Port resilience: a primer

The aim of this conceptual paper is to help stimulate further research and enquiry into UK Port Resilience and is a product of the EPSRC funded Knowledge Transfer Collaboration between the University of Nottingham and the Department for Transport (DfT). The paper draws on collaborative work between the authors and senior policy makers within the DfT, as well as on workshops, meetings and an extensive interview series with members of the UK’s port sector in order to address four key questions: • How important are ports for the UK? • How vulnerable are UK ports? • How do ports currently prepare themselves against vulnerabilities? • How can port resilience be improved? Interim drafts of the paper were also circulated across Whitehall for further comment and input. The views presented in this paper as well as any errors or misrepresentations remain those of the authors alone

Multi-level port resilience planning in the UK: how can information sharing be made easier?

Port resilience planning is a subset of the wider disaster resilience literature and it is concerned with how port stakeholders work together to make port systems more resilience. Port stakeholders include government departments, the port operator, ship operators, importers, agents and logistics firms. Ports are vital for the operation of cities and whole countries, especial island nations like the UK. Single port systems are multi-level systems with complex operational-level relationships and interdependencies. Additional levels to this include government and the policy-level. Preparing for the crises and disasters that might befall ports requires information sharing between stakeholders about key dependencies and alternative actions. The complexity of ports presents barriers to information sharing; as do commercial and political sensitivities. This paper uses a multi-level case study on the UK's system of ports to propose an approach to information sharing that uses the subjectivity of information from a supplier's perspective and from a user's perspective to reduce barriers of complexity, confidentiality and political sensitivity

Resilience orchestration and resilience facilitation: how government can orchestrate the whole UK ports market with limited resources: the case of UK ports resilience

Government departments have limited resources but they are responsible for the healthy functioning of whole markets. This tension is amplified by the opportunities to generate, share and use information from new data sources and digital technologies. Huge increases in volumes and types of data produced by sensors and firms' IT systems can potentially be shared between firms which can cause information overload. This paper uses government orchestration theory to investigate the problems and opportunities of the UK's maritime transport ministry as it supports resilience planning for the whole country's ports system. We build on the developing Lean Government (l-Government) literature by theorizing on the differences between government and other stakeholders. We use a case study to investigate how these differences hinder as well as support the role of a government department. And how the special perspective of an orchestrator can integrate and filter information, motivate diverse collaborators and support the use of orchestration platforms in l-Government

A digital information model framework for uas-enabled bridge inspection

Unmanned aerial systems (UAS) provide two main functions with regards to bridge inspections: (1) high-quality digital imaging to detect element defects; (2) spatial point cloud data for the reconstruction of 3D asset models. With UAS being a relatively new inspection method, there is little in the way of existing framework for storing, processing and managing the resulting inspection data. This study has proposed a novel methodology for a digital information model covering data acquisition through to a 3D GIS visualisation environment, also capable of integrating within a bridge management system (BMS). Previous efforts focusing on visualisation functionality have focused on BIM and GIS as separate entities, which has a number of problems associated with it. This methodology has a core focus on the integration of BIM and GIS, providing an effective and efficient information model, which provides vital visual context to inspectors and users of the BMS. Three-dimensional GIS visualisation allows the user to navigate through a fully interactive environment, where element level inspection information can be obtained through point-and-click operations on the 3D structural model. Two visualisation environments were created: a web-based GIS application and a desktop solution. Both environments develop a fully interactive, user-friendly model which have fulfilled the aims of coordinating and streamlining the BMS process.publishedVersio

Port resilience: a primer

The aim of this conceptual paper is to help stimulate further research and enquiry into UK Port Resilience and is a product of the EPSRC funded Knowledge Transfer Collaboration between the University of Nottingham and the Department for Transport (DfT). The paper draws on collaborative work between the authors and senior policy makers within the DfT, as well as on workshops, meetings and an extensive interview series with members of the UK’s port sector in order to address four key questions:• How important are ports for the UK?• How vulnerable are UK ports?• How do ports currently prepare themselves against vulnerabilities?• How can port resilience be improved?Interim drafts of the paper were also circulated across Whitehall for further comment and input. The views presented in this paper as well as any errors or misrepresentations remain those of the authors alone

Piloting Upfront Xpert MTB/RIF Testing on Various Specimens under Programmatic Conditions for Diagnosis of TB & DR-TB in Paediatric Population

India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB/RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO.Xpert MTB/RIF testing was offered to all paediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities in the project areas covering 4 cities of India.Under this pilot project, 8,370 paediatric presumptive TB & presumptive DR-TB cases were tested between April and-November 2014. Overall, 9,149 specimens were tested, of which 4,445 (48.6%) were non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI 99.0-99.4) valid results. Of the 8,143 presumptive TB cases enrolled, 517 (6.3%, CI 5.8-6.9) were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB/RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project.Xpert MTB/RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance

Port resilience: a primer

The aim of this conceptual paper is to help stimulate further research and enquiry into UK Port Resilience and is a product of the EPSRC funded Knowledge Transfer Collaboration between the University of Nottingham and the Department for Transport (DfT). The paper draws on collaborative work between the authors and senior policy makers within the DfT, as well as on workshops, meetings and an extensive interview series with members of the UK’s port sector in order to address four key questions: • How important are ports for the UK? • How vulnerable are UK ports? • How do ports currently prepare themselves against vulnerabilities? • How can port resilience be improved? Interim drafts of the paper were also circulated across Whitehall for further comment and input. The views presented in this paper as well as any errors or misrepresentations remain those of the authors alone

Upfront Xpert MTB/RIF testing on various specimen types for presumptive infant TB cases for early and appropriate treatment initiation.

BACKGROUND:Diagnosis of tuberculosis (TB) in infants is challenging due to non-specific clinical presentations of the disease in this age-group and low sensitivity of widely available TB diagnostic tools, which in turn delays prompt access to TB treatment. Upfront access to Xpert/MTB RIF (Xpert) testing, a highly sensitive and specific rapid diagnostic tool, could potentially address some of these challenges. Under the current project, we assessed the utility and feasibility of applying upfront Xpert for diagnosis of tuberculosis in infants, including for testing of non-sputum specimens. METHODS:A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city, through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all infant (<2 years of age) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. RESULTS:A total of 7,994 presumptive infant TB cases were enrolled in the project from April 2014 to October 2016, detecting 465 (5.8%, CI: 5.3-6.4) TB cases. The majority (93.9%; CI: 93.4-94.4) of patient specimens were non-sputum and TB positivity was higher amongst non-sputum specimens. Further, a high proportion (5.6% CI 3.8-8.1) of infant TB cases were found to be rifampicin resistant. Covering large cities with a single lab per city over more than two years, the project demonstrated the feasibility of same-day diagnosis with upfront Xpert testing. This in turn led to prompt treatment initiation, with a two-day median turnaround time to treatment initiation. Case mortality observed in the project cohort of diagnosed TB cases was 11.0% (CI 8.4-14.1), the majority of which was pre- or early treatment mortality, in spite of prompt access to treatment for most diagnosed cases. CONCLUSION:The current project demonstrated the feasibility of applying rapid and upfront Xpert testing for presumptive infant TB cases. Rapid TB diagnosis in turn facilitates prompt and appropriate treatment initiation. Further, levels of rifampicin resistance observed in infants TB cases highlight the additional benefit of upfront resistance testing. However, high rates of early case mortality, in spite of prompt diagnosis and treatment initiation, highlight the need for further research in infant patient pathways for overall improvement in TB care for infant populations

Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India.

Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care.A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all pediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities.The current project enrolled 42,238 pediatric presumptive TB cases from April, 2014 to June, 2016. A total of 3,340 (7.91%, CI 7.65-8.17) bacteriologically confirmed TB cases were detected, of which 295 (8.83%, CI 7.9-9.86) were rifampicin-resistant. The level of rifampicin resistance in the project cohort was high. Overall Xpert yielded a high proportion of valid results and TB detection rates were more than three-fold higher than smear microscopy. The project provided same-day testing and early availability of results led to rapid treatment initiation and success rates and very low rates of treatment failure and loss to follow-up.The current project demonstrated the feasibility of rolling out rapid and upfront Xpert testing for pediatric presumptive TB cases through a single Xpert lab per city in an efficient manner. Rapid turnaround testing time facilitated prompt and appropriate treatment initiation. These results suggest that the upfront Xpert assay is a promising solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population