The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear

Textbooks are a vital component in many higher education contexts. Increasing textbook prices, coupled with general rising costs of higher education have led some instructors to experiment with substituting open educational resources (OER) for commercial textbooks as their primary class curriculum. This article synthesizes the results of 16 studies that examine either (1) the influence of OER on student learning outcomes in higher education settings or (2) the perceptions of college students and instructors of OER. Results across multiple studies indicate that students generally achieve the same learning outcomes when OER are utilized and simultaneously save significant amounts of money. Studies across a variety of settings indicate that both students and faculty are generally positive regarding OER.

In some educational settings, the cost of textbooks approaches or even exceeds the cost of tuition. Given limited resources, it is important to better understand the impacts of free open educational resources (OER) on student outcomes. Utilizing digital resources such as OER can substantially reduce costs for students. The purpose of this study was to analyze whether the adoption of no-cost open digital textbooks significantly predicted students' completion of courses, class achievement, and enrollment intensity during and after semesters in which OER were used. This study utilized a quantitative quasi-experimental design with propensity-score matched groups to examine differences in outcomes between students that used OER and those who did not. The demographics of the initial sample of 16,727 included 4909 students in the treatment condition with a pool of 11,818 in the control condition. There were statistically significant differences between groups, with most favoring students utilizing OER.

The term “open pedagogy” has been used in a variety of different ways over the past several decades. In recent years, its use has also become associated with Open Educational Resources (OER). The wide range of competing definitions of open pedagogy, together with its semantic overlap with another underspecified term, open educational practices, makes it difficult to conduct research on the topic of open pedagogy. In making this claim we do not mean to cast doubt on the potential effectiveness of the many pedagogical approaches labeled open. In this article, rather than attempting to argue for a canonical definition of open pedagogy, we propose a new term, “OER-enabled pedagogy,” defined as the set of teaching and learning practices that are only possible or practical in the context of the 5R permissions that are characteristic of OER. We propose criteria used to evaluate whether a form of teaching constitutes OER-enabled pedagogy and analyze several examples of OER-enabled pedagogy with these criteria.

Despite increased development and dissemination, there has been very little empirical research on Open Educational Resources (OER). Teachers and students involved in a large-scale OER initiative at eight community colleges across the United States were given a detailed questionnaire aimed at uncovering their perceptions of the cost, outcomes, uses and perceptions of quality of the OER used in their courses. Teachers and students alike reported significant cost savings and various pedagogical and learning impacts due to the implementation of OER in the classroom. In addition, most students and teachers perceived their OER to be at least equal in quality to traditional textbooks they had used in the past. Implications for further research are discussed.

A significant movement in education concerns the use of open educational resources. By -open‖ it is generally meant that the resource is available at no cost to others for adaptation and reuse in different contexts. However -open‖ is not a simple dichotomy; rather, there is a continuum of openness. We discuss four separate aspects of reuse and demonstrate how these describe different levels of openness. We discuss how the licensing and technical aspects of open educational resources affect the relative openness of an OER. Implications for those creating open educational resources are discussed. Frameworks for OER, 3The Four R's of Openness and ALMS Analysis: Frameworks for Open Educational Resources

<p>The high cost of textbooks is of concern not only to college students but also to society as a whole. Open textbooks promise the same educational benefits as traditional textbooks; however, their efficacy remains largely untested. We report on one community college’s adoption of a collection of open resources across five different mathematics classes. During the 2012 fall semester, 2,043 students in five different courses used these open access resources. We present a comparison between the previous two years in terms of the number of students who withdrew from the courses and the number that completed the courses with a C grade or better. Our analysis suggests that while there was likely no change in these educational outcomes, students who have access to open access materials collectively saved a significant amount of money. Students and faculty were surveyed as to their perceptions of these materials and the results were generally favorable.</p>

Proponents of open educational resources (OER) claim that significant cost savings are possible when open textbooks displace traditional textbooks in the college classroom. We investigated student and faculty perceptions of OER used in a community college context. Over 125 students and 11 faculty from seven colleges responded to an online questionnaire about the cost and quality of the open textbooks used in their classrooms. Results showed that the majority of students and faculty had a positive experience using the open textbooks, appreciated the lower costs, and perceived the texts as being of high quality. The potential implications for OER initiatives at the college level seem large. If primary instructional materials can in fact be made available to students at no or very low cost, without harming learning outcomes, there appears to be a significant opportunity for disruption and innovation in higher education.