Syftet var att beskriva faktorer som kan påverka patientsäkerheten vid crowding på akutmottagningar. Designen som använts är en allmän litteraturöversikt med systematisk metod där data har samlats in genom sökningar i vetenskapliga databaser. Artiklar som har inkluderats har varit publicerade mellan år 2017–2022, skrivna på engelska och granskade av oberoende forskare. Resultatet visade att crowding på akutmottagningar får konsekvenser på flera plan och att orsakerna till crowding är flera. Dödligheten, vårdskador och missnöjdheten hos patienterna ökade. Orsaken till detta var blanda annat att inflödet av patienter var större än utflödet. Lokalerna var inte dimensionerade och anpassade för den ökad mängd patienter som vistades samtidigt på akutmottagningarna, vilket fick konsekvensen att korridorer och tillfälliga utrymmen användes till patientvård. Sjuksköterskorna som arbetade på akutmottagningarna hade då inte möjlighet att bedöma och reevaluera alla patienter de ansvarar för vilket ledde till att försämringar missas och orsakar lidande. Slutsatsen var att patientsäkerheten är hotad av crowding på akutmottagningar. Sjukvårdspersonal gavs inte möjligheten att bedriva patientsäker och personcentrerad vård när akutmottagningarna var högt belastade vilket kunde leda till att sjukvårdpersonalen upplevde stress och en negativinställning till sin arbetsplats. Genom att belysa riskerna kan sjukvårdspersonal och arbetsledningar arbeta proaktivt för att förebygga crowding och minska riskerna för vårdskada. / The aim was to describe factors that can affect patient safety in crowded emergency departments. The design used was a general literature review with a systematic method where data has been collected through searches in scientific databases. Articles that have been included was published between year 2017–2022, written in English and reviewed by independent researchers. The results showed that overcrowding in emergency departments had consequences on numerous levels and that the causes of overcrowding was various. Mortality, healthcare injuries, and patient dissatisfaction was increasing. The reason for this was, among other things, that the inflow of patients was greater than the outflow. The premises was not dimensioned and adapted to the increased number of patients staying at the same time in the emergency departments, which had the consequence that corridors and temporary spaces was used for patient care. The nurses who worked in the emergency departments did not have the possibility to assess and re-evaluate all the patients they were responsible for, which leads to deterioration being missed and causing suffering. The conclusion was that patient safety was jeopardized by crowding in the emergency departments. Healthcare staff were not given the opportunity to provide patient-safe and person-centred care when the emergency departments was crowded, which could lead to the healthcare staff experiencing stress and a negative attitude towards their workplace. By emphasising the risks, healthcare staff and work management can work proactively to prevent crowding and reduce the risks of healthcare injury.

Data clustering involves partitioning data points into clusters where data points within the same cluster have high similarity, but are dissimilar to the data points in other clusters. The k-means algorithm is among the most extensively used clustering techniques. Genetic algorithms (GA) have been successfully used to evolve successive generations of cluster centers. The primary goal of this research was to develop improved GA-based methods for center selection in k-means by using heuristic methods to improve the overall fitness of the initial population of chromosomes along with crowding techniques to avoid premature convergence. Prior to this research, no rigorous systematic examination of the use of heuristics and crowding methods in this domain had been performed. The evaluation included computational experiments involving repeated runs of the genetic algorithm in which values that affect heuristics or crowding were systematically varied and the results analyzed. Genetic algorithm performance under the various configurations was analyzed based upon (1) the fitness of the partitions produced, and by (2) the overall time it took the GA to converge to good solutions. Two heuristic methods for initial center seeding were tested: Density and Separation. Two crowding techniques were evaluated on their ability to prevent premature convergence: Deterministic and Parent Favored Hybrid local tournament selection. Based on the experiment results, the Density method provides no significant advantage over random seeding either in discovering quality partitions or in more quickly evolving better partitions. The Separation method appears to result in an increased probability of the genetic algorithm finding slightly better partitions in slightly fewer generations, and to more quickly converge to quality partitions. Both local tournament selection techniques consistently allowed the genetic algorithm to find better quality partitions than roulette-wheel sampling. Deterministic selection consistently found better quality partitions in fewer generations than Parent Favored Hybrid. The combination of Separation center seeding and Deterministic selection performed better than any other combination, achieving the lowest mean best SSE value more than twice as often as any other combination. On all 28 benchmark problem instances, the combination identified solutions that were at least as good as any identified by extant methods.

The fight against poverty in the United States has existed since the inception of the country. Each successive generation has had their own unique view on the causes of poverty and the use of institutions to suppress it. This dissertation focuses on institutions helping the poor during the Progressive Era from 1900 to 1930. During this time period poverty relief fundamentally evolved from private charities providing the bulk of relief efforts to government agencies becoming the more important source of aid.Research into poverty relief for this time period has been deficient mostly from a lack of quality data. To further the literature, I have created a unique data set that provides information about both governmental and private relief efforts throughout the era. The first chapter of the dissertation focuses on quantitatively and qualitatively documenting the evolution of institutions from 1900 to 1930 in Massachusetts. Particular emphasis is on how the public's changing attitudes towards the poor altered the institutions used to provide relief. The second chapter studies the effects of government spending on private spending. I highlight how nonprofit managers' behavior would lead them to reduce spending when the government became the first avenue of support for the poor. The third chapter tests assumptions made in the second chapter about nonprofit managerial behavior. Unfortunately, data from 1900 to 1930 does not have the quality to answer these questions. Therefore, I use a similar data set from 1998 to 2003 to test how nonprofit managers adjust their spending, program service revenue, and savings to the business cycle.

Emergency Departments have begun implementing new patient flow processes aimed at improving ED throughput and limiting ED crowding. The purpose of this study was to evaluate the effectiveness of two flow processes. <br>This was a retrospective quasi-experimental study designed to evaluate the impact of a Rapid Medical Assessment process versus Fast Track process on improving ED throughput. Data analysis included descriptive statistics and two-factor analyses of covariance (ANCOVA). ANCOVA statistics were calculated using “arrival to first provider contact time” and “arrival to departure time” as the dependent variables and RMA process versus FT process as well as ESI levels as the independent variables. There was a significant difference in the mean arrival to first provider contact times for all patients during all hours, F (1, 5744) = 9.5, p = .002. There was also a significant difference in the mean arrival to first provider contact time for low-acuity patients during all hours, F (1, 3131) = 14.6, p = < .001 <br>There was a significant difference in the mean arrival to departure times for all patients during all hours, F (1, 6079) = 5.8, p = .016. There was no significant difference in the mean arrival to departure times for low-acuity patients during all hours, F (1, 3306) = 0.774, p = .379, or for all patients during FT hours, F (1, 2647) = 1.1, p = .295. The results of the study support the belief that rapid evaluation and disposition of low-acuity patients improve ED efficiency and reduce ED crowding. / School of Nursing; / Nursing / PhD; / Dissertation;

This paper explores cross-country variations in charitable giving and investigates the association of welfare state policies with private philanthropy. Hypotheses are drawn from crowding-out theory and considerations about the influence of a country's mixed economy of welfare. We add to the on-going discussion concerning the crowding-out hypothesis with empirical evidence by looking at specific charitable subsectors people donate to across countries. Using Eurobarometer survey data that include 23 countries, we find no evidence for a crowding-out effect, but rather a crosswise crowding-in effect of private donations. Moreover, giving behaviour differs between non-profit regimes.

O presente estudo objetivou comparar retrospectivamente a estabilidade póscontenção do alinhamento dos incisivos ântero-superiores em pacientes Classe I e Classe II de Angle. A amostra consistiu-se de 38 pacientes de ambos os gêneros, tratados sem extrações e mecânica Edgewise. A amostra foi dividida em dois grupos: Grupo 1 (Classe I) constituído por 19 pacientes (12 do gênero feminino e 7 do gênero masculino), com idade inicial média de 13,06 anos (d.p. = ± 1,27), portadores da má oclusão de Classe I com apinhamento ântero-superior inicial maior que 3mm. Grupo 2 (Classe II) apresentando 19 pacientes (14 do gênero feminino e 5 gênero masculino), com idade inicial de 12,54 (d.p. = ± 1,37), portadores da má oclusão de Classe II, e também com apinhamento ântero-superior inicial maior que 3mm. Foram medidos nos modelos de estudo das fases pré (T1), pós-tratamento (T2) e pós-contenção (T3), o índice de irregularidade de Little, as distâncias intercaninos e entre os primeiros e segundos pré-molares, a distância intermolares e o comprimento do arco superior. Após a obtenção dos dados, realizou-se a análise estatística. Para a comparação intragrupo nos 3 tempos de avaliação, utilizou-se a análise de variância a um critério de seleção, e em caso de resultado significante, o teste de Tukey. A comparação intergrupos foi realizada por meio de testes t independentes. Para verificação da presença de correlação entre a recidiva do apinhamento ântero-superior e a recidiva das variáveis: distâncias intercaninos, interpré-molares, intermolares e comprimento do arco, utilizou-se o teste de correlação de Pearson. Os resultados evidenciaram maior estabilidade do tratamento no grupo 2 (Classe II), pois durante o período pós-contenção, foi observada uma menor recidiva do apinhamento dos dentes ântero-superiores no grupo 2 (0,80mm) do que no grupo 1 (1,67mm). Concluiu-se que o tratamento do apinhamento dos dentes ântero-superiores é mais estável na má oclusão de Classe II do que na má oclusão de Classe I. / The present study aimed to retrospectively compare the postretention stability of maxillary anterior incisors alignment in Angle Class I and Class II patients. Sample comprised 38 patients of both genders, treated nonextraction and edgewise mechanics. Sample was divided into two groups: Group 1 (Class I) comprised 19 patients (12 females and 7 males), at a mean age of 13,06 years (d.p. = ± 1,27), with Class I malocclusion and initial maxillary anterior crowding greater than 3mm. Group 2 (Class II) comprised 19 patients (14 females and 5 males), at a mean age of 12,54 (d.p. = ± 1,37), with Class II malocclusion, and also with a initial maxillary anterior crowding greater than 3mm. It was measured the dental casts of pre (T1), posttreatment (T2) and postretention (T3), the Little irregularity index, intercanine distance and between first and second premolars, intermolar distance and maxillary arch length. After obtainment of data, the statistical analysis was performed. For intragroup comparison among the three times of evaluation, it was used the one-way ANOVA followed by Tukey test in case of a significant result. Intergroup comparison was performed by independent t tests. To verify the presence of correlation among the relapse of maxillary anterior crowding and the relapse of the variables: intercanine, interpremolar and intermolar distances and arch length, the Pearson correlation test was used. Results evidenced greater stability of treatment in group 2 (Class II), because during the postretention period, it was observed a lesser relapse of maxillary anterior crowding in group 2 (0,80mm) than in group 1 (1,67mm). It was concluded that treatment of maxillary anterior crowding is more stable in Class II malocclusion than in Class I malocclusion.

The diffusion of a particle in a crowded environment typically proceeds through three regimes: for very short times the particle diffuses freely until it collides with an obstacle for the first time, while for very long times diffusion the motion is Fickian with a diffusion coefficient D that depends on the concentration and type of obstacles present in the system. For intermediate times, the mean-square displacement of the particle often increases approximately as t α , with α < 1, typical of what is generally called anomalous diffusion. However, it is not clear how one can identify or choose a time or displacement interval that would give a reliable estimate of α. In this paper, we use two exact numerical approaches to obtain diffusion data for a simple Lattice Monte Carlo model in both time limits. This allows us to propose an objective definition of the transient regime and a unique value for α. Furthermore, our methodology directly gives us the length scale over which the transient regime switches to the steady-state regime. We test our proposed approach using several types of obstacle systems, and we introduce the novel concept of excess diffusion lengths. Finally, we show that the values of the parameters describing the anomalous transient regime depend on the Monte Carlo moves used to describe the dynamics of the particle, and we propose a new algorithm that correctly models the short time diffusion of a particle on a lattice.

O presente estudo retrospectivo objetivou correlacionar a recidiva da sobremordida e da sobressaliência com a recidiva do apinhamento dos incisivos ântero-superiores e ântero-inferiores. A amostra consistiu de 34 pacientes (17 de cada gênero),apresentando más oclusões iniciais de Classe I e II,tratados sem extração e mecânica Edgewise.O tempo médio de duração do tratamento foi de 2,19 anos e os tempos de contenção e pós-contenção foram de 1,46 e 5,31 anos respectivamente. Todos os pacientes apresentavam, pelo menos, 3 mm de sobremordida e 4 mm de sobressaliência e apinhamento superior e inferior, de suave a severo. Foram medidos nos modelos de estudo das fases pré (T1), pós-tratamento (T2) e pós-contenção (T3) a sobremordida, a sobressaliência e o índice de irregularidade de Little superior e inferior. Após a obtenção dos dados, passou-se à análise estatística. A comparação intergrupos foi realizada por meio do teste t independente. Os testes ANOVA e Tukey foram apl icados para verificar se houve recidiva da sobremordida, da sobressaliência e dos apinhamentos ântero-superior e ântero-inferior. Para verificação da presença de correlação entre a recidiva da sobremordida, da sobressaliência e do apinhamento anterior, utilizou-se o teste de correlação de Pearson. Os resultados evidenciaram recidiva estat ist icamente signi ficante para o apinhamento ântero-super ior e ântero- infer ior . Houve correlação entre a recidiva da sobremordida e da sobressaliência, no entanto, não houve relação entre essas duas recidivas e o apinhamento anterior. / The present study aimed to correlate, by means of a retrospective analysis, the postretention stability of the overbite and overjet with the relapse of the crowding of maxillary and mandibular anterior teeth. The sample comprised 34 subjects (17 of each gender), at a mean initial age of 12.89 years, presenting Class I and II malocclusions, treated nonextraction and Edgewise mechanics.All patients presented at least 3mm of overbite and 4mm of overjet and maxillary and mandibular crowding from slight to severe. It was measured, in the dental casts from the stages pretreatment (T1), posttreatment (T2) and postretention (T3), the overbite, overjet and the maxillary and mandibular Little irregularity index. After data were obtained, the statistical analysis was performed. The intergroup comparison was performed by independent t tests. The ANOVA and Tukey tests were applied to verify the relapse of the overbite, overjet and maxillary and mandibular anterior crowding. To verify the presence of correlation among the relapse of the overbite, overjet and the anterior crowding, the Pearsons correlation test was used. Results did not show statistically significant difference between Angles Class I and Class II patients. There was correlation of the relapse of overbite with the relapse of overjet, however, there was no relationship among the relapse of overbite and overjet with the relapse of anterior crowding.

Les structures des urgences (SU) sont une porte d'entrée importante de l'hôpital, fortes d'un personnel dont les capacités progressent et aidées par un plateau technique hospitalier de qualité. Dès son arrivée en SU, la prise en charge du patient s'inscrit dans un circuit qui a pour objectif l'optimisation des soins. Ce circuit patient peut être ralenti ou altéré lorsqu'il y a une surcharge de la SU, c'est-à-dire lorsque les capacités de celle-ci sont dépassées par le nombre de patients en attente d'être vu, d'évaluation, de traitement et de place d'hospitalisation. La surcharge des SU est associée à de nombreux effets indésirables et il est démontré que l'origine de cette surcharge est multifactorielle. Pour y trouver des solutions, il convient d'examiner la surcharge dans la globalité de l'institution hospitalière et du système de soins. L'objectif de ce travail est de décrire le circuit du patient de son arrivée en SU jusqu'à son départ et, parfois, son retour. Chaque article de ce travail, constituant autant d'étapes dans le circuit patient, place en perspective la surcharge de la SU ou de l'institution dans sa globalité. Cet ensemble d'articles souligne la complexité de la problématique et la nécessaire mobilisation de toute l'institution pour y répondre. / Emergency departments (ED) are an important front gate of the hospital with strong skill staff and helped by a high quality technical platform. After his/her arrival at the hospital, the patient follow a pathway which aims to optimize the healthcare. This patient's pathway may be slowed down or alter when there is an overcrowding of the ED, when capacities are exceeded by the number of patients to be seen, evaluated, treated, and to hospitalize. ED overcrowding is associated with many adverse effects and it is shown that the origin of this overcrowding is multifactorial. To find solutions, we must observe overcrowding in the whole of the hospital institution and of the healthcare system. The aim of this thesis is to describe the patient's pathway from his/her arrival at the ED to his/her departure, and sometimes his/her come back. Each article of this thesis represents a step of the patient's pathway. Then, the overcrowding of the ED, or of the hospital, is studied in its entirety. This collection of articles highlights the complexity of the issue and the need to mobilize the whole institution to respond.

Associations Between Dietary Factors and Malocclusion. Blackwelder AC*, Warren JJ, Levy SM, Marshall TA, Bishara SE (University of Iowa, Iowa City, IA) Purpose: Malocclusions, including crowding, have a multifactorial etiology, but it has been suggested that dietary factors may be a risk factor for malocclusion. Thus, the objective was to assess associations between dietary factors and dental crowding in a sample of Iowa Fluoride Study participants. Methods: As participants in the Iowa Fluoride Study, subjects were followed up from birth to 102 months using questionnaires and diet diaries periodically to gather information on dietary intake. Subjects were also examined clinically around age 5 (n=168) and 9 (n=125) with dental casts made to gather information on malocclusion such as Tooth Size Arch Length Discrepancy (TSALD) and Canine Arch Width (CAW), as well as body mass index (BMI). Relationships between dietary factors and malocclusion were assessed. Results: The maxillary and mandibular TSALD values for the age 5 and age 9 exams were correlated with the dietary data. The age 5 maxillary TSALD (1.74 mm) was statistically significant when correlated with kilocalories (P=.031) before and after adjusting for BMI. Further examination of the extreme TSALD values with dietary data was completed using Student's t-test. The age 9 mandibular extreme TSALD value and kilocalories was also statistically significant (P=.028). The age 5 CAW was correlated with the dietary data and kilocalories was also statistically significant (P=.012). Other dietary factors were found to approach statistical significance but were not significant at the alpha=0.05 level. Conclusions: The findings from this study suggest that dietary factors may be associated with crowding of the dentition as measured by TSALD and CAW; however, further research is needed.