All at sea? A critical appraisal of the C4 framework for the management of major maritime emergencies (MME)

This study is the result of nearly four decades of professional practice in the maritime industry and, in particular, dealing with shipping emergencies, including many high profile accidents and several hundred lesser, but potentially life-threatening, emergencies. The study uses this knowledge and experience as a basis for undertaking a critical evaluation of the Command, Control, Communication and Coordination (C4) framework that is typically used in dealing with such emergencies. It begins with a brief history and background to the C4 framework in the context of a major maritime emergency (MME). The components of the framework are defined and an exemplar activity map used to describe the framework in detail and the relationship between its components and external influences. A preliminary evaluation of the C4 framework suggested that while it is largely robust in principle, there is considerable evidence to suggest that its utility in the handling of live emergencies is frequently undermined in practice. This finding led to a second phase of evaluation, which attempted to identify optimal operational principles that can contribute to a more effective implementation of the C4 framework in major maritime emergencies. Six command principles (P1-P6) plus one sub-principle (P1a) developed from the author’s career are described and used as a basis upon which to build additional principles. To determine these additional principles, seven case studies based on experience and professional practice, are examined to identify key statements and observations of Favourable (F) and Unfavourable (U) practice. Evaluation and analysis of the key statements and observations led to thirty additional C4 framework principles. A short cross-sectional (latitudinal) survey was also conducted of emergency service professionals to support the professional practice and the principles derived from the case studies. Given the time constraints of this study and the difficulty in maintaining responses over time from all 395 respondents, a longitudinal survey was ruled out. Analysis of the survey led to a further three principles that included qualities required of a commander, and the selection of potential recruits to emergency response organisations, in particular command positions. The six original principles of command (plus one sub-principle) are matched with extant cognitive decision making studies, together with a limited review of the psychology of decision making outside of the maritime context using real life examples, and evaluated for commonality or otherwise of biases and thinking approach. From these appraisals a further 5 principles were identified. In all, a comprehensive list of 46 C4 framework principles is produced that covers command in terms of people (command, skills and knowledge), Process (Design), Resources (Design), Organisation (Design). The 46 principles are classified under 3 headings: Capability, Readiness, Response, producing 26 consolidated principles under 10 sub-headings. The list is further refined to produce three distinct tables of principles in an operational format that can be used by any emergency response organisation. The study, which is based on practical experience and professional practice supported by academic research, concludes that the implementation of the C4 framework for the management of an MME can be significantly flawed, and would benefit from the adoption of many of the principles derived from the author’s own experiences and also from complementary sources. The study also supports the contention that it is the human element in the implementation of the C4 framework that could be improved and that the framework itself is largely fit for purpose. The refined principles derived require actions to be undertaken, some more extensive than others, by commanders, trainers, recruiters and managers before they can be effective. To aid this approach, the principles are marshalled into three key groups, as commonly used by emergency services, as described above. The key groups can be used to aid the formation of simulated exercises for training purposes and for organisational design. In summary, the principles identified provide a foundation for improving the implementation of the C4 framework for the management of MMEs, and for emergencies across all other fields and in many other contexts

Dose–response effect of a whey protein preload on within-day energy intake in lean subjects

The effect of consuming different amounts of whey protein on appetite and energy intake was investigated in two separate studies using randomised, crossover designs. Healthy-weight men and women (range: BMI 19·0–25·0 kg/m2, age 19·4–40·4 years) consumed one of four 400 ml liquid preloads, followed by an ad libitum test meal 90 min later. In study 1, preloads were 1675 kJ with 12·5, 25 or 50 % of energy from protein, and in study 2, preloads were 1047 kJ with 10, 20 or 40 % energy from protein. Flavoured water was used as the control in both the studies. Appetite ratings were collected immediately before 30, 60 and 90 min after consuming the preloads; and immediately, 30 and 60 min after consuming the test meal. In study 1, energy intake following the control preload (4136 (sem 337) kJ) was significantly higher than each of the 12·5 % (3520 (sem 296) kJ), 25 % (3384 (sem 265) kJ) and 50 % (2853 (sem 244) kJ) protein preloads (P < 0·05). Intake after the 12·5 % preload was significantly higher than following 25 and 50 % preloads (P < 0·05). In study 2, energy intake following the control preload (4801 (sem 325) kJ) was higher than following the 10 % (4205 (sem 310) kJ), 20 % (3988 (sem 250) kJ) and 40 % (3801 (sem 245) kJ) protein preloads (P < 0·05). There were no differences in subjective appetite ratings between preloads in either study. These findings indicate a dose–response effect of protein content of the preload on energy intake at a subsequent meal

Broaching the brook : daylighting, community and the ‘stickiness’ of water

Over the last century, under the modern hydraulic model, waterways across the world have been heavily canalized and culverted, driven into underground pipes, drains and sewers. This hydraulic approach has hardwired an isolated water network into the urban fabric, fragmenting erstwhile patterns and dynamics of life, both human and nonhuman. Ecologically, it has been hugely damaging, reducing water quality and biotic diversity, but also socially, disconnecting citizens from the waterways that service and characterize the city. Consequently, since the 1990s, waterway restoration has become widespread as a design solution to degraded rivers and streams, reinstating compromised hydrological, geomorphological and ecological processes. Deculverting or ‘daylighting’, the focus of this paper, is a radical form of restoration, opening up subterranean, culverted waterways often forgotten by communities above ground. Yet, as this paper emphasizes, waterway restoration has tended to privilege ecological over social objectives, while public engagement in project conceptualization has been limited, conducted ‘downstream’ subsequent to planning and design stages. Restoration schemes have therefore tended to reflect the concerns of professionals rather than communities, overlooking their potential for social renewal and change. Drawing on workshop data collected through participatory mapping exercises, this paper explores the case for daylighting a culverted brook in Urmston, Greater Manchester, focusing in particular on the preferences, concerns and knowledge of local residents. The paper compares professional and community perspectives on the preferred scheme design and potential benefits of daylighting, drawing out differences and tensions between them, temporarily ‘unblackboxing’ the brook. It is ventured that daylighting can unleash the social ‘stickiness’ of water, its proclivity to draw and bind together, to revitalize the park, enhancing connection to wildness, attachment to place and sense of community. This is particularly crucial in the face of decreased local authority funding and related crises in park management

Reliable computational quantification of liver fibrosis is compromised by inherent staining variation

Biopsy remains the gold standard measure for staging liver disease, both to inform prognosis and to assess the response to a given treatment. Semiquantitative scores such as the Ishak fibrosis score are used for evaluation. These scores are utilised in clinical trials, with the US Food and Drug Administration mandating particular scores as inclusion criteria for participants and using the change in score as evidence of treatment efficacy. There is an urgent need for improved, quantitative assessment of liver biopsies to detect small incremental changes in liver architecture over the course of a clinical trial. Artificial intelligence (AI) methods have been proposed as a way to increase the amount of information extracted from a biopsy and to potentially remove bias introduced by manual scoring. We have trained and evaluated an AI tool for measuring the amount of scarring in sections of picrosirius red-stained liver. The AI methodology was compared with both manual scoring and widely available colour space thresholding. Four sequential sections from each case were stained on two separate occasions by two independent clinical laboratories using routine protocols to study the effect of inter- and intra-laboratory staining variation on these tools. Finally, we compared these methods to second harmonic generation (SHG) imaging, a stain-free quantitative measure of collagen. Although AI methods provided a modest improvement over simpler computer-assisted measures, staining variation both within and between labs had a dramatic effect on quantitation, with manual assignment of scar proportion the most consistent. Manual assessment also correlated the most strongly with collagen measured by SHG. In conclusion, results suggest that computational measures of liver scarring from stained sections are compromised by inter- and intra-laboratory staining. Stain-free quantitative measurement using SHG avoids staining-related variation and may prove more accurate in detecting small changes in scarring that may occur in therapeutic trials

The reaction ppbar -> Lambda_c-Lambda_cbar close to threshold

Predictions for the charm-production reaction antiproton-proton -> antiLambda_c-Lambda_c for energies near the threshold are presented. The calculations are performed in a meson-exchange framework in close analogy to our earlier study on antiproton-proton -> antiLambda-Lambda by connecting the two processes via SU(4) symmetry. The obtained antiLambda_c-Lambda_c production cross sections are in the order of 1 to 7 \mub, i.e. a factor of around 10 smaller than the corresponding cross sections for antiLambda-Lambda. However, they are 100 to 1000 times larger than predictions of other model calculations in the literature.Comment: 12 pages, 4 figure

Consistency of metabolic responses and appetite sensations under postabsorptive and postprandial conditions

The present study aimed to investigate the reliability of metabolic and subjective appetite responses under fasted conditions and following consumption of a cereal-based breakfast. Twelve healthy, physically active males completed two postabsorption (PA) and two postprandial (PP) trials in a randomised order. In PP trials a cereal based breakfast providing 1859 kJ of energy was consumed. Expired gas samples were used to estimate energy expenditure and fat oxidation and 100 mm visual analogue scales were used to determine appetite sensations at baseline and every 30 min for 120 min. Reliability was assessed using limits of agreement, coefficient of variation (CV), intraclass coefficient of correlation and 95% confidence limits of typical error. The limits of agreement and typical error were 292.0 and 105.5 kJ for total energy expenditure, 9.3 and 3.4 g for total fat oxidation and 22.9 and 8.3 mm for time-averaged AUC for hunger sensations, respectively over the 120 min period in the PP trial. The reliability of energy expenditure and appetite in the 2 h response to a cereal-based breakfast would suggest that an intervention requires a 211 kJ and 16.6 mm difference in total postprandial energy expenditure and time-averaged hunger AUC to be meaningful, fat oxidation would require a 6.7 g difference which may not be sensitive to most meal manipulations