Existing literature on boarding and rooming establishes the important role of boarding in the housing market. Boarding and rooming have traditionally provided temporary, inexpensive accommodation for those who have come to the city to seek employment. The first half of the twentieth century was a period of dramatic economic and social change and yet there is no study of boarding during this period. This is a study of the declining incidence of boarding and rooming in Hamilton during the period 1900 to 1948. There is a dramatic decline in boarding and rooming during the first fifteen years of the twentieth century. Rates remain low during the 1920's with a slight resurgence seen during the Great Depression and the Second World War. There is a substantial decline in boarding and rooming over the entire period of study 1900 to 1948. Also, there is a decline in the percentage of boarders and roomers that were boarders during the period of study. Changing social tastes demonstrate an increasing preference for the nuclear family. Therefore, individuals residing with the family are no longer encouraged to live as one of the family. The relationship that exists between boarding and rooming and periods of economic prosperity and recession are found to be complex and contradictory in nature. Although periods of prosperity allow individuals to find their own accommodation, this same prosperity attracts increasing numbers of people to the city creating a housing shortage and causing people to have to double up. Similarly, periods of recession create a need for inexpensive accommodation but also, many individuals return to farming during these periods. Finally, the decline that took place in boarding and rooming during this period cannot be explained exclusively by economic changes but also by dramatic social changes that were also taking place during this period. / Thesis / Bachelor of Science (BSc)

Akutmottagningens uppgift är att omhänderta den akut sjuka patienten, stabilisera, behandla och erbjuda en patientsäker vård av god kvalitet vid oförutsägbara och akuta händelser. Sedan längre tid ses en global trend med ett ökande inflöde till akutmottagningarna, även i Sverige. Detta belastar i allt högre grad en redan pressad organisation och orsakar överbeläggning (“Crowding”), en situation där patientflödet på akutmottagningen överstiger kapaciteten som verksamheten är dimensionerad för. Inte bara inflöde påverkar, utan även vårdtyngd och möjlighet att förflytta patienternavidare i vårdkedjan. Crowding kan leda till försämrat patientflöde, längre vänte- och vårdtider på akutmottagningen, högre arbetsbelastning för personalen och negativa konsekvenser för patienterna. Syftet med detta examensarbete var att belysa hur crowding på akutmottagningen kan påverka patientsäkerheten. För att besvara syftet gjordes en systematisk, integrativ litteraturstudie inkluderande 18 vetenskapliga studier publicerade mellan 2013-2022. Inkluderade studier hämtades från databaserna PubMed, CINAHL och Scopus och kvalitetsgranskades enligt granskningsmallar från Joanna Briggs Institute. En tematisk analys genomfördes, där tre huvudteman identifierades: “Organisatoriska brister”, “Upplevelser av crowding” samt “Vårdskador orsakade av crowding”. Resultatet påvisade att crowding har negativ påverkan på patientsäkerheten, med ökning av både mortalitet och morbiditet. Det tycks däremot inte vara någon proportionell samstämmighet, utan andra faktorer tycks påverka i hög grad. Crowding och otillräckliga resurser medför ett ökat lidande för patienter, anhöriga och personal. Slutsatsen är att crowding på akutmottagningen är ett komplext problem som påverkar hela sjukvården. Med växande och åldrande befolkning kommer problemet troligen fortsätta öka och åtgärder i hela vårdkedjan blir nödvändiga för att inte äventyra patientsäkerheten.

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The first two chapters of this dissertation focus on the child health outcomes in brief, child diarrheal incidence in India, and child growth measures in Rwanda. The third chapter examines the determinants of timely access to health care in emergency departments in the United States. All three essays are different in their area of interest, data sources, and methodology.ESSAY 1 India has recorded the highest number of child diarrheal deaths at the global level. Oral Rehydration Therapy (ORT) would just provide hydration and few mineral supplements for infected children. However, their malnutrition and weakened immune system cannot be reversed. Malnutrition affects child growth, and causes stunting, and makes them susceptible to other forms of infections. The rotavirus vaccine provides a pseudo-sense of protection from non-rotaviral diarrhea. Preventing diarrhea right away from the source of the infection would be a better solution. Since most diarrheal pathogens are water borne, disinfection treatment of drinking water at the point of use could prevent diarrheal incidence of children and adults as well. Household data from the National Family and Health Survey and their estimators viz., Propensity Score Matching (PSM), and Inverse Probability Weights Regression Adjustment (IPWRA) have been employed to examine the effects of water treatment techniques in households. This chapter attempted a novel approach in studying all the popularly used water treatment techniques currently practiced in India in one study. They have been ranked for multi-value treatment effects model. Water filters with ceramic candles are more effective than other point-of-use water treatment techniques, followed by chlorination, water purifiers, and boiling. ESSAY 2 Rwanda is a sub-Sahara African country affected by genocide with a patriarchal family structure system. Higher poverty and gender imbalance were not alleviated by gender equality being on the political agenda. Despite the highest female representation in the parliament in the world, gender equality and liberty are confined to elite women. Additionally, flawed laws for women's equality made women's empowerment a paradoxical phenomenon. Women at the gross root levels, i.e., community and household, are still dependent or interdependent on men (husband/father). This has been confirmed by the findings in Chapter 3, that is, for most decisions, women are taken jointly with their partners. A minimal percentage of women are autonomous in their decisions and in their home. This study made an attempt to examine the mother’s autonomy in Rwanda and its impact on child health. Mother’s autonomy is negatively related to child’s height and weight for their age. Although the expected association between mother’s autonomy and child height/weight is positive, it would also depend on the historical and cultural context of the country of interest. Instrumental variable analysis is used to study women’s autonomy due to its complex and endogenous nature. Spousal educational difference and marriage-to-birth interval are valid instruments but weakly identified. ESSAY 3 An increasing burden on emergency services that exceeded its resources led to congestion in the emergency department (ED), with patients waiting for physicians on the examination bed and for inpatient bed transfer. This creates a blockage between access to healthcare and emergent patients. ED measures adopted to reduce ED congestion, boarding, and waiting times, such as ambulance diversion management, fast tracking of patients with low acuity, and bed coordination do not effectively control waiting time and boarding. ED crowding is a patient flow, but not necessarily a hospital resource deficiency. This is evident from the findings that even EDs with new treatment spaces still keep patients waiting for an inpatient bed, however, they reported a shorter wait time for the physician. Optimal utilization of nurses by floating them to needy units is effective in timely transfers of patients to inpatient beds compared to EDs without floating nurses.

Mental health conditions affect one in five children with only half of these children receiving proper treatment (CDC, 2022). This is partly due to the continued shortage of trained pediatric psychiatric providers in the community (American Academy of Child and Adolescent Psychiatry, 2019). In addition to the shortage of providers, there remains a shortage of pediatric psychiatric beds (Kraft et al., 2021). These combined factors have led to the pediatric boarding crisis in America (Leyenaar et al., 2021; McEnany et al., 2020; Nash et al., 2021). When adolescents are admitted to the emergency department due to a mental health crisis, their ability to rest and sleep is often disrupted. The “Utilizing Mindfulness-Based Practices in a Pediatric Emergency Department” program offers occupational therapy practitioners a framework to help these adolescents regain a sense of normalcy in their daily routines and purposeful activities. Through the incorporation of mindfulness-based practices and comprehensive education, adolescents can work on re-establishing a healthy balance in their rest and sleep patterns.

No, she is not my mom, not my aunt, we are not family. Yes, we do look alike, we do live in the same neighborhood, we smell the same coffee beans each morning, and we share the same zip code. The only difference between us is I do have an actual address here, she does not. Yes, she must have lived here much longer than me, she has a history in this town, a lot of the people would recognize her smiling spirit right away, yet she only occupies a corner in a street near a coffee shop most of the year. Everyone knows that space is hers, except the legal papers. Where are you from? The question may seem so simple, but regardless of how many times I am asked the answer has never been so easy for me each time I am asked, and I am asked very often. Belonging, identity, countries, tribes, bloodlines and borders are things that confuse me a lot, and for that I decided to do my thesis about them, trying to find an answer to a simple question, in a very complicated universe. I chose to study these matters through a transitional program, in a transforming neighborhood and for users who are in their most confused age; an international 6 boarding school in Dupont circle. / Master of Architecture

Abstrakt Bakgrund: När slutenvården inte kan ta emot patienter från akutmottagningen uppstår fenomenet boarding. Boarding innebär att patienter kvarstannar på akuten i väntan på slutenvård. Vid hög arbetsbelastning på akutmottagningen uppstår tydliga missförhållanden mellan efterfrågan och tillgång på vård, något som påvisats både i nationella och internationella studier. Trots ansatsen att tillse god omvårdnad under sådana förhållanden tvingas sjuksköterskor på akutmottagningen till prioriteringar. Syfte: Syftet var att belysa sjuksköterskors upplevelse av patientsäkerhet vid omvårdnad av patienter som omfattas av fenomenet boarding på akutmottagning. Metod: En strukturerad litteraturstudie har genomförts innefattande 13 kvalitativa vårdvetenskapliga artiklar som grund för resultatet. Analysen utfördes genom tematisk syntes, beskriven av Thomas och Harden. Resultat: Den tematiska syntesen producerade tre analytiska teman; Sjuksköterskor upplever att den boardade patientens omvårdnadsbehov inte tillgodoses, Sjuksköterskor upplever att brister i material, utrustning och lokaler skapar en skadlig vårdmiljö för den boardade patienten och Sjuksköterskor upplever att organisation, strukturer och attityder påverkar patientsäkerheten för den boardade patienten. Slutsats: Resultaten av litteraturstudien kan tolkas som att när boarding föreligger finns ett ökat antal patienter på akuten som sjuksköterskor upplever riskerar att utsättas för onödigt lidande i olika former. Resultaten kan även tolkas som att boardade patienter i högre grad utsätts för patientsäkerhetsrisker än andra patienter. / Abstract Background: When no inpatient bed are available to receive patients from the Emergency Department (ED) the phenomenon of boarding occurs. Boarding of patients in the ED means that the patient who is deemed in need of inpatient care remains in the ED until beds open in the inpatient wards. Previous studies have shown that boarding of patients in the ED is associated with a rising workload. The studies further describe a pronounced mismatch between supply and demand of care arises due to high workload in ED’s. Tough the nurses strive to preform quality of care during these times they are forced to prioritize. Aim: This study aims to depict nurses’ experiences of patient safety regarding care of patients encompassed by the phenomenon of boarding occurs in the emergency department. Method: 13 qualitative studies to answer the study aim. A structured literature study has been carried out through thematic synthesis as described by Thomas and Harden. Results: The thematic synthesis produced three analytical themes; Nurses experience that the needs for care of the boarded patient is not met, Nurses experience that deficiencies in space and equipment creates a hazardous environment for the boarded patient and Nurses experience that organization, structures and attitudes influences patient safety regarding the boarded patient. Conclusion: The results can be seen as that when boarding occurs in the ED there is an increased group of patients that according to nurses are at risk of preventable suffering. The results indicate that the boarded patient is more exposed to patient safety risks than other groups of patients.

Nella prima parte la tesi analizza la fondazione e i primi anni di attività dei quattro collegi femminili fondati in età napoleonica: il Reale Collegio delle fanciulle di Milano, il Collegio agli angeli di Verona, il Collegio san Benedetto di Montagnana e il collegio Maria Cosway di Lodi. Lo studio è stato condotto mediante una puntuale attività di ricerca negli archivi di stato di Milano, Verona e Venezia, e nell'archivio comunale di Montagnana. Il collegio di Milano fu il modello per gli altri collegi, ai quali fornì l'esempio dei regolamenti, dei programmi di studio e più in generale, dell'impostazione pedagogica complessiva di un moderno convitto laicale. Nel presente lavoro quindi vengono ricostruite la giornata delle educande e il livello della loro preparazione culturale in un'ottica di un rinnovato modello di donna. Si analizzano con attenzione i libri di testo adottati per comprendere la qualità dei saperi riservati alle donne. Nell'ultima parte della tesi, vi è uno studio quantitativo relativo all'età delle alunne e alla loro provenienza geografica e sociale. / In the first part the doctoral thesis analyses the foundation and the first years of activity of the four girls' boarding schools founded during the Napoleonic age: the Reale Collegio delle fanciulle in Milan, the Collegio agli angeli in Verona, the Collegio San Benedetto in Montagnana and the Collegio Maria Cosway in Lodi. The survey has been pursued through accurate researches in the state archives in Milan, Verona and Venice and in the municipal archives in Montagnana. The Milan girls' boarding school was the model for the other schools, to which it provided paragon for regulations, curricula and in general for comprehensive pedagogic methods of a modern lay boarding school. This work reconstructs the boarders' daily life and the level of their cultural background in the perspective of a renewed idea of woman. The chosen textbooks are carefully examined to understand the quality of knowledge intended for women. In the last part of the dissertation there is a quantitative study about the age of the schoolgirls and about their social and geographical provenance.

published_or_final_version / Architecture / Master / Master of Architecture

Emergency department (ED) crowding is a patient safety concern that has been increasing for more than a decade. Increased visits have resulted in ED crowding, longer wait times, ambulance diversions, and boarding of admitted patients (Hing & Bhuiya, 2012). Numerous factors affect ED crowding. Once various extraneous issues are resolved and a bed is available for a patient, it becomes the responsibility of nurses across unit boundaries to coordinate the patient transfer. This study applies Relational Coordination Theory (RCT) as a framework to provide nurses insight into the relational aspects of their work in the transfer of ED patients to inpatient beds. Relational coordination is a mutually reinforcing process of interaction between communication and relationships that is carried out for the purpose of task interaction. It is useful for coordinating work that is highly interdependent, uncertain, and time constrained (Gittell, 2002). Nurses work during ED transfers requires task interaction as they coordinate their efforts. This study, guided by RCT, will examine relational and communication dynamics among nurses within their own units and across unit boundaries as they interact during ED transfers. A cross-sectional, descriptive design will explore the seven dimensions of Relational Coordination (RC) during ED admissions and explain nurses relational and communication dimensions that may influence ED boarding times. The results of this study provide new information and a sound theoretical model on which to base future research.