk of acute and chronic [musculoskeletal] injuries, which occur in patterns unique to the skeletally immature athlete. Prompt recognition and treatment of these injuries are critical to prevent long-term functional disability and deformity.

Dr. Badia also cites results of an American Orthopaedic Society for Sports Medicine survey of high-school baseball coaches, players, and their parents. In that survey, a significant percentage of respondents indicate being under the misguided belief that the number of balls thrown at high velocity by a pitcher is not associated with greater risk of UCL elbow damage. Some even suggest Tommy John surgery might be a welcome procedure because they think it improves a pitchers velocity and command.

The UCL is a system of three fibrous tissue bands on the inside of the elbow. One end of the band is connected to the upper-arm bone (humerus) and the other to the ulna on the pinky side of the forearm. The UCL complex plays a critical role in stabilizing the elbow joint, which is formed by the intersection of the humerus, the ulna, and a second forearm bone, the radius (on the thumb side).

Although a traumatic blow to the elbow or a fall on an outstretched arm can rupture the UCL, repeated stress on the elbow from overhead activities, such as throwing a baseball, spiking a volleyball or serving in tennis, is what usually causes the UCL to deteriorate over time, gradually fraying and tearing. In fact, a biomechanical analysis done of professional baseball pitchers and reported in 2016 finds the torque and force of a thrown ball on the elbow and shoulder are equivalent to five 12-pound bowling balls pulling down on [a persons] arm.

Symptoms of a partial or fully torn UCL include pain sometimes intense pain -- on the inside of the elbow when throwing, pain when accelerating the arm forward, and numbness or a tingling sensation in the pinky and ring fingers. The injury, however, does not normally interfere with other activities, including lifting, explains Dr. Badia.

Tommy John surgery named after the professional pitcher on whom the technique was pioneered in 1974 is performed as the reconstructive method of choice for a completely torn elbow UCL, according to Dr. Badia. The procedure involves taking a ligament from elsewhere in a patients body and then grafting it onto the elbow joint as a UCL replacement. The surgery is normally conducted in an outpatient setting and takes about an hour to 90 minutes to complete. The patient can go home the same day.

While experienced orthopedic surgeons are generally agreed on the optimal surgical approach to a ruptured UCL, Dr. Badia says a member survey taken several years ago by the American Shoulder and Elbow Surgeons (ASES) shows lack of consensus regarding non-surgical management of partial UCL tears and ligament strains, particularly in children, adolescents, and athletes who are not professionals. One approach gaining some traction has been injection of a patients own platelet-rich plasma (PRP). In the ASES survey, more than a third of respondents said they use PRP for some UCL injuries.

However, the jury remains out on the effectiveness of PRP, mesenchymal stem cells, and other orthobiologics, Dr. Badia says. For example, a study in the American Journal of Orthopedics concludes that PRP injections may be particularly beneficial in young athletes who have sustained acute damage to an isolated part of the [UCLM] ligament and in athletes unwilling or unable to undergo the extended rehabilitation required after surgical reconstruction of the ligament.

The ideal solution, of course, is to prevent UCL injuries in the first place, Dr. Badia says. He offers the following tips to athletes, coaches, trainers, and parents of young athletes:

Finally, should you, or your athletic son or daughter, develop elbow pain, especially when performing an overhead activity in your sport, do not ignore it. Contact an orthopedic specialist immediately to avoid further damage to the joint, Dr. Badia advises.

Bio: Alejandro Badia, MD, FACS, is an internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW, a network of walk-in orthopedic centers. Dr. Badia is the author of Healthcare from the Trenches. http://www.drbadia.com http://www.orthonowcare.com

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Hand and Upper Limb Orthopedic Surgeon Dr. Alejandro Badia Offers Tips to Stem the Increase in Elbow Injuries, Especially in Kids - PR Web

This will be part of the free-of-charge online Federalist Society convention:

MONDAY, NOVEMBER 9Religious LibertiesReligious Liberty and the New Court11:00 a.m. 12:15 p.m.

Prof. Stephanie Barclay, Associate Professor of Law, University of Notre Dame LawSchoolProf. Gerard V. Bradley, Professor of Law, University of Notre Dame Law SchoolProf. Eugene Volokh, Gary T. Schwartz Distinguished Professor of Law, University ofCalifornia, Los Angeles School of LawMs. Lori Windham, Senior Counsel, The Becket Fund for Religious LibertyModerator: Hon. Neomi Rao, United States Court of Appeals, District of ColumbiaCircuit

My understanding is that Prof. Barclay and Ms. Windham will be on the side of reading the Free Exercise Clause as securing a strong presumption of religious exemptions from generally applicable laws (i.e., applying the Sherbert v. Verner and Wisconsin v. Yoder approach to a wide range of laws), while Prof. Bradley and I will be on the other side (i.e., generally supporting Employment Division v. Smith). Ought to be fun as well as, we hope, enlightening.

Register for the webinars or watch the live streams at https://fedsoc.org/2020nlc.

CLE Instructions are at https://fedsoc.org/nlc-cle (payment is required to get CLE credit, but notif you just want to watch the programs).

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Federalist Society Panel on the Free Exercise Clause Next Monday (the 9th), 11 am to 12:15 pm Eastern - Reason

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Support staff and Black and Latinx hospital employees with and without patient care responsibilities are at highest risk for SARS-CoV-2 infection in health care settings, a Rutgers study found.

After screening 3,904 employees and clinicians at a New Jersey hospital between late April and late June for the SARS-CoV-2 virus and for lgG-antibodies to the virus, whose presence suggests past recent infection, the study, published in the journal Open Forum Infectious Diseases, found that these employees are at higher risk than previously thought.

"The risk to workers in health care settings with little or no patient contact has attracted relatively little attention to date, but our results suggest potentially high infection rates in this group," said lead author Emily S. Barrett, an associate professor at Rutgers School of Public Health and a member of the Environmental and Occupational Health Sciences Institute. "By contrast and to our surprise, physicians, nurses and emergency medical technicians showed much lower infection rates."

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Health care workers who live in highly impacted communities may have been susceptible to becoming infected outside of the hospital during the early surge of COVID-19, according to co-lead author Daniel B. Horton, an assistant professor at Rutgers Robert Wood Johnson Medical School and a member of the Institute for Health, Health Care Policy and Aging Research.

"In the early phase of the pandemic, support staff in the hospital may also have had less access to personal protective equipment or less enforcement of safety protocols," he said. "Going forward, as cases of COVID-19 in the hospital rise again, protecting these and all hospital workers from infection both in and out of the hospital is critical."

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In the hospital-based study, researchers found that 13 participants tested positive for the virus and 374 tested positive for the antibody, which suggests recent past infection nearly 10 percent of those studied and that Black and Latinx workers had two times the odds of receiving a positive test for the virus or antibody compared to white workers.

Phlebotomists had the highest proportionate rate of positive testsnearly 1 in 4 testedfollowed by those employed in maintenance/housekeeping, dining/food services and interpersonal/support roles. By comparison, positivity rates were lower among doctors (7 percent) and nurses (9 percent).

Regardless of whether the infections originated in the hospital or in the community, Barrett said, the results suggest a need to enact safety protocols for hospital employees to protect the health care workforce from future waves of infection.

"The 40 percent of infected health care workers who reported having had no symptoms of infection could be a potential source of SARS-CoV-2 spread in hospitals even if their infections were initially acquired in the community," she said.

The study was funded by the National Center for Advancing Translational Sciences and the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

Other Rutgers authors include Jason Roy, Weiyi Xia, Patricia Greenberg, Tracy Andrews, Maria Laura Gennaro, Veenat Parmar, William D. Russell, Nancy Reilly, Priyanka Uprety, John J. Gantner, Lydia Stockman, Stanley Z. Trooskin, Martin J. Blaser, Jeffrey L. Carson and Reynold A. Panettieri Jr.

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Hospital Support Staff at Higher Risk of COVID-19 than Thought - Patch.com

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When COVID-19 struck, the oncology community, along with health care systems across the globe, faced new challenges. Rutgers Cancer Institute of New Jersey in partnership with RWJBarnabas Health moved quickly to adapt to these new demands and made adjustments to operations in patient care to protect patients, their families and staff.

Andrew M. Evens, the associate director for clinical services and director of the lymphoma program at Rutgers Cancer Institute and the medical director of oncology services at RWJBarnabas Health, discusses the impact of the COVID-19 pandemic on cancer care.

What were the biggest adjustments that occurred to keep patients and staff safe?As New Jersey's only National Cancer Institutedesignated Comprehensive Cancer Center and the state's leading authority on cancer, experts at Rutgers Cancer Institute of New Jersey and RWJBarnabas Health know that cancer doesn't stop, and cancer care simply can't wait. Our primary concern is our patients, and even before COVID-19, we have been concerned about the risk of any patient with cancer contracting infection. We were tasked with meeting the ongoing needs of cancer patients and implementing safety guidelines so essential cancer treatments could continue.

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Several processes and guidelines for reducing the spread of the virus have been implemented at our facilities across the state to ensure that patients can continue to receive their cancer care. These include screening for COVID-19 symptoms upon entry, following strict social distancing measures, prohibiting most visitors, enhancing already rigorous cleaning and disinfecting practices, and mandating a mask or face covering for all patients, visitors and staff. Through these heavy precautions and screening measures, we have maintained a stable environment to continue providing exceptional care to patients throughout the pandemic.

To further promote social distancing, we have leveraged the use of our telemedicine program that we had established last year pre-COVID as a way to better provide opinions from our oncology experts to patients who might be hours away. Some patients might still feel uncomfortable coming into our facilities, so telemedicine has been a highly useful option for managing care and giving patients the assurances that they need during the pandemic, including for new patient consultations.

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How did COVID-19 impact treatment and surgery for cancer patients?Rearranging or delaying cancer treatment because of the coronavirus has remained a highly individualized decision. Cancer experts have an understanding of which cancers need immediate treatment depending on a patient's health, and have the knowledge to determine if treatment would outweigh the risk of the virus. In deciding whether to delay treatment, patients were encouraged to discuss a plan with their expert cancer care team. In New Jersey, surgical care for cancer patients continued during the pandemic. In adherence to all public health guidance and regulatory policies, we enhanced our safety measures to continue preforming essential cancer surgeries.

Currently, all patients are tested for coronavirus prior to undergoing any scheduled surgical procedures or prior to starting chemotherapy. Staff involved in surgical care are screened for exposure and tested for coronavirus as necessary prior to working in the operating room or being involved in a surgical procedure. Additionally, rigorous cleaning and disinfecting practices have been concentrated on surgical and recovery room spaces, frequently touched surfaces, exam rooms and computer terminals. Whatever we face in the coming months, our teams at Rutgers Cancer Institute and RWJBarnabas Health will continue to evaluate these safety practices in accordance with federal, state and local guidance.

How does COVID-19 impact access to cancer screening?At the start of the pandemic, other aspects of cancer care including screenings were put on hold to slow the spread of COVID-19 in healthcare settings, especially in areas of high transmission. Research has shown that new cancer diagnoses have declined, possibly due to delayed cancer screenings or delayed routine appointments. This has led to some cancers being diagnosed at later stages, which can present treatment challenges.

Healthcare facilities continue to schedule routine screenings. Cancer screenings remain important as they help to detect cancer at its earliest stages. We are continuing to communicate with the community that rescheduling your routine screening is safe at this time, and it is imperative to focus on overall health and wellness while continuing to stay committed to preventing the spread of the virus.

Has COVID-19 impacted research or enrollment in clinical trials?Cancer research globally has been impacted due to the pandemic. Across the world, research at cancer centers, academic institutions and within the industry was affected due to mandated procedural shifts, such as how many people were safely permitted inside a laboratory to conduct basic science research. In addition, restrictions also posed some limitations for clinical cancer research. However, Rutgers Cancer Institute did an outstanding job in maintaining enrollment on therapeutic clinical trials throughout the pandemic. Furthermore, Rutgers has designed and opened several clinical trials studying COVID-19, including in cancer patients.

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Its all about stigma. Philadelphia wants to enforce its laws against sexual orientation discrimination, while an agency that contracts with the city wants an exemption, rooted in free exercise of religion, so it does not have to give foster children to same-sex couples. The stigma of racial discrimination was raised at the argument before the Supreme Court in Fulton v. City of Philadelphia, which took place on November 4, 2020. The question is whether the Justices will see sexual orientation discrimination as similarly stigmatic to racial discrimination, or if they will think it is a good thing protected by religious freedom.

Justice Sonia Sotomayor mentioned the role of stigma in antidiscrimination laws. As she put it, the government has a compelling state interest in protecting against racial discrimination. The reason for a compelling state interest was not merely that race was important but that the burden on the people who are rejected because of race is an interest that the state could seek to protect. That a rejection on the basis of race or any protected category creates a stigma on that person, and its a compelling state interest for the state to have an antidiscrimination law on the basis of protecting classes. (emphasis added).

The compelling state interest question arose because Fulton examines the governments approach to sexual orientation discrimination, which is illegal. Justice Anthony Kennedy wrote about the dignity of same-sex marriage in Obergefell v. Hodges: There is dignity in the bond between two men or two women who seek to marry and in their autonomy to make such profound choices. Discrimination on the basis of sexual orientation in the context of employment law is prohibited by Title VII. Philadelphia ended its contract with Catholic Social Services (CSS) because CSS refused to give foster children to same-sex couples. Philadelphia law protects against such discrimination, and should protect against the stigma of discrimination against LGBTQs, which they have long suffered.

Questions about racial discrimination arose several times during the argument. Justice Elena Kagan asked if the compelling state interest test applied to racial discrimination, but not to other forms of discrimination, including gender and sexual orientation discrimination. The Solicitor General, arguing in support of Fulton, did not take a position on the other forms of discrimination, but did say the argument against racism was super compelling.

Justice Amy Coney Barrett asked Fultons lawyer what would happen if an agency opposed to interracial marriage wanted to do business with the city, and refused to give foster children to interracial marriages. Lawyer Lori Halstead Windham replied that the Court would use the strict scrutiny it has always used for racial discrimination, and not allow the exemption.

Justice Stephen Breyer asked the Solicitor Generals attorney Hashim Mooppan, who was arguing in support of Fulton, if he was saying We should write an opinion which says discrimination on the basis of race constitutionally speaking is different from discrimination on the basis of gender, on the basis of religion, on the basis of nationality, on the basis of homosexuality. . . . Is that the opinion you want us to write? The SGs answer was that race is unique.

Justice Sotomayor and others raised the question of what would happen if a contractor could discriminate, not only on the basis of sexual orientation, but if a different contractor wanted to exclude families from other religions or someone with a disability from consideration.

I wrote an amicus brief in this case supporting Philadelphia on behalf of Miguel H. Diaz, Ambassador to the Holy See, Retired; CHILD USA; Dignity USA; New Ways Ministry; the Womens Alliance for Theology, Ethics and Ritual; and the Womens Ordination Conference. Our brief explained that some religions long supported in the past and continue to support racial discrimination. Slaveholders invoked the Bible to support their activity, and much of society accepted the discrimination as a plan of God.

Fortunately the courts have repeatedly explained that racial discrimination is illegal, even when religions want to practice it. Religious organizations do not enjoy religious freedom to stigmatize people of color. We believe the same rule should apply to sexual orientation discrimination, which has long stigmatized LGBTQs wherever such discrimination occurs. The claimed religious need to discriminate against and stigmatize based on sexual orientation is no easier to defend than religiously motivated discrimination based on race. The believers can believe whatever they like and organize their affairs through discriminatory purposes, to be sure, but not when the government is paying and not when the public is impacted.

And that is the beauty of Employment Division v. Smith, the free exercise case that is at stake in Fulton. Smith says everyone has to obey neutral laws of general applicability, without religious exception, as the lower courts said Fulton should do here. Smith protects us from a world in which, once Fulton gets its exception, other contractors get theirs. Fulton can discriminate on the basis of sexual orientation? And then someone else will want to favor one religion over others. Or one gender over another. And so forth. Some of the Justices pointed out all the kinds of discrimination that could occur once one type is allowed. Unfortunately, Fulton and others would like Smith overruled so that they get more religious freedom to discriminate with city funds as a contractor for the government.

The litigants and Justices raised the worry that fewer children will be assigned to foster parents, and great harm is being done by keeping CSS out of the program. Neal Kumar Katyal, Philadelphias lawyer, explained that studies from around the country show that nondiscrimination programs increase, not decrease the number of people available to care for foster children because it opens them to people who had previously been excluded. And new studies suggest that more, not fewer, parents became available when religious agencies closed in Boston and elsewhere.

At the end, Jeffrey L. Fisher, Child Advocates lawyer with Philadelphia, addressed a question from Justice Barrett, who said the law would not really allow an exemption for racial discrimination. Mr. Fisher responded that in the context of this case there was no difference between gender and sexual orientation discrimination and racial discrimination in terms of exemption.

I wait to see what the Court will decide, and hope it will rule against stigma!

Link:
Stigma and the Oral Argument in Fulton v. City of Philadelphia - Justia Verdict

NEW BRUNSWICK, NJ Election Day 2020 is here! You cannot machine vote at the polls on Nov. 3 unless you have a documented disability.

Even if you go to to your regular polling place to vote, you will only be able to vote via a provisional ballot (paper ballot) and they count provisional ballots last, after all the mail-in and machine votes have been counted. County clerks across New Jersey have said the best way to vote is drop your sealed ballot in a ballot drop box Don't forget to sign it.

Middlesex County put ballot drop boxes in New Brunswick in two locations:

Ballot drop boxes are collected and returned directly to the Middlesex County Board of Elections office. These ballots are only handled by designated Board of Elections representatives.

If you are mailing it, you must put the ballot in the mail today so it is postmarked Nov. 3.

Residents can either cast a write-in vote or choose, among the major parties, between Republican President Donald Trump and Vice President Mike Pence, or Democratic former Vice President Joe Biden and US Sen. Kamala Harris. Also running are: Don Blankenship/William Mohr (Constitution Party); Howie Hawkins/Angela Nicole Walker (Green); Jo Jorgensen/Spike Cohen (Libertarian); Gloria La Riva/Sunil Freeman (Party for Socialism and Liberation); Roque De La Fuente/Darcy Richardson (The Alliance Party) and Bill Hammons/Eric Bodenstab (Unity Party).

Congress: One U.S. Senate seat is up for vote: Incumbent Democrat Cory Booker will face Republican Rik Mehta.

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Voting In New Brunswick: Everything You Need To Know - New Brunswick, NJ Patch

COVID-19 can do some pretty scary things to the human heart. It can trigger blood clots in severe cases and cause inflammation and scarring.

New research now shows that even young people with COVID-19 who are asymptomatic are at risk for developing potentially dangerous inflammation around the heart.

I am an imaging cardiologist who is developing diagnostic techniques to assess changes in heart muscle function in patients with COVID-19. In a study released Nov. 4, my colleagues and I found evidence of heart abnormalities in over one-third of student athletes who tested positive for COVID-19 and underwent cardiac screening at West Virginia University this fall.

While we didnt detect ongoing damage to the heart muscle itself, we frequently found evidence of inflammation and excess fluid in the pericardium, the sac around the heart. Almost all of the 54 students tested had either mild COVID-19 or were asymptomatic.

Based on our results and other studies, a group of experts convened by the Journal of the American College of Cardiology: Cardiovascular Imaging has also published a list of recommendations for heart testing and recovery times before student athletes return to play.

An important takeaway: Student athletes who test positive for COVID-19 should consult their primary care physicians to determine if heart screening tests are needed even if they never showed symptoms.

There is still a lot we dont know about COVID-19 and its lingering effects on the human body.

SARS-CoV-2, the coronavirus that causes COVID-19, can cause a mind-boggling array of damage, including triggering inflammatory responses in the heart muscle and surrounding tissue as the body tries to fight it off. As many as 1 in 8 hospitalized COVID-19 patients have some form of heart damage.

What we worry most about with competitive athletes is whether the virus can get into the heart muscle and trigger myocarditis, rare inflammation of the heart muscle that can be caused by viral infections. Myocarditis can disrupt your hearts ability to pump blood and cause arrhythmias. It can also cause sudden heart failure in athletes who seemed healthy. If you have myocarditis, you should not be on the field or in training until well after you recover.

A small number of college athletes with COVID-19 are known to have been diagnosed with myocarditis. In one study, Ohio State University doctors tested 26 college athletes in September and found signs of heart inflammation consistent with myocarditis in four.

Myocarditis isnt the only heart problem to worry about, however. Sports doctors for years have warned that athletes who develop pericarditis should not return to play until it resolves.

At West Virginia University, my colleagues and I examined 54 student athletes who had tested positive for COVID-19 three to five weeks earlier.

We didnt find convincing signs of ongoing myocarditis, but we did see a lot of evidence of pericarditis. Among the student athletes screened, 40% had pericardial enhancement, suggesting resolving inflammation in the sac that protects the heart, and 58% had pericardial effusion, meaning excess fluid had built up.

Usually, this kind of inflammation heals within a few weeks with no residual effects. However, in some cases, there can be long-term effects, like pericardial inflammation recurring. It can lead to scarring of the pericardial sac, which in rare cases can be severe, and the pericardium can constrict around the heart. This can lead to symptoms similar to heart failure and cause congestion in the lungs and liver.

Its difficult to predict if a patient will develop any of these rare long-term complications, and its too soon to tell if its happening.

Currently, athletic programs around the country have a patchwork of rules for quarantining and screening COVID-19-positive athletes for heart damage as they try to balance players health and the desire to return to play.

To help them develop standards, I and other cardiologists from the U.S., Canada, U.K. and Australia reviewed the current evidence and wrote an expert consensus statement. A similar statement focused on myocarditis was published by some of the same doctors in JAMA Cardiology.

We suggest the following:

Any student athlete testing positive for COVID-19 should follow quarantine rules and avoid exposing their teammates, coaches or anyone else to the virus.

Before returning to play, athletes who test positive for COVID-19 should consult with their physicians to determine if heart screening tests are needed. Although routine testing is not recommended for all asymptomatic individuals, a physician should determine on an individual basis when the risks are high enough.

If an athlete has active myocarditis, we recommend no competition or strenuous training for three to six months, with follow-up exams with a cardiologist. Exercise can worsen the diseases progression and create arrhythmias, or irregular heartbeat. After that period, the athlete can gradually resume exercise and play if he or she has no lingering inflammation or arrhythmia.

If an athlete has active features of pericarditis, we also recommend restricting exercise, since it can exacerbate inflammation or cause inflammation to return. Athletes should avoid competitive sports during the acute phase. Once tests show no inflammation or excess fluid, the athlete should be able to return to play.

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COVID-19 is no joke. The best way for athletes to stay healthy so they can keep playing sports is to avoid getting the coronavirus in the first place. Teams should test student athletes for the virus and make sure those who test positive see a doctor to determine if screening tests for heart damage are needed.

Read more:
Even if you're asymptomatic, COVID-19 can harm your heart, study shows here's what student athletes need to know - The Conversation US

Army veteran, proud New Yorker, eager to make a lasting social impact.

Hometown: Queens, New York

Fun Fact About Yourself:Last year, I convinced my family to do the Coney Island Polar Bear plunge with me. Afterward, Telemundo asked me for a soundbite on what draws people to continuing the annual tradition of taking a plunge in the bay on New Years Day.

Undergraduate School and Major:

United States Military Academy at West Point

B.S. in Defense and Strategic Studies

Most Recent Employer and Job Title:

U.S. Army

Military Intelligence Company Commander

Aside from your classmates, what was the key part of the schools MBA programming that led you to choose this business school and why was it so important to you? I chose to attend Stern primarily because of its location in the heart of New York City and its focus on IQ + EQ. Stern capitalizes on its location by offering its students opportunities to become immersed in and learn from NYC-based businesses. The schools Stern Solutions experiential learning opportunities and Stern Consulting Corps empower MBA students to solve complex business problems during the semester with esteemed Stern professors help.

What makes you most excited about getting your MBA at NYU Stern? What makes you most nervous? I am most excited about joining the Sternie community. Sterns vast alumni network in NYC has already opened many doors for me. I am most nervous about being a valued contributor considering most of my classmates are incredibly accomplished. Several have years of experience working for prominent firms.

What club or activity excites you most at this school? The Military Veterans Club. Both former and current veterans at Stern were welcoming even before I was officially accepted. I am excited to have a community of people I can lean on and who have a better understanding of what it is like to transition from the military to business.

What word best describes the NYU Stern classmates youve met so far? Why? Trailblazers. My classmates come from all walks of life, but they have one thing in common: they have been agents of change in their previous companies and organizations. Sternies are not afraid to chart their own path, and that mentality is apparent in the conversations we have on a daily basis.

Describe your biggest accomplishment in your career so far: In my last job as a military intelligence company commander, I led a team of 130 soldiers during a training exercise. My company outperformed other intelligence companies in the Army that had gone through the same training exercise. During the 14-day training exercise, our success set new metrics for other intelligence companies in the Army to be graded against.

In preparation for that validating exercise in Louisianas swamps, I developed new systems, implemented a culture change within the company, and redesigned the companys structure to be more decentralized. During the training exercise, we were able to validate a data collection platform in a short period in part because of the new decentralized company structure that allowed my soldiers to be more effective by working in small, symbiotic virtual teams. We also utilized a new virtual cloud system. My company was the first to successfully implement that type of system in a tactical environment during this validating training exercise. I am proud of what my company accomplished because that training exercise was the culminating event of several lines of effort that took months to develop and refine. My companys accomplishments contributed significantly to my brigades overall success during that training exercise.

What led you to pursue an MBA at this point in your career? After serving in the military for eight years, I decided it was time to take the skills I had learned leading teams of soldiers and use those skills to optimize civilian organizations. As a military officer, I enjoyed figuring out ways to help teams accomplish specific objectives. Although there are valuable lessons drawn from the military context, managing a civilian organization is a bit different. Getting an MBA is the first step in bridging the gap between my military experience and my goal of managing and optimizing organizations in the corporate world through personnel and group management.

What other MBA programs did you apply to? Columbia Business School, Georgetowns McDonough School of Business, Vanderbilts Owen School of Management, Rices Jones Graduate School of Business

What was the most challenging question you were asked during the admissions process? The standard Tell me about yourself was the most challenging question to answer. Where do you start with a question like that? What aspect of your life do you focus on? For me, there was the additional challenge of removing military jargon from my vocabulary. After almost a decade of being indoctrinated to speak a certain way and to use specific terminology, it was challenging to break myself of certain speech habits.

How did you determine your fit at various schools? It was important to me to attend a school located in an urban area, primarily because of the increased opportunities to network with a broader range of companies and with individuals from diverse backgrounds. Returning to NYC was particularly appealing because I know the area and my family is here.

What have you been doing to prepare yourself for business school? Among the first things I did when deciding to apply to business school was reflect on my weaknesses. I commissioned into the military immediately after college, so I had no experience working in a civilian organization. I decided to intern with Amazon as a manager in their operations department while I transitioned out of the military through the U.S. Chamber of Commerce Foundations Hiring Our Heroes Program. That experience gave me a glimpse into the cultural and structural difference of working for a civilian organization. It also helped me better explain during the application process how my military experience taught me skills that are transferable to a corporate organization.

What was your defining moment and how did it prepare you for business school? I was a newly-trained intelligence officer during my first deployment to Kandahar, Afghanistan. No training could genuinely prepare me for the challenges of serving as an intelligence officer in that environment, where I was expected to interface with various stakeholders to accomplish mission objectives and help keep US Soldiers safe. I learned to be resilient in almost any stressful situation during that deployment and how to effectively analyze what sometimes felt like an insurmountable amount of data.

On the aircraft back to the US, I reflected on how fulfilling and effective it was to use data to drive strategic change. My time in the military as an intelligence officer has prepared me to tackle business school because I now have a robust foundation of essential skills, including problem-solving, data analysis, and resiliency.

What is your favorite Company, and what could business students learn from them? Besides the United States Army, the company I admire the most is Amazon. Amazons ability to implement an expeditious operation tempo, continuously innovate and expand, and empower its employees through a commitment to 14 leadership principles is impressive.

DONT MISS: MEET NYU STERNS MBA CLASS OF 2022

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Meet the MBA Class of 2022: Josue Gonzalez, New York University (Stern) - Poets&Quants

Interested in setting up a place to work out in your home so that you can keep yourself moving without having to deal with the crowd at your local gym? You may want a treadmill. Treadmills are an easy to use, effective tool toward achieving your cardio goals, losing weight, and improving your mobility. They can be set to a variety of automated workout programs or operated manually at a pace that challenges you, but does not overwhelm you.

The best treadmill for your home gym will depend on available space in your home, the type of workouts you prefer, and whether you would rather have a motorized treadmill or a manual treadmill. You could also look for added features like WiFi or Bluetooth connectivity, or built-in speakers. Take a look at some of the top products below that have been selected based on product efficacy and overall value.

Treadmills can be separated into two main types based on whether they are manually operated or if they are motorized.

Manual treadmills are not plugged into an electrical outlet, which means you wont have to worry about tripping over a power cord. However, it also means that the belt is completely powered by you. Due to this manual driving force, you will actually expend more energy on a manual treadmill than you do on a motorized treadmill.

Manual treadmills are less expensive and also safer than motorized treadmills because they stop when you stop. The drawback to manual treadmills is that you miss out on a lot of automatic features that can set your incline or decline, control your speed, connect to WiFi or Bluetooth, and even display an interactive guided workout on an electronic screen. Manual treadmills are also typically less sturdy, making them a poor choice for heavier users and runners who put a lot of force into the frame of the treadmill.

Motorized treadmills are the most commonly used version of this exercise tool because they are made with a number of conveniences to help make your workout more enjoyable and effective, though they do have a higher price tag. These treadmills operate on electricity, so once you have it plugged in and turned on you can use the electronic controls to choose an exercise program, set a speed, or set an incline.

Depending on the machine, there can be relatively few or many different workout customization choices, giving you the ability to set a unique workout every time you step on the treadmill. Despite these benefits, motorized treadmills do have safety concerns because the belt does not stop when you stop. This means that it could propel you off of the surface at a high speed. However, most treadmills have a safety line, also known as a safety key or safety cord. It simply attaches from the machine to your clothing and if you move too far away, it will pull out of the machine turning it off, keeping you safe. It is important to follow all of the safety guidelines recommended by the treadmill manufacturer.

Before choosing the best treadmill for your home gym, take a few minutes to educate yourself on the most important shopping considerations.

The amount of available space you have in your home is an important factor that you need to determine before beginning to look for a new treadmill. You will want to use a tape measure to get the exact length, width, and height of the space where you intend to set up your treadmill.

Typically, a treadmill will measure about 7 feet long and 3 feet wide, but compact treadmills reduce the overall size of the machine and can be as small as 4 1/2 feet long and 2 1/2 feet wide. Folding treadmills fold the length of the machine up and out of the way when not in use, so you dont have to dedicate that floor space at all times, only when in use. Folding treadmills can also reduce the size of the machine by allowing you to fold down the controls for storage, or even for a more open running experience.

The majority of motorized treadmills come with a range of preset workout programs that are designed to target areas of improvement by increasing or decreasing the speed, resistance, and incline of the treadmill while you exercise. This mimics the natural resistance runners face when their path takes them over hilly terrain.

Beginners may want to use a basic cardio program, but as your level of experience increases you can get a great benefit from using some of the more advanced features that allow you to work on specific muscle groups using targeted movements.

Some treadmills even offer a guided workout program with a pre-recorded or live trainer leading you through a series of challenges to ensure that you get the best result from your time on the treadmill.

A motorized treadmill has an internal motor that provides energy to move the belt. This may seem like a small power output, considering you could move the belt along with your hands or feet, like you would on a manual treadmill. However, this motor must also move your weight as you stand, walk, jog, or run on top of the belt.

The power output from the motor is typically measured in horsepower (HP), with an average range of 2-HP to 4-HP. You can use the type of movement you will be doing as a general framework for deciding on a power output. If a 200-pound individual is primarily using the treadmill for walking, then they will be fine with a 2-HP motor, for jogging they should increase to at least a 2.5-HP motor, and if they will be running more than any other type of movement then they need a 3-HP motor.

However, keep in mind that as the weight on the treadmill decreases, the motor does not need to work as hard, so smaller individuals may not need 3-HP to run all the time. The inverse is also true, meaning that a 300-pound person will require a higher horsepower motor to experience the same belt movement speed and resistance as a 200-pound person.

On a manual treadmill the speed is set by your pace, so if you slow down or speed up then the pace belt will increase or decrease in speed to match your efforts. These treadmills may also have an incline option that allows you to raise the angle of the belt to simulate moving up an incline. However, manual treadmills with this option must have the incline manually set by getting off the treadmill and lifting it up into the proper position and locking it in place.

Motorized treadmills frequently have an incline control on the electronic control panel that can be set before your workout, during, or even programmed to automatically adjust so that you get a unique experience every time you work out. Speed on a motorized treadmill is set at the control panel or automatically controlled by a preselected exercise program. The average maximum speed ranges from 8-MPH up to 12-MPH, with most users only needing a max of 8-MPH.

Treadmills are designed to support a lot of weight and impact as your entire body weight comes down hard on the flat surface while you run. To ensure that users are being safe while they work out, manufacturers list a maximum recommended weight capacity to inform you of the capabilities of the product. If you know that you or another person that will regularly use the machine is heavier than the weight capacity of the treadmill, do not choose that product as it will break or wear out much faster than an appropriate model.

On average, treadmill weight capacities will range from about 200 pounds to 400 pounds, with the price increasing as the weight capacity increases. To ensure that you get a treadmill that is right for your weight you should look for a product that can handle about 50 pounds more than you weigh. Not only does this give you a little space if you put on five pounds at Thanksgiving, but it also puts less strain on the motor, which extends the life of the machine.

Manual treadmills dont normally come with many safety features, though the manually driven belt can be considered a safety feature on its own. When you work out with a manual treadmill and slip or fall, the belt wont propel you down onto your backside. Instead, the belt stops relatively quickly without your momentum to push it backwards, allowing you to regain your footing.

Motorized treadmills do have powered belts that can throw you if you slip or fall, so consider choosing a model with a safety line or support rails. A safety line is your emergency stop button. One side attaches to your clothing and the other connects to the treadmill. If you slip or fall, causing the safety line to detach from the machine, the power to the belt is turned off and it comes to a stop so that you are not thrown. Support rails can also help you keep your footing if you slip while running or jogging, though these may impede the swing of your arms. Due to this drawback, support rails are a better option for walkers who may need the rail to maintain their balance.

Treadmills have developed alongside the other technological advances in the world, allowing them to be built with a wide array of additional features that make your workout more effective and enjoyable. Many models have digital displays, guided workouts, Bluetooth and WiFi connectivity, headphone inputs, and cup holders.

The products below were chosen for quality, price, and features to help you find the best treadmill for your home gym.

Photo: amazon.com

The Sunny Health & Fitness Smart Treadmill is a great option for your home gym with built-in speakers, a device holder for your phone or tablet, and Bluetooth connectivity. The motorized treadmill also has a media port that you can use to play MP3s, talk on the phone, or connect your headphones. It has a top speed of 8-MPH, a horsepower of 2.2, and a maximum weight capacity of 250 pounds.

The treadmill measures 64.5 inches by 28 inches by 50.5 inches and it can be folded up and transported on a pair of wheels for easier mobility. The electronic control panel has a digital display to show time, speed, distance, calories burned, and even your heart rate if you are holding the hand pulse sensor handles. It also gives you the option to choose between 12 workout programs and 12 incline levels and comes with a safety line so that you can set the difficulty of your workout to meet your current abilities without worrying about danger if you fall.

Photo: amazon.com

If you want to outfit your home with a new motorized treadmill, but you dont need a premium model, this treadmill comes with many amazing features at an affordable price, like 15 workout programs, a phone or tablet holder, and a white LED display. The display gives you up-to-date information on your calories burned, distance, time, speed, and heart rate, which is tracked with pulse sensors in the handles.

The treadmill can be folded up and moved on the built-in transportation wheels so that you can store it when it is not in use. The entire treadmill measures 54 inches by 28 inches by 45 inches and it has a 2.5-HP motor with a maximum weight capacity of 220 pounds and a max speed of 8.5-MPH. The incline can be adjusted manually to one of three different levels, but it is the control buttons on the safety handles and the emergency stop that make this treadmill ideal for safety-conscious individuals.

Photo: amazon.com

This Nautilus motorized treadmill has a high price, but what you get may be worth the extra cost. The electronic control panel on the treadmill has 26 customized training programs including interval training. When you want to train on your own you can use the heart rate monitoring and weight management features. When you want to connect, it can sync with multiple fitness apps including the Nautilus Trainer and Run Social app so you can train with many different people from across the world in real time.

The treadmill comes with Bluetooth connectivity and a blue backlit LCD display so you can reference your speed, calories, and other fitness information while you work out. This machine has a powerful 3.5-HP motor, a max speed of 12-MPH, and a weight limit of 350 pounds. It measures 78 inches by 37.6 inches by 62.8 inches and has a motorized incline that can be set up to a 15-degree incline, to really challenge your limits.

Photo: amazon.com

Setting up a home gym can take up a lot of room, but with a folding treadmill like the XTERRA Fitness Folding Treadmill, you can quickly regain some floor space by folding it when you are done working out. Unfolded, the motorized treadmill measures 63.4 inches by 28.8 inches by 51.4 inches, but when it is folded you only need to worry about storing a machine that is 28.5 inches by 28.8 inches by 61 inches. The built-in wheels allow you to move it to a nearby closet or any other storage space.

The treadmill has a 2.25-HP motor, a 250-pound weight capacity, and a maximum speed setting of 10-MPH. The handles have speed controls so you dont have to let go to reduce or increase your speed. There are also pulse sensors in the handles to track your heart rate. With this treadmill, you get an LCD display with 12 workout programs and real-time information on your speed, time, distance, calories, and your current incline which can be manually set to one of three levels for a customized workout.

Photo: amazon.com

Deciding to hop on the treadmill every day to get your workout can be challenging when you exercise on your own, but with the NordicTrack T Series Treadmill you get the iFit Coach program free for a 30-day trial, but to continue with this customized feature you need to pay a monthly subscription fee. With this program, you get a trainer-led workout that is set and controlled in real time by the iFit trainer to adjust your incline and your speed up to 10-MPH.

The five-inch backlit screen on the control panel displays your prominent workout information like speed, plus heart rate if you are holding the pulse sensor handles. The motorized treadmill measures 73.5 inches by 36 inches by 54 inches, and it has a 2.6-HP motor and a 300-pound weight capacity. When you are done working out, just fold up the treadmill for simple storage.

Photo: amazon.com

Apartment and dorm living can leave you with a very small amount of space to exercise at home, but with the Goplus motorized treadmill, you can fold the LED display down to the sides for a completely flat running surface that doesnt take up vertical space. You can still control your workout with the included remote that fits easily in your hand while you walk, jog, or run. The treadmill measures just 52 inches by 27 inches by 5 inches when it is folded or 49 inches by 27 inches by 42 inches when unfolded.

When the treadmill is folded it only operates in walking mode, preventing you from going higher than 2.5-MPH. It has built-in speakers and Bluetooth connectivity to listen to your music hands-free while you work out. The treadmill has a 2.25 HP motor, with a top speed setting of 8 MPH and a maximum weight capacity of 265 pounds, making it a great choice for small spaces, and ideal for larger individuals.

Photo: amazon.com

The ProGear 190 Manual Treadmill gives you the opportunity to work hard by relying on your own physical power to drive the treadmill belt, instead of using electricity. The manual treadmill has long safety handles that are padded with easy-to-hold foam grips, and because there is no electricity you wont have to worry about being thrown from a motorized belt if you stumble.

The treadmill has a weight capacity of 230 pounds, folds up for convenient storage to a size of 21 inches by 23 inches by 51 inches, and measures 47 inches by 23 inches by 51 inches when unfolded. Even without a power cord you can track your workout time, distance, calories burned, and speed with the battery-powered LCD display, and you can manually set the treadmill to one of two incline levels to change your workout.

Before investing in a new treadmill, take a look at these frequently asked questions and their answers below.

The Centers for Disease Control and Prevention (CDC) suggest running for 75 minutes per week is beneficial for most healthy people. However, if you engage in regular exercise then you understand the importance of rest days to allow your body to recuperate. This means you could run for 15 minutes per day, five days a week to hit this goal while also taking two necessary rest days. Healthy individuals can engage in more exercise than this, however, those with pre-existing conditions need to take caution. When in doubt, consult a medical professional.

The CDC suggests that if you are walking instead of running for aerobic activity, then you should walk for about 150 minutes every week. This allows you to separate your workout goal into a 30-minute interval per day, for five days each week.

Treadmills can be bad for your knees, but only if you are not using them properly. While the recumbent exercise bike is recommended for people with bad knees, the padded surface and built-in weight absorption of a treadmill is much better for your knees than hard concrete. However, running on any type of a hard surface will cause some strain to your joints, so ensure that you move at an appropriate pace for your experience and health level, taking breaks when necessary.

If the belt on your treadmill is sticking or out of place then there are a few different things you can try to fix the belt yourself, before you should call in a repair technician.

If these fixes do not work, then you may need to hire a repair technician to replace the belt or to address issues that could be occurring with the speed sensor.

Keep your treadmill clean by following these easy steps.

Read more from the original source:
The Best Treadmill Options for the Home Gym in 2020 - BobVila.com

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