Looking in the wrong place for healthcare improvements: a system dynamics study of an accident and emergency department

Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.

(Re)shaping the South Bank: the (post)politics of sustainable place-making

While the private sector has long been in the vanguard of shaping and managing urban environs, under the New Labour government business actors were also heralded as key agents in the delivery of sustainable places. Policy interventions, such as Business Improvement Districts (BIDs), saw business-led local partnerships positioned as key drivers in the production of economically, socially and environmentally sustainable urban communities. This research considers how one business-led body, South Bank Employer’s Group (SBEG), has inserted itself into, and influenced, local (re)development trajectories. Interview, observational and archival data are used to explore how, in a neighbourhood noted for its turbulent and conflictual development past, SBEG has led on a series of regeneration programmes that it asserts will create a “better South Bank for all”. A belief in consensual solutions underscored New Labour’s urban agenda and cast regeneration as a politically neutral process in which different stakeholders can reach mutually beneficial solutions (Southern, 2001). For authors such as Mouffe (2005), the search for consensus represents a move towards a ‘post-political’ approach to governing in which the (necessarily) antagonistic nature of the political is denied. The research utilises writings on the ‘post-political’ condition to frame an empirical exploration of regeneration at the neighbourhood level. It shows how SBEG has brokered a consensual vision of regeneration with the aim of overriding past disagreements about local development. While this may be seen as an attempt to enact what Honig (1993: 3) calls the ‘erasure of resistance from political orderings’ by assuming control of regeneration agendas (see also Baeten, 2009), the research shows that ‘resistances’ to SBEG’s activities continue to be expressed in a series of ways. These resistances suggest that, while increasingly ‘post-political’ in character, local place shaping continues to evidence what Massey (2005: 10) calls the ‘space of loose ends and missing links’ from which political activity can, at least potentially, emerge.

Thin place

This publication is a full colour bi-lingual catalogue for the exhibition Thin Place, curated by Ciara Healy for Oriel Myrddin. It includes artwork by five interdisciplinary artists based in West Wales, the West of Ireland and London. The exhibition, symposium and education programme, funded by the Arts Council of Wales aims to show how the fields of art, literature, science and theology are interconnected, especially when considering the nature of reality, the concept of an otherworld and the prospect of an afterlife. Included in the catalogue are texts especially commissioned for the exhibition by professionals who work in disciplines outside of the art world. It also includes an introductory essay by Ciara Healy.

Meta-morphs: – being a mediator of the ‘thin’ place and ‘thin’ experience in the HE classroom. A paper on the experience of creating transformations in HE teaching and learning

The research which underpins this paper began as a doctoral project exploring archaic beliefs concerning Otherworlds and Thin Places in two particular landscapes - the West Coast of Wales and the West Coast of Ireland. A Thin Place is an ancient Celtic Christian term used to describe a marginal, liminal realm, beyond everyday human experience and perception, where mortals could pass into the Otherworld more readily, or make contact with those in the Otherworld more willingly. To encounter a Thin Place in ancient folklore was significant because it engendered a state of alertness, an awakening to what the theologian John O’ Donohue (2004: 49) called “the primal affection.” These complex notions and terms will be further explored in this paper in relation to Education. Thin Teaching is a pedagogical approach which offers students the space to ruminate on the possibility that their existence can be more and can mean more than the categories they believed they belonged to or felt they should inhabit. Central to the argument then, is that certain places and their inhabitants can become revitalised by sensitively considered teaching methodologies. This raises interesting questions about the role spirituality plays in teaching practice as a tool for healing in the twenty first century.

The IT outsourcing market-place: vendors and their selection

This paper focuses on outsourcing vendors, their characteristics and the vendor selection process. It draws on current research and two research studies, one specifi- cally examining outsourcing vendors and the other examining vendor-client issues. We first outline the development of the market for the outsourcing of information technology/information systems services and activities, then detail the characteristics of different types of vendor companies and their competitive positions, before providing a client perspective to the issue of vendor selection.

Insecure attachment during infancy predicts greater amygdala volumes in early adulthood

Background The quality of the early environment is hypothesized to be an influence on morphological development in key neural areas related to affective responding, but direct evidence to support this possibility is limited. In a 22-year longitudinal study, we examined hippocampal and amygdala volumes in adulthood in relation to early infant attachment status, an important indicator of the quality of the early caregiving environment. Methods Participants (N = 59) were derived from a prospective longitudinal study of the impact of maternal postnatal depression on child development. Infant attachment status (24 Secure; 35 Insecure) was observed at 18 months of age, and MRI assessments were completed at 22 years. Results In line with hypotheses, insecure versus secure infant attachment status was associated with larger amygdala volumes in young adults, an effect that was not accounted for by maternal depression history. We did not find early infant attachment status to predict hippocampal volumes. Conclusions Common variations in the quality of early environment are associated with gross alterations in amygdala morphology in the adult brain. Further research is required to establish the neural changes that underpin the volumetric differences reported here, and any functional implications.

Re-evaluating the place of urban planning history

This commentary seeks to prompt new discussion about the place of urban planning history in the era of contemporary globalisation. Given the deep historic engagement of urban planning thought and practice with ‘place’ shaping and thus with the constitution of society, culture and politics, we ask how relevant is planning's legacy to the shaping of present day cities. Late twentieth century urban sociology, cultural and economic geography have demonstrated the increasing significance of intercity relations and the functional porosity of metropolitan boundaries in the network society, however statutory urban planning systems remain tied to the administrative geographies of states. This ‘territorial fixing’ of practice constrains the operational space of planning and, we argue, also limits its vision to geopolitical scales and agendas that have receding relevance for emerging urban relations. We propose that a re-evaluation of planning history could have an important part to play in addressing this spatial conundrum.

Anna In-Between: Caribbean and not Caribbean: attachment, loss and strange Longing: a conversation with Elizabeth Nunez

Presents an interview with Elizabeth Nunez, author and professor. Nunez discusses the issues on migration, family, and intimacy which are the topics of her novel "Anna In-Between." She explains the demands of the publishing industry that cast a shadow in the world of the novel and the real world of Caribbean writers. This interview was translated by Maria Lusia Ruiz.

Telefantasy tower blocks: space, place and social realism shake-ups in Misfits

This article considers the ways in which British youth telefantasy Misfits (E4, 2009–13) takes up and makes strange urban spaces familiar from social-realist narratives. Filmed on the sprawling East London estate, Thamesmead, the programme chronicles a group of young offenders who are given powers by a freak storm, turning them into ‘ASBO superheroes’. Misfits depends on its British urban landscapes for the assertion of its ‘authenticity’ within British youth television, using spaces and landscapes familiar from urban youth exploitation cinema and television's narratives of the underclass. After situating the series within existing cultural discourses and recent developments in social-realist representations, the article explores how Misfits disrupts what have become signifiers for the ‘real’ – the brutalism of housing estates, the grey of the concrete and sky – by making them strange, turning them into telefantasy. The series presents the estate as an uncanny place: the domestic, social-realist world shifted into a fantastical space by the storm. Through close analysis, this article explores how the familiar spaces become skewed and unsettling to match our protagonists' isolation, shifting bodies and scrambled sense of self.

Attachment, borderline personality, and romantic relationship dysfunction

Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women (N = 58) aged 25–36. Study 2 consisted of a psychiatric sample (N = 138) aged 21–60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction.

Anger, preoccupied attachment and domain disorganisation in borderline personality disorder

Emotional dysregulation and attachment insecurity have been reported in borderline personality disorder (BPD). Domain disorganization, evidenced in poor regulation of emotions and behaviors in relation to the demands of different social domains, may be a distinguishing feature of BPD. Understanding the interplay between these factors may be critical for identifying interacting processes in BPD and potential subtypes of BPD. Therefore, we examined the joint and interactive effects of anger, preoccupied attachment, and domain disorganization on BPD traits in a clinical sample of 128 psychiatric patients. The results suggest that these factors contribute to BPD both independently and in interaction, even when controlling for other personality disorder traits and Axis I symptoms. In regression analyses, the interaction between anger and domain disorganization predicted BPD traits. In recursive partitioning analyses, two possible paths to BPD were identified: high anger combined with high domain disorganization and low anger combined with preoccupied attachment. These results may suggest possible subtypes of BPD or possible mechanisms by which BPD traits are established and maintained.