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Overcrowding continues to afflict emergency departments (EDs), and its attendant consequences are becoming increasingly severe. The burden of the COVID-19 pandemic is further escalating the situation worldwide. One of the most critical questions is how to adequately quantify what constitutes overcrowding and determine implications for operations management in improving service efficiency. This paper aims to discuss the aforementioned.

The authors propose the time and class complexity measures for ED service systems, taking into account important patient-level and system characteristics. Using an extensive data set from a Canadian ED, the authors investigate the performance of complexity-based measures in predicting service delays.

The authors find that the complexity measure is potentially more important than some well-known crowding metrics. In particular, EDs can improve service efficiency by managing the level of complexity within a desirable interval. Furthermore, complexity exposes how the interplay between demand-side behavioral changes and supply-side responses affects operational performance. Moreover, the results suggest that arrival patterns—the number of patients of each class arriving per time and times between events (arrivals and service completions)—increase the risk of service delays more than the demand volume.

This paper is the first to provide an extensive investigation into the application of the complexity-based measure for ED crowding. The study demonstrates potential values to be gained in ED service systems if complexity measure is incorporated into their operations management decisions.

This paper aims to present new evidence from the Cambridge Study in Delinquent Development (CSDD) showing the extent to which obstetric (e.g. abnormal birth weight, confinement at birth, severe abnormality of pregnancy, etc.) and early childhood and family factors (illegitimate child, unwanted conception, family overcrowding, etc.) have predictive effects on psychopathic traits measured later in life at age 48 years.

Data collected in the CSDD are analysed. This is a prospective longitudinal study of 411 London men from age 8 to age 61 years.

The results suggest that none of the obstetric problems were predictive of adult psychopathy. However, some other early childhood factors were significant. Unwanted conception (by the mother) was significantly associated with high psychopathy. The likelihood of being an unwanted child was higher when the mother was younger (19 years or less), and when the child was illegitimate. The poor health of the mother and living in an overcrowded family were also significant in predicting psychopathy in adulthood, as well as both psychopathic personality (F1) and psychopathic behaviour (F2).

These findings suggest the influence of very early emotional tensions and problematic social background in predicting psychopathic traits in adulthood (at age 48 years). They also emphasise the importance of investigating further the very early roots of psychopathic traits.

As host to over one million Syrian refugees, Lebanon continues to experience challenges addressing the needs of refugee families. This research examined the experiences of Syrian families with the refugee support system in Lebanon. The purpose of this study was to better understand the strengths and gaps in existing mechanisms of support for these Syrian families, including informal support from family, neighbors and community and more formalized support provided through entities such as nongovernmental organizations and United Nations agencies.

Data were collected from 46 families displaced by the war and living in Lebanon (N = 351 individuals within 46 families). Collaborative family interviews were conducted with parents, children and often extended family.

The data identified both strengths and gaps in the refugee support system in Lebanon. Gaps in the refugee support system included inadequate housing, a lack of financial and economic support, challenges with a lack of psychosocial support for pregnant women and support for disabled youth. Despite these challenges, families and community workers reported informal community support as a strong mediator of the challenges in Lebanon. Furthermore, the data find that organizations working with Syrian families are utilizing informal community support through capacity building, to create more effective and sustainable support services.

This study provides an overview of strengths and gaps in supports identified by refugees themselves. The research will inform the development and improvement of better support systems in Lebanon and in other refugee–hosting contexts.

A primary urban destination can be accessed through its regional periphery. Thus, while a city centre may be the primary attraction, by approaching it from and through the periphery, suburbs can become part of the place and marginalised people as part of the destination from a more holistic perspective. Tourists who are more attuned to the various layers of the transformation of a destination may be more attentive visitors and might empathise and engage with the lives and survival of others when given an opportunity to reflect on other elements of the destination beyond the central area. As part of a field trip to Rome, the Chair of Tourism of the Catholic University Eichstätt-Ingolstadt explored the inequalities at the periphery of Rome as a destination with undergraduate students from the Faculty of Mathematics and Geography. The results show that a holistic impression and deep understanding of a destination can only be gained by visiting both: its centre and its periphery. Moreover, the centre and periphery of a destination can then be compared in terms of, for example, poor or rich, well kept or unkempt, or native or migrant. However, these comparisons should not be used to look at poverty or similar factors, but to develop an awareness of differences and to look behind the typical tourist zones of a destination. In this case, we suggest that tourist routes can be key in providing a more holistic experience in an historic city.

This chapter discusses how an urban regeneration process, with culture as an economic asset, can contribute to creating a city brand and identity for the city of Mestre, a new habitat, and economic opportunities for the local community, as well as helping neighboring Venice tackle overtourism. This chapter highlights that places suffering from undertourism often are located closely to those suffering from overtourism. Urban regeneration policies driven by culture can be a key solution for both places, by creating a new future, identity, and economic opportunities for one community and for the other, in helping to regulate their touristic flows.

This study aims to disclose the antecedent factors for predicting support for cruise tourism in the Bahamas. It investigated the relationship between residents’ support for cruise tourism and the four indicators that were the positive/negative impact of cruise tourism on the community, perceived conflicts in sharing information and concerns about the COVID-19 pandemic.

Using 278 surveys of local residents near major cruise ports in the Bahamas, this study identified the salient variables in tourism impact and conflict factors. The survey questionnaire was adapted and developed from relevant studies and modified to suit the context of cruise tourism.

The results revealed that residents’ perceived conflict was insignificantly associated with their support for cruise tourism. In contrast, their concerns about COVID-19 and perceptions of the positive and negative cruise tourism impacts were statistically significant in predicting the likelihood of support for tourism.

This study suggests implications for enhancing the long-term growth of the cruise industry, which is vulnerable to environmental threats such as Covid-19.