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Background: It is well established that emergency department (ED) crowding leads to worse health outcomes. Although various patient surveys provide information about reasons to visit EDs, less is known in terms of beliefs about EDs among the general population. This study examines public beliefs regarding accessibility and quality of EDs and their associations with social characteristics (gender, age, education, immigration background) as well as knowledge about emergency care services and health literacy.Methods: We conducted a cross-sectional study based on a random sample of 2,404 adults living in Hamburg, Germany, in winter 2021/2022. We developed eight statements regarding accessibility andquality of EDs leading to two scales (Cronbach’s α accessibility = 0.76 and quality of care = 0.75). Descriptive statistics of the eight items are shown and linear regression were conducted to determine associations of the two scales with social characteristics as well as knowledge about emergency care services and health literacy (HLS-EU-Q6).Results: Nearly 44% of the respondents agreed that “you can always go to an ED, if you do not get a short-term appointment with a general practitioner or specialist.” And 38% agreed with the statement, “If you do not have the time during normal practice hours due to your work, you can always go to an ED.” In terms of quality, 38% believed that doctors in EDs are more competent than doctors in general practice, and 25% believed that doctors in EDs are more competent than doctors in specialized practices. In the fully adjusted model, public beliefs about emergency care accessibility and quality of EDs were significantly associated with all social characteristics and knowledge of emergency care options with the strongest associations between knowledge and accessibility (β = −0.17; P < 0.001) and between education and quality (β = −0.23; P < 0.001).Conclusion: We found endorsement of public beliefs about accessibility and quality of EDs that can lead to inappropriate utilization. Our results also suggest that knowledge of different emergency services plays an important role. Therefore, after system-related reorganizations of emergency care, information campaigns about such services tailored to socially deprived populations may help alleviate the issue of crowding.

'Ramping' is a commonly used term in contemporary Australian healthcare. It is also a part of the public and political zeitgeist. However, its precise definition varies among sources. In the published literature, there are distinctions between related terms, such as 'entry overload' and 'Patient Off Stretcher Time Delay'. How ramping is defined and how it came to be defined have significance for policies and procedures relating to the described phenomenon. Through examination of the history of the term, insights are obtained into the underlying issues contributing to ramping and, accordingly, associated possible solutions. [ABSTRACT FROM AUTHOR]

After the temporary shock of the Covid-19 pandemic, the rapid recovery and resumed growth of the tourism sectors accelerates unsustainable tourism, resulting in local (over-)crowding, environmental damage, increased emissions, and diminished tourism acceptance. Addressing these challenges requires an active visitor management system at points of interest (POI), which requires local and timely POI-specific occupancy predictions to predict and mitigate crowding. Therefore, we present a new approach to measure visitor movement at an open-spaced, and freely accessible POI and evaluate the prediction performance of multiple occupancy and visitor count machine learning prediction models. We analyze multiple case combinations regarding spatial granularity, time granularity, and prediction time horizons. With an analysis of the SHAP values we determine the influence of the most important features on the prediction and extract transferable knowledge for similar regions lacking visitor movement data. The results underline that POI-specific prediction is achievable with a moderate relation for occupancy prediction and a strong relation for visitor count prediction. Across all cases, XGBoost and Random Forest outperform other models, with prediction accuracy increasing as the prediction time horizon shortens. For effective active visitor management, combining multiple models with different spatial aggregations and prediction time horizons provides the best information basis to identify appropriate steering measures. This innovative application of digital technologies facilitates information exchange between destination management organizations and tourists, promoting sustainable destination development and enhancing tourism experience. [ABSTRACT FROM AUTHOR]

This study was designed to examine the changes in emergency room visits in otolaryngology, head and neck surgery, during the COVID-19 pandemic. The study included 11,277 patients who presented to a tertiary care hospital (ER) and an emergency practice (EP) during on-call hours in the first half of 2018, 2019, and 2020. The epidemiologic parameters, diagnoses, and level of urgency were recorded using a four-step scale. A comparison was made between the pre-pandemic years and 2020. The findings revealed a significant decrease in the frequency of ER visits in the second quarter of 2020 compared to 2019 (ER: 30.8%, EP: 37.8%), mainly due to the fact that there were significantly fewer patients, with low levels of urgency. Certain diagnoses, such as epistaxis (−3.0%) and globus sensation (−3.2%), were made at similar frequencies to 2019, while inflammatory diseases like skin infections (−51.2%), tonsillitis (−55.6%), sinusitis (−59%), and otitis media (−70.4%) showed a significant reduction. The study concludes that patients with a low triage level were less likely to visit the ER during the early stages of the pandemic, but some diagnoses were still observed at comparable rates. This suggests a disparity in perception between patients and ER staff regarding urgency. Many of the issues discussed were also emphasized in the 2024 proposal by the German Ministry of Health to reform emergency care in Germany. [ABSTRACT FROM AUTHOR]

As public transportation faces increasing ridership demand, metrics such as the number of passengers denied boarding become important for measuring the service quality of transit systems. Many studies in the past have used automated fare collection (AFC) (also known as smart card data) and automated vehicle location data to infer the probability distributions for commuters that experience unable-to-board (UTB) events in metro systems, but few have studied UTB events for buses. In this paper, we demonstrate that the probability distribution of UTB commuters inferred from AFC data can be modelled by a truncated binomial distribution under certain assumptions. This model is then validated against synthetic UTB events generated using simulations and against actual UTB events recorded from ground surveys. Finally, we apply our model on real AFC data of commuters in the Singapore bus network to serve as a case study. Our method enables transport planners and operators to identify bus stops and time intervals where overcrowding and UTB events is prevalent, so that appropriate measures can be taken to mitigate such occurrences. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of the present study was to assess the predictors of need for paediatric intensive care unit (PICU) admission for inter‐hospital transfer patients to a tertiary paediatric hospital ED on high flow (HF) or continuous positive airway pressure (CPAP) ventilation.Single‐centre retrospective study of patients transferred to the state's tertiary paediatric hospital. Demographic information and disease management information was obtained.Between October 2021 and September 2022, 53 patients were transferred to the tertiary hospital on HF or CPAP. Of these, 23 required admission to PICU. Those admitted to PICU had a higher median fraction of inspired oxygen than those not admitted (0.4 vs 0.3, respectively, P = 0.013). Patients transported by road (vs flight) were more likely (20/23 patients, RR = 3.15, P = 0.016) to be admitted to PICU (56% vs 18%). Those who had received CPAP prior to or during transfer were more likely to require PICU admission (P = 0.012).We have demonstrated that children who require CPAP to manage their respiratory disease are more likely to require PICU care on transfer to the tertiary paediatric hospital. In addition, those patients being transferred from secondary metropolitan hospitals after a trial of HF are also likely to require PICU care. This suggests that these patients should be directly admitted to PICU, allowing for improved patient experience and flow as well as reducing unnecessary ED resource utilisation. [ABSTRACT FROM AUTHOR]

In Peru, the excessive increase in the prison population turns out to be one of the most complex problems faced by the State in the framework of its prison policies. The purpose of this research is to determine the factors that have influenced the increase in the prison population in Peru between 2007 and 2022. The methodology used is explanatory with a mixed approach, divided into two stages: first, literature review with qualitative analysis and a second stage of empirical analysis with a quantitative, descriptive and cross-sectional approach. The main result was the trend of increase in the prison population in Peru in the last fifteen years. At the conclusion level, it has been possible to determine that the most influential factors in the increase in the penitentiary population in Peru between the years 2007 and 2022 are the high rate difference between the admissions and discharges of inmates to penal establishments, the disproportionate increase in sentences that generate a longer stay in penitentiary establishments, the prohibition of extramural penitentiary benefits and the excessive use of preventive detention. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine how perceptions of crowding and emotions influence visitor satisfaction and loyalty in a managed visitor attraction. Although perceived crowding is an important indicator of experience quality, there is a lack of empirical knowledge about the relationship between perceived crowding, satisfaction, and loyalty, especially in the context of managed visitor attractions. In our study, we extend theoretical models from previous studies and apply them to a particular type of managed visitor attraction, a ski resort. A non-probability sample of 248 skiers and snowboarders responded to a retrospective online survey. The findings indicate that emotions joy and anger mediate the relationships between perceived crowding and satisfaction. The effects of crowding on loyalty are indirect and mediated by satisfaction. Differing from findings in other contexts, the effect of crowding on satisfaction did not depend on prior expectations of crowding nor on tolerance to crowding. [ABSTRACT FROM AUTHOR]

Copyright of Ayer: Revista de Historia Contemporánea is the property of Asociacion de Historia Contemporanea and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Foro Revista de Derecho is the property of Universidad Andina Simon Bolivar, Sede Ecuador and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Foro Revista de Derecho is the property of Universidad Andina Simon Bolivar, Sede Ecuador and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract A critical problem that Emergency Departments (EDs) must address is overcrowding, as it causes extended waiting times and increased patient dissatisfaction, both of which are immediately linked to a greater number of patients who leave the ED early, without any evaluation by a healthcare provider (Leave Without Being Seen, LWBS). This has an impact on the hospital in terms of missing income from lost opportunities to offer treatment and, in general, of negative outcomes from the ED process. Consequently, healthcare managers must be able to forecast and control patients who leave the ED without being evaluated in advance. This study is a retrospective analysis of patients registered at the ED of the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno (Italy) during the years 2014–2021. The goal was firstly to analyze factors that lead to patients abandoning the ED without being examined, taking into account the features related to patient characteristics such as age, gender, arrival mode, triage color, day of week of arrival, time of arrival, waiting time for take-over and year. These factors were used as process measures to perform a correlation analysis with the LWBS status. Then, Machine Learning (ML) techniques are exploited to develop and compare several LWBS prediction algorithms, with the purpose of providing a useful support model for the administration and management of EDs in the healthcare institutions. During the examined period, 688,870 patients were registered and 39188 (5.68%) left without being seen. Of the total LWBS patients, 59.6% were male and 40.4% were female. Moreover, from the statistical analysis emerged that the parameter that most influence the abandonment rate is the waiting time for take-over. The final ML classification model achieved an Area Under the Curve (AUC) of 0.97, indicating high performance in estimating LWBS for the years considered in this study. Various patient and ED process characteristics are related to patients who LWBS. The possibility of predicting LWBS rates in advance could be a valid tool quickly identifying and addressing “bottlenecks” in the hospital organization, thereby improving efficiency.

This study aims to conduct a bibliometric analysis of existing literature on crowding in tourist destinations and its effects, thereby recognizing areas for further research. The authors evaluated 421 Scopus-indexed documents related to the subject of crowding. This study involved analysing the annual publications on the topic and the past trends to suggest solutions for better management of the destinations in the future. The results reveal a noticeable rise in the academic literature on crowding, especially about popular tourist destinations. The findings also indicate that unmonitored tourism and subsequent media coverage have significantly contributed to this upswing in scholarly work. The problem of crowding disappeared for a short period during the COVID-19 pandemic. This research note explores a possible solution to the problem to be utilised in the future and comments on the changing nature of the psychological concept after COVID-19. This study offers a comprehensive review of the current state of research on crowding, thereby helping to guide future research in this area. Moreover, it underscores the need for strategies to manage crowding to promote sustainable tourism. [ABSTRACT FROM AUTHOR]

Housing deprivation is a multidimensional concept that can be measured using various indicators. This study focuses on severe housing deprivation and its components – overcrowding and housing conditions problems. Severe housing deprivation means the failure to meet basic housing needs. Eurostat defines it as the simultaneous occurrence of overcrowding and housing conditions problems. All analyzed indicators of housing deprivation are based on European Union Statistics on Income and Living Conditions (EUSILC) 2019 survey data. The study covers households in Poland – a country facing serious problems of housing deprivation. In fact, three dimensions of housing deprivation are examined: experiencing only housing conditions problems, experiencing only overcrowding, and being severely housing deprived. The study aims to investigate the prevalence of three-dimensional housing deprivation and reveal which socioeconomic features of the household are associated with the analyzed phenomenon. To achieve these purposes, the multinomial logit model was used to assess the average marginal effects for explanatory variables. It was found that the significant factors associated with housing deprivation are tenure status, dwelling type, household income, average age of household members, their level of educational achievement, presence of disabled and unemployed people, and household type.

The condition of the italian prisons is tragic and worrying, despite, during the pandemic period, the situation was little better. Statistic data show which are the worst problems of the italian places of detention: overcrowding, excessive use (rectius abuse) of the pre-trial detention, criminalisation of the weaker people, very high and dramatic number of suicides. The inmates are forced to live in a idleness condition rather than in the prospects of social reintegration. To rethink execution in the sense of humanising and resocialising punishment a strong political will is needed, even if, today, it’s hard to imagine. Maybe, a feeble hope can be seen in the aims pursued by the Cartabia reform. For now, however, the prison continues to be a non-place.

Jefferson Garcia Guerrero,1 Ayidah Sanad Alqarni,1 Rock Parreno Cordero,2 Imad Aljarrah,3 Mohsen Ali Almahaid4 1College of Nursing, King Khalid University, Abha, Aseer Region, Saudi Arabia; 2Emergency Health Services Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates; 3Faculty of Nursing, Philadelphia University, Amman, Jordan; 4Nursing Department, King Khalid Hospital, Najran, Saudi ArabiaCorrespondence: Jefferson Garcia Guerrero, College of Nursing, King Khalid University, Building C, Gate 2, Al-Qureiger Campus, Abha, Aseer Region, 62529, Saudi Arabia, Email jgarcia@kku.edu.saPurpose: Emergency department (ED) overcrowding is a significant concern in many hospitals in Saudi Arabia, resulting in long waiting times, delays in treating patients who need urgent care, and, consequently, decreased patient satisfaction. Additionally, ED overcrowding has been linked to increased nurse turnover rates. Therefore, this study aimed to assess nurses’ perceived causes and effects of overcrowding in the EDs of five tertiary hospitals in Saudi Arabia.Methods: This study used a descriptive cross-sectional design. We surveyed 311 nurses working in the EDs of five tertiary hospitals in Saudi Arabia using the convenience sampling technique. The self-administered questionnaires used in the study were developed by the researchers. The study was conducted from October 16 to November 10, 2022. Consensus-Based Checklist for Reporting of Survey Studies was followed.Results: The results revealed that the primary perceived causes of ED overcrowding in five tertiary hospitals were unnecessary visits due to a lack of standard procedures (mean = 2.70; SD = 0.58) and lack of inpatients beds (mean = 2.69; SD = 0.65). The perceived effect of overcrowding was stress and burnout among nurses (mean = 2.85; SD = 0.47). The perceived causes and effects of overcrowding in the ED were found to be highly significant (p < 0.001) based on Pearson correlation and Spearman’s rank correlation.Conclusion: Unnecessary visits due to a lack of standard procedures lead to overcrowding. In addition, a lack of inpatient beds in the ED affects the care provided to patients seeking immediate medical attention. This may prolong patient waiting time, causing their conditions to deteriorate and prolonging hospital stay. Overcrowding leads to increased stress and burnout among nurses. The results of this study can be used to develop a comprehensive action plan to address ED overcrowding and its effects on patients, staff, and ED flow.Keywords: nurses, overcrowding, patient safety, quality of care, stress, burnout, staff turnover

Prison radicalization poses a significant and evolving threat in Bangladesh's correctional facilities. This research article delves into the conditions fostering radicalization, including corruption, overcrowding, violence, and the lack of essential amenities. Drawing on extensive analysis of secondary data and expert interviews, this article argues that these conducive conditions have transformed Bangladeshi prisons into breeding grounds for radical ideologies, allowing militants to establish networks and plan attacks within and beyond prison confines. This article also points out the transformation of prisoners, even those with minimal radical tendencies, into militant leaders, along with the shift of non‐radical individuals toward extremism. Moreover, it underscores the lack of de‐radicalization programs within the current prison system as a crucial gap in countering this escalating issue. Furthermore, the research identifies societal denial, limited post‐release opportunities, and mistreatment by security forces as factors exacerbating radicalization post‐incarceration. As such, this study emphasizes the urgent need for comprehensive strategies to address prison radicalization. Related Articles: Awan, Imran. 2012. "'I Am a Muslim Not an Extremist': How the Prevent Strategy Has Constructed a 'Suspect' Community." Politics & Policy 40(6): 1158–85. https://doi.org/10.1111/j.1747‐1346.2012.00397.x. Heinmiller, B. Timothy, Matthew A. Hennigar, and Sandra Kopec. 2017. "Degenerative Politics and Youth Criminal Justice Policy in Canada." Politics & Policy 45(3): 406–31. https://doi.org/10.1111/polp.12204. Spalek, Basia. 2010. "Community Policing, Trust, and Muslim Communities in Relation to 'New Terrorism.'" Politics & Policy 38(4): 789–815. https://doi.org/10.1111/j.1747‐1346.2010.00258.x. [ABSTRACT FROM AUTHOR]

By January 2024, the COVID-19 pandemic claimed more than 1.1 million deaths in the United States (U.S.). People in prison are particularly vulnerable to COVID-19 as they have no ability to socially distance, secure masks, disinfect their environment or have as much access to tests or vaccinations as is available in the community. In addition, many of these individuals reside in crowded conditions with little ventilation, which makes the spread of the virus more likely. In this paper, we used data from two projects, including the UCLA Law COVID Behind Bars Data Project and the COVID Prison Project, and supplemented these with publicly available data to examine the number of deaths and infection rates caused by COVID-19 among people in prison and prison staff in the U.S., as reported by the population of those facilities. We found that the incidence of infections and death rates in prisons were affected by crowding, prison security type (maximum, medium, minimum, or mixed) and level of prison (state or federal). People in prison who were less likely to have as much human contact (e.g., maximum-security prisons) were also less likely to be afflicted with COVID-19. People in prison were twice as likely to be infected by COVID-19 but had a similar death rate compared to the general public. Prison overcrowding increased the infection rate. The most effective state health policy was to quarantine people who had close contact with confirmed, positive cases. Further, state prisons demonstrated a higher death rate compared to federal prisons. Greater efforts to ameliorate COVID-19 and similar pathogens should be directed at state prisons with lower-level security and prisons with closer contact with the community. Quarantining close-contacts and restricting movements were the most effective state-level responses to reduce infections in prisons during April 2020 to April 2022. [ABSTRACT FROM AUTHOR]

The highly popular tourist destination Darjeeling, lovingly named the ‘Queen of Hills’, has been facing the menace of excessive and unrestricted tourism development due to massive tourist influx throughout the year. This has resulted in ecological degradation in terms of the proliferation of multistoried buildings, unchecked felling of trees, piles of garbage, increased road networks on wobbly hillsides, unbridled tinkering with the social structure of hilly ethnic communities, etc. Homestay-based tourism can offer a sustainable solution to the perils of overtourism in Darjeeling hills, not only by preaching and following responsible tourism practices but also by diverting a substantial portion of tourist inflow to various unexplored virgin areas of Darjeeling hills, thereby playing a balancing role among tourism, the environment and economic development of the local populace and the region altogether. The present study aims to address these concerns and propose effective suggestions and recommendations to meaningfully contribute to the sustainable socioeconomic growth of this region suffering from problems of unemployment, poverty, illiteracy and inadequate infrastructure through the effective utilization of the opportunity presented by homestay tourism, which makes use of the 4Rs of sustainable tourism, i.e., reduce, reuse, recycle and regulate. The study concludes that homestay tourism in Darjeeling hills still remains in its infancy in relation to sustainability endeavours. [ABSTRACT FROM AUTHOR]

This study examines the challenge of overcrowding within Emergency Department (ED) processes and elucidates the potential for AI-based interventions to enhance patient care and operational efficiency. We used qualitative interviews conducted in two German hospitals to identify five challenges along the ED care pathway: limited demand predictability, task overload, information unavailability, lack of IT systems interoperability, and low process standardization. We propose AI-based solutions to target these issues. For example, demand forecasting models could optimize resource allocation during patient arrival, while AI-guided queries and Decision Support Systems could improve data quality and standardization in registration & triage and diagnosis & treatment, respectively. Additionally, AI-driven text recognition and monitoring could streamline information management and patient observation. While the study is constrained by its geographic and methodological scope, it is foundational work for future research, including Design Science Research approaches to validate and implement the proposed AI-based process aids in the ED. [ABSTRACT FROM AUTHOR]

The Yala National Park is the premier protected area in Sri Lanka. Overcrowding has been an issue in Yala for over a decade. Information sharing by mobile communication was thought to result in safari jeeps flocking to favoured sightings, causing overcrowding and reckless driving. We assessed visitor satisfaction and the impact of switching off mobile communication towers providing park coverage, by conducting a questionnaire survey, checking signal strength and assessing vehicle speed. We found that visitor satisfaction was related to sightings of the 'big three', elephants, leopards and sloth bears, but not to overcrowding at sightings. Reckless driving impacted visitor satisfaction both negatively and positively. High speed driving was mostly due to trying to exit the park before the park-closure time. Switching off mobile communication towers reduced signal strength and accessibility but did not eliminate it. Reduced mobile coverage lessened overcrowding at sightings but also decreased sightings, resulting in an overall reduction of visitor satisfaction. We conclude that reducing or eliminating mobile communication is not a viable solution to overcrowding. [ABSTRACT FROM AUTHOR]

Copyright of Larq Journal for Philosophy, Linguistics & Social Sciences is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Female emergency department (ED) patients with abdominal pain require consultation and investigation for accurate diagnosis, thus prolonging their stay. Materials and Methods: This study employed a retrospective design and focused on female patients who sought medical attention at an ED between April and September 2015. The study included patients who were referred to general surgery and/or obstetrics and gynecology clinics for consultation. Other variables included the length of stay (LOS), duration of consultations, recommendations provided in the consultation notes, and laboratory and imaging results. Results: The data of 1,146 patients were analyzed over a 6-month period. Upon analysis of their hospitalization and discharge status, it was concluded that there was no statistically significant disparity in terms of LOS in the ED (p=0.611). Patients who underwent computed tomography scans, had negative beta human chorionic gonadotropin results, or sought general surgeon consultation had longer stays in the ED. Conclusion: The sequential administration of examinations and consultations prolonged the ED stays of female abdominal pain patients. Thus, a standardized protocol for female abdominal pain patients is widely believed to be necessary. [ABSTRACT FROM AUTHOR]

BackgroundHousing is a well-recognised determinant of health. It is not known, however, how local decision makers conceptualise the links between housing and health and, in turn, what opportunities they recognise to intervene to address health inequalities.Materials and methodsA qualitative interview study was undertaken in two areas of London with a range of staff working for public services or local voluntary groups who had professional or lived experience of local housing problems. Data were analysed using a conceptual model that articulated how housing may lead to health inequalities.ResultsTwenty individuals were interviewed, comprising fifteen staff employed by two London Councils and five individuals working in the voluntary sector helping people with housing problems. All participants recognised the importance of structural inequalities in determining access to appropriate quality housing and in influencing the health effects of housing. Overcrowding emerged as a prominent theme, exemplifying the interrelated nature of housing problems. Participants actively considered how the role of public services could alleviate or exacerbate health inequalities. Interventions were often focused specifically on housing and were limited by participants' partial views of the housing-health landscape.DiscussionA comprehensive framing of housing as a determinant of health inequities was a relevant lens to conceptualise the relationship between housing and health in London. Integration of policies, services and information is needed to design and implement holistic interventions to address inequalities associated with housing. Future conceptual models to understand the interrelationship between place, housing and health may benefit from explicit consideration of the role of public services.

Introduction: Emergency medicine is a dynamic specialty that offers various medical cases and situations. Emergency medicine doctors treat patients from all age groups and with a large spectrum of physical and mental disorders. Emergency medicine is the specialty of treating illnesses or injuries requiring immediate medical attention. Emergency medicine doctors assess and treat patients in the emergency department, regardless of their illness or injury type. Their main focus is to stabilize patients as quickly as possible and determine the best next step in treating many patients simultaneously, with life-threatening conditions being the main priority. Emergency physicians treat all medical conditions of all age groups, such as cardiology, neurological, pulmonological, nephrological, endocrinological, hematological, gastrointestinal, orthopedic, gynecological-obstetrical, dermatological, psychiatric, traumatological, and accidental conditions. Efforts should be made to reduce the accumulation of ED with a solid organizational culture; rather than adopting “generic” approaches, interventions should be selected and implemented to address the unique challenges of each hospital ED. Emergency medicine can potentially improve patient care and outcomes; however, establishing evidence-based protocols and a multidisciplinary approach to patient management are essential. Creating long-term health policies to regulate the referral system through the national plan and document would regulate the three levels of health care to stop the overcrowding of the hospital's ED.

Abstract Background Emergency Department (ED) overcrowding is a global concern, with tools like NEDOCS, READI, and Work Score used as predictors. These tools aid healthcare professionals in identifying overcrowding and preventing negative patient outcomes. However, there’s no agreed-upon method to define ED overcrowding. Most studies on this topic are U.S.-based, limiting their applicability in EDs without waiting rooms or ambulance diversion roles. Additionally, the intricate calculations required for these scores, with multiple variables, make them impractical for use in developing nations. Objective This study sought to examine the relationship between prevalent ED overcrowding scores such as EDWIN, occupancy rate, and Work Score, and a modified version of EDWIN newly introduced by the authors, in comparison to the real-time perspectives of emergency physicians. Additionally, the study explored the links between these overcrowding scores and adverse events related to ED code activations as secondary outcomes. Method The method described in the provided text is a correlational study. The study aims to examine the relationship between various Emergency Department (ED) overcrowding scores and the real-time perceptions of emergency physicians in every two-hour period. Additionally, it seeks to explore the associations between these scores and adverse events related to ED code activations. Results The study analyzed 459 periods, with 5.2% having Likert scores of 5–6. EDOR had the highest correlation coefficient (0.69, p

Introduction: Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia. Methods: A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95 % confidence level and a p-value

Background: The outbreak of pneumonia among young healthy recruits in military training establishments during winter months is well documented. Rapid gathering of recruits from all parts of the country in crowded living conditions exposes them to a variety of pathogens. The objective of the present investigation was to identify causes, establish diagnosis, imply control measures, and develop future strategies after the occurrence of pneumonia outbreak during winter. Methods: The outbreak was investigated using standard epidemiological methods and medical case sheets, X-ray findings, laboratory findings, etc., to describe the epidemiology and guide the control efforts. Results: Over 3 months, 67 cases of pneumonia occurred among recruits with an attack rate of 11.1/1000 recruits/month. Radiological positivity in the form of consolidation in chest X-ray was found in 100% of cases with complications like pleural effusion in seven cases, of which intercostal chest tube drainage was required in two cases. The outbreak responded rapidly following mass chemoprophylaxis with tablet azithromycin 500 mg in five doses. Conclusion: The outbreak of pneumonia occurred among young healthy recruits (age – 17–23 years) residing in an overcrowded dwelling. Mass chemoprophylaxis was a suitable strategy along with conventional remedial measures such as health advisories, health education, hand hygiene/respiratory hygiene etiquettes, and segregations of affected squads to control the outbreak.

Background: Emergency Department (ED) overcrowding is a global concern, with tools like NEDOCS, READI, and Work Score used as predictors. These tools aid healthcare professionals in identifying overcrowding and preventing negative patient outcomes. However, there's no agreed-upon method to define ED overcrowding. Most studies on this topic are U.S.-based, limiting their applicability in EDs without waiting rooms or ambulance diversion roles. Additionally, the intricate calculations required for these scores, with multiple variables, make them impractical for use in developing nations. Objective: This study sought to examine the relationship between prevalent ED overcrowding scores such as EDWIN, occupancy rate, and Work Score, and a modified version of EDWIN newly introduced by the authors, in comparison to the real-time perspectives of emergency physicians. Additionally, the study explored the links between these overcrowding scores and adverse events related to ED code activations as secondary outcomes. Method: The method described in the provided text is a correlational study. The study aims to examine the relationship between various Emergency Department (ED) overcrowding scores and the real-time perceptions of emergency physicians in every two-hour period. Additionally, it seeks to explore the associations between these scores and adverse events related to ED code activations. Results: The study analyzed 459 periods, with 5.2% having Likert scores of 5–6. EDOR had the highest correlation coefficient (0.69, p < 0.001) and an AUC of 0.864. Only EDOR significantly correlated with adverse events (p = 0.033). Conclusion: EDOR shows the most robust link with 'emergency physicians' views on overcrowding. Additionally, elevated EDOR scores correlate with a rise in adverse events. Emergency physicians' perceptionof overcrowding could hint at possible adverse events. Notably, all overcrowding scores have high negative predictive values, efficiently negating the likelihood of adverse incidents. [ABSTRACT FROM AUTHOR]

• Literature is sparse on the burden and cause of ED overcrowding specifically in urban tertiary hospitals. • Tackling ED overcrowding will improve patient care and burnout of ED staff Decrease morbidity and mortality • It will help as a baseline for researcher for scaleup national studies. • Knowing ED crowding status is important for resource allocation and Input for protocols for designing ED patient flow. Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia. A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95 % confidence level and a p-value < 0.05. The interrater agreement showed a strong correlation with a Cohen's kappa (κ) of 0.80. The National Emergency Department Overcrowding Study Score demonstrated a strong association with subjective assessments from residents and case team nurses, with an AUC of 0.81 and 0.79, respectively. According to residents' perceptions, ED were considered overcrowded 65.8 % of the time. Factors significantly associated with ED overcrowding included waiting time for triage (AOR: 2.24; 95 % CI: 1.54–3.27), working time (AOR: 2.23; 95 % CI: 1.52–3.26), length of stay (AOR: 2.40; 95 % CI: 1.27–4.54), saturation level (AOR: 2.35; 95 % CI: 1.31–4.20), chronic illness (AOR: 2.19; 95 % CI: 1.37–3.53), and abnormal pulse rate (AOR: 1.52; 95 % CI: 1.06–2.16). The study revealed that ED were overcrowded approximately two-thirds of the time. [ABSTRACT FROM AUTHOR]

Emergency Department (ED) crowding is defined as a situation wherein the demands of emergency services overcome the ability of a department to provide high-quality care within an appropriate time frame. There is a need for solutions, as the harms of crowding impact patients, staff, and healthcare spending. An overview of ED crowding was previously published by our group, which outlines these global issues. The problem of overcrowding in emergency departments has emerged as a global public health concern, and several healthcare agencies have addressed the issue and proposed possible solutions at each level of emergency care. There is no current literature summarizing the extensive research on interventions and solutions, thus there is a need for data synthesis to inform policymakers in this field. The aim of this overview was to summarize the interventions at each level of emergency care: input, throughput, and output. The methodology was supported by the current PRIOR statement for an overview of reviews. The study summarized twenty-seven full-text systematic reviews, which encompassed three hundred and eight primary studies. The results of the summary displayed a requirement for increasing studies in input and output interventions, as these showed the best outcomes with regard to ED crowding metrics. Moreover, the results displayed heterogeneous results at each level of ED care; these reflected that generally solutions have not been matched to specific problems facing regional centres. Thus, individual factors need to be considered when implementing solutions in Emergency Departments. [ABSTRACT FROM AUTHOR]

The article explored overcrowding in Ghana prisons and sought to understand its impact on the health and well-being of persons in custody and prison officers. Qualitative data from 38 participants who were serving terms or working in three prison facilities in Ghana revealed three themes, including (a) fear over the spread of communicable diseases, (b) limited access to basic resources, and (c) psychological and emotional burden, attributing them to overcrowding in the prisons. We discussed the findings from human rights and prison and public security perspectives and concluded that addressing overcrowding in prisons would ensure a healthy prison environment, which may have implications for the well-being and human rights of persons in custody, as well as public safety and the health of prison officers and the community. To achieve a healthy prison, policies should target prison depopulation and commitment from stakeholders to implement local and international prison rules and conventions. [ABSTRACT FROM AUTHOR]

Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs. [ABSTRACT FROM AUTHOR]

While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established. This retrospective observational study aimed to assess the relationship between macroeconomic trends and CVD ED visits. This study uses data from the National Hospital Ambulatory Care Survey (NHAMCS), Federal Reserve Economic Database (FRED), National Bureau of Economic Research (NBER), and CVD groupings from National Vital Statistics (NVS) and Center for Medicare and Medicaid Services (CMS) from 1999 to 2020 to analyze ED visits in relation to macroeconomic indicators and NBER defined recessions and expansions. CVD ED visits grew by 79.7% from 1999 to 2020, significantly more than total ED visits (27.8%, p < 0.001). A national estimate of 213.2 million CVD ED visits, with 22.9 million visits in economic recessions were analyzed. A secondary group including a 6-month period before and after each recession (defined as a "broadened recession") was also analyzed to account for potential leading and lagging effects of the recession, with a total of 50.0 million visits. A significantly higher proportion of CVD ED visits related to heart failure (HF) and other acute ischemic heart diseases (IHD) was observed during recessionary time periods both directly and with a 6-month lead and lag (p < 0.05). The proportion of aortic aneurysm and dissection (AAA) and atherosclerosis (ASVD) ED visits was significantly higher (p = 0.024) in the recession period with a 6-month lead and lag. When controlled for common demographic factors, economic approximations of recession such as the CPI, federal funds rate, and real disposable income were significantly associated with increased CVD ED visits. Macroeconomic trends have a significant relationship with the overall mix of CVD ED visits and represent an understudied social determinant of health. [ABSTRACT FROM AUTHOR]

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COVID-19 has become a pandemic which has resulted in measures being taken for the health and safety of people. The spreading of this disease is particularly evident in indoor spaces, which tend to get overcrowded with people. One such place is the airport where a plethora of passengers gather in common places, such as coffee shops and duty-free shops as well as toilets and gates. Guiding the passengers to less overcrowded places within the airport may be a solution to reduce disease spread. In this paper, we suggest a passenger routing algorithm whereby the passengers are guided to less crowded places by using a weighting factor, which is minimised to accomplish the desired goal. We modeled a number of shops in an airport using the AnyLogic software and we tested the algorithm showing that the exposure time is less with routing and that people are appropriately spread out across the common spaces, thus preventing overcrowding. Finally, we added a real airport in Kavala, Greece to show the efficiency of our approach. [ABSTRACT FROM AUTHOR]

Measures against overcrowding have been developed and analyzed mainly in the context of urban destinations. For rural areas near metropolitan areas, which have been strongly affected by overcrowding by day trip tourists since the two Covid-summers of 2020/21 on many weekends, there is hardly any research available on this topic. In the context of a case study for Tölzer Land, 129 strategies and measures developed for urban areas and protected areas were compiled from the literature and their applicability in rural areas was examined. A comparison with the measures already implemented and planned in the destination showed that the concepts can be mostly transferred to rural areas where they are also suitable to counteract the negative effects of overcrowding. [ABSTRACT FROM AUTHOR]

Background and objective: In German forensic psychiatry detention under Sections 63 and 64 of the German Penal Code have been repeatedly reformed over the past years; however, despite the most recent amendments to the law on detention, clinics and state authorities warn of insufficient capacities and worrying conditions. Media reports paint a defiant picture. At the same time, there is a lack of valid data that would allow an objective description of the situation in forensic psychiatry. Against this background the management of institutions in Germany has been surveyed. Material and methods: The survey was conducted as an online survey and sent to all 78 forensic hospitals in Germany. The survey covered topics such as structural data of the facilities, the occupancy and staffing situation, incidents, support from supervisory authorities and funding agencies, and patient characteristics. The results are presented descriptively. Results: Of the 78 facilities contacted, 45 (approximately 60%) participated at least partially in the survey. Many of the clinics (68.5%) complained of significant overcrowding. A clear lack of staff and rooms was reported, at the same time it was stated that patients do not receive adequate treatment. Approximately 1 in 5 patients have a length of stay for more than 10 years and one third of the clinics reported an increasing number of physical assaults by patients. Conclusion: This overview shows that the forensic psychiatric hospitals are in very different but generally strained situations. A significant number of clinics are under great pressure. Financial, structural, spatial and personnel resources were described as insufficient to properly and professionally fulfill the legal mandate. The treatment standards presented by the DGPPN in 2017 are not met in many clinics. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the factors associated with prolonged emergency department (ED) length of stay (LOS) in inpatients. Methods: This was a retrospective and cross-sectional study conducted in the adult ED of a tertiary care hospital where approximately half a million patients are examined annually. Between August 1, 2022 and August 1, 2023, patients hospitalized from the adult ED were included in the study. Prolonged LOS was defined as patients who stayed in the ED for at least 8 hours. The relationship between prolonged LOS and patient-related and hospital-related factors was investigated. Mann-Whitney U and chi-square tests were performed statistically. Results: The median LOS of all patients in the ED was 4.4 h. Prolonged LOS (>8 hours) was independently significantly associated with older age (p=0.009), refugee status (p=0.004), non-urgent triage category (p<0.001), diagnostic tests and imaging (p<0.01), internal ward admission, and night shift arrival (p<0.01). Conclusion: Several factors were significantly associated with prolonged LOS in the ED. Prolonged LOS can be reduced through the implementation of these strategies designed to address these contributing factors. [ABSTRACT FROM AUTHOR]

Emergency rooms are one of the most complex and vital areas of healthcare institutions, which have presented overcrowding, long waiting, and length of stay times, affecting the timeliness, responsiveness, and quality of service. This research aimed to design a detailed patient flow model to improve emergency room performance using the hierarchical timed colored Petri nets. Then, the model was simulated to evaluate scenarios considering tactical decisions such as physician staff planning, operational decisions such as adjusting work schedules, and strategic decisions such as increasing observation beds. The best scenario would reduce the average waiting times for triage II patients by 17.30 % and 47.57 %, and triage III by 33.49 % and 43.49 % for medical consultation in the office or the minor surgery room, respectively. In addition, the waiting time in observation and the rate of patients left without being seen by a physician would be reduced by 92.45 % and 74.67 %, respectively. These results improve the quality and timeliness of the service and avoid putting the patient’s health and life at risk. The designed model included more attributes for patients concerning the place of medical care in the emergency room, the number of visits to the physician, and the physician who will care for the patient. Moreover, the simulation model includes observation beds as a limited resource blocking new patient admission. Finally, this model is a tool to support emergency room managers in making short, medium, and long-term decisions to address problems such as overcrowding, long waiting and length of stay times, and high rates of patients left without being seen by a physician. [ABSTRACT FROM AUTHOR]

Even though several studies have reported how stress induces detrimental pathophysiological responses that are linked to increase in disease susceptibility, no study has evaluated the impact of overcrowding on the serum chemistry of Heterobranchus longifilis. This study aimed at evaluating the impact of overcrowding on serum chemistry in Heterobranchus longifilis. Briefly, 30 apparently healthy Heterobranchus longifilis weighing between 1 kg and 1.5 kg were randomly divided into 2 groups of 15 catfish, each designated as groups 1 and 2. Group 1 (control group) was not subjected to stress, while group 2 was subjected to 3 hours of overcrowding in a 120 L plastic water tank at 201 g/L of water. Blood samples were collected from the caudal vein into non-heparinized tubes before stress, immediately after stress and 24 hours after stress. Sera were collected, and serum chemistry and electrolytes were analyzed. At 24 hours after stress, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, creatinine, uric acid, total bilirubin, conjugated bilirubin, total protein, albumin, total cholesterol, triglyceride, chloride, potassium, and sodium were significantly higher in group 2 compared to the control group. Based on the findings of this study, it was concluded that overcrowding of Heterobranchus longifilis for 3 hours has a significant impact on its health status. [ABSTRACT FROM AUTHOR]

Respecting human rights in prison represents one of the most important issues when we speak about detention. The quality of prison life is depending on a series of factors, which can influence the behaviour of detainees. Romania is subject of criticism regarding the prison condition, with multiple convictions at European Human Rights Court and still the number of incidents are not higher than those happening in other countries with better detention conditions. The author presents the results of a research focused on the relation between prison service quality, detention condition and medical treatment of the inmates and their behaviour. The conclusion of his study complemented with the good practices identified at international level can represent a guide for improvement of practices and policies within prison service.

Abstract Objectives Emergency department (ED) crowding negatively affects patient care, but the effect on resident education has been difficult to quantify. We aimed to describe the relationship between ED crowding and residents’ ability to meet point‐of‐care ultrasound (POCUS) education goals. Methods We retrospectively reviewed medical records from November 2021 to June 2023 at an academic level 1 trauma center, where emergency medicine residents complete longitudinal POCUS scanning shifts throughout 3 years of training. Residents are expected to complete ≥14 scans per scanning shift. We assessed whether completing the goal POCUS scans on a scanning shift (success: ≥14 scans, near‐success: 10‒13, failure:

This study was designed to examine the changes in emergency room visits in otolaryngology, head and neck surgery, during the COVID-19 pandemic. The study included 11,277 patients who presented to a tertiary care hospital (ER) and an emergency practice (EP) during on-call hours in the first half of 2018, 2019, and 2020. The epidemiologic parameters, diagnoses, and level of urgency were recorded using a four-step scale. A comparison was made between the pre-pandemic years and 2020. The findings revealed a significant decrease in the frequency of ER visits in the second quarter of 2020 compared to 2019 (ER: 30.8%, EP: 37.8%), mainly due to the fact that there were significantly fewer patients, with low levels of urgency. Certain diagnoses, such as epistaxis (−3.0%) and globus sensation (−3.2%), were made at similar frequencies to 2019, while inflammatory diseases like skin infections (−51.2%), tonsillitis (−55.6%), sinusitis (−59%), and otitis media (−70.4%) showed a significant reduction. The study concludes that patients with a low triage level were less likely to visit the ER during the early stages of the pandemic, but some diagnoses were still observed at comparable rates. This suggests a disparity in perception between patients and ER staff regarding urgency. Many of the issues discussed were also emphasized in the 2024 proposal by the German Ministry of Health to reform emergency care in Germany.