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Dynamics in the workplace are tumultuous. Downsizing within organizations is one strategy to adjust staffing to volumes. Survivor demoralization and loss of trust in the organization are the primary outcomes of organizational downsizing. These deep emotional responses to psychological contract breach/violation result in decreased organizational citizenship behavior, decreased organizational commitment, decreased productivity, and employees who desire to work elsewhere. A 72-year-old man with bilateral knee osteoarthritis treated elsewhe