Who Will Take Care of Me?

Foreseeing the needs and availability of anaesthesiologists across Europe is a challenging task. This is influenced by different factors that include the composition of the workforce and the organization and structure of health services in every country. Some trends call for attention, such as changes in work patterns brought about by an ageing specialist population, the increasing numbers of women in anaesthesia, or cultural and societal shifts towards work-life balance. Anaesthesiology is a challenging specialty with an expanding scope of practice, requiring highly motivated professionals, frequent long work hours, and addressing stressful situations often. To ensure quality anaesthesia provision, the wellbeing of this diverse population of anaesthesiologists should be addressed. Achieving rational and flexible work hours, adequate compensation, and promotion of a workplace culture that fosters safety, motivation to learn, and equal opportunities for leadership or academia positions are challenges to be addressed to make sure that excellence in patient care is maintained.

COVID and Counseling

Due to the COVID-19 crisis, the mental health profession has shifted to online service provision, or telehealth. The aim of this chapter is to describe the COVID-19 crisis and subsequent changes that occurred to mental health service provision; the benefits and drawbacks to telehealth from practical, ethical, and cultural perspectives; and the learning opportunities that have come from this crisis. Finally, reflections on the future of the counseling profession and trends in service provision for serving an increasingly diverse population will be analyzed.

Attitudes of Society Towards People With Neurodevelopmental Disorders

Social acceptance and inclusion of people with neuro-developmental disorders is challenging. Though each human being is unique, the world population can be segregated into two groups: neuro-typical and neuro-diverse people who have conditions such as autism spectrum disorder, cerebral palsy, learning disabilities, ADHD, and several others. The neuro-typical population claims to be accepting of the neuro-diverse population, but some case studies show that it may sadly not be true. Life can be bewildering and confusing for a person with disabilities. Dealing with so many aspects can be daunting and frustrating for them and their families. Social attitude is a significant factor as the Pwd navigates the harsh world of discrimination and social abandonment and faces barriers where support, guidance, and services are required. Many go through painful journeys and come out stronger and wiser, but bitter as well. Others have had better support. This chapter is a collection of experiences of some Pwd and their families and a list of solutions to the different challenges they encounter.

Post-Mastectomy Patients in an Urban Safety-Net Hospital: How Do Safety-Net Hospital Breast Reconstruction Rates Compare to National Breast Reconstruction Rates?

Background Breast reconstruction (BR) has documented psychological benefits following mastectomy. Yet, racial/ethnic minority groups have lower reported rates of BR. We sought to evaluate the rate, type, and outcome of BR in a racially and ethnically diverse population within a safety-net hospital system. Methods All patients who underwent mastectomy between October 2015 and July 2019 at Harbor-UCLA Medical Center were retrospectively examined. Rates and type of BR were analyzed according to patient characteristics (race/ethnicity, age, and body mass index), smoking status, cancer stage, and presence of diabetes mellitus. Breast reconstruction outcomes were also assessed. Results Of the 259 patients that underwent mastectomy, 87 (33.6%) received BR. Immediate BR was performed in 79 (30.5%) patients and delayed BR in 8 (3.1%). Of the 79 patients with immediate BR, 58 (73.4%) received implant-based BR and 21 (26.5%) autologous tissue. The BR failure rate was 10%, all implant-based. Increasing age and smoking negatively impacted BR rates. Black ( P =.331) and Hispanic ( P =.132) ethnicity were not independent predictors of decreased breast reconstruction. Conclusion This study demonstrated that the rate, type, and quality of BR in this integrated safety-net hospital within a diverse population are comparable to national rates. When made available, historically underrepresented minority patients of Black and Hispanic ethnicity utilize BR.

Tight Bounds on the Expected Runtime of a Standard Steady State Genetic Algorithm

Recent progress in the runtime analysis of evolutionary algorithms (EAs) has allowed the derivation of upper bounds on the expected runtime of standard steady-state genetic algorithms (GAs). These upper bounds have shown speed-ups of the GAs using crossover and mutation over the same algorithms that only use mutation operators (i.e., steady-state EAs) both for standard unimodal (i.e., OneMax) and multimodal (i.e., Jump) benchmark functions. The bounds suggest that populations are beneficial to the GA as well as higher mutation rates than the default 1/n rate. However, making rigorous claims was not possible because matching lower bounds were not available. Proving lower bounds on crossover-based EAs is a notoriously difficult task as it is hard to capture the progress that a diverse population can make. We use a potential function approach to prove a tight lower bound on the expected runtime of the (2+1) GA for OneMax for all mutation rates c/n with $$c < 1.422$$ c < 1.422 . This provides the last piece of the puzzle that completes the proof that larger population sizes improve the performance of the standard steady-state GA for OneMax for various mutation rates, and it proves that the optimal mutation rate for the (2+1) GA on OneMax is $$(\sqrt{97}-5)/(4n) \approx 1.2122/n$$ ( 97 - 5 ) / ( 4 n ) ≈ 1.2122 / n .

Chronic Rhinosinusitis’s with Nasal Polyps

Chronic Rhinosinusitis is a chronic disease that negatively affects the quality of life. When associated with nasal polyps, there is worsening of the condition, and it becomes harder to treat due to the high rates of recurrence and the increased morbidity rates. Though having a set treatment method, the condition still has unknown etiology and pathophysiology, which makes it extremely hard to diagnose and evaluate. Due to these unknown factors, treatment is still not as precise and effective; we still rely on systemic drugs like corticosteroids which most often do not resolve the disease, and we then present surgical options, though effective still do not pose as an effective cure, which may be a factor in the high rate of recurrences. However, there have been giant leaps in the specialized research of this particular topic, leading to classification through biomarkers allowing us to study and consolidate data on the disease pathology and all of the different options causing recurrences, which further enhances our understanding of how this disease affects a diverse population. The majority of the treatment given in this disease is not evidence-based but instead based on clinical observation and experience. Therefore, with CRSwNP, we are confronted with more questions than answers, which is problematic as the disease can often be associated with comorbidities leading to a further decrease in quality of life. Hence, this review article aims to aggregate and compile this valuable research and highlight the strides which have already been made while promoting additional research so that the disease can become more manageable without any recurrence.

The Pilgrimage Concept in the Caribbean?

Espenshade (2014) has argued that pre-Columbian major ballcourts/plazas on Puerto Rico, particularly with rock art, could be considered special religious places. He proposes that these precincts were being transformed from locations of communal social and ceremonial activities integrating diverse population segments to increasingly restricted-to-religious functions as shrines or pilgrimage centers serving a greatly reduced local population by the end of the pre-colonial period. The extent of incorporation of pre-colonial late phase plazas into a formal pilgrimage round for the Puerto Rico island will be examined employing archaeological data from both the Greater and Lesser Antilles. We conclude that while Espenshade’s particular argument for enclosures-as-pilgrimage sites may or may not be appropriate, simply raising the issue prompts a wider consideration of the region’s ritual structure involving rock art and non-rock art sites.

Considerations on out-of-hospital pain assessment of a diverse population

Nearly all medical emergency calls are related to someone experiencing some form of discomfort—either due to trauma or pain. Initial pain assessment may be undertaken over the telephone by an emergency medical dispatcher, without seeing the patient; however, the next key moment in pain assessment is completed patient-side by the paramedic. This inquiry is detailed and guides the paramedic in the formation of a differential diagnosis and provision of appropriate pain management. The research team recently conducted and published a study on pain assessment which raised concerns on the subjectivity of pain scoring. The work presented was in the context of a very multicultural environment. The aim of this commentary article is to further explore this topic and encourage health professionals to reflect on this aspect of patient assessment.