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Received 12th May 2021. Accepted 17th May 2021. Published online 28th May 2021. Issue published 1st August 2021.

A short-cut review of the literature was carried out to examine the diagnostic test characteristics and potential patient benefits through the use of the Ottawa Subarachnoid Haemorrhage Clinical Decision Rule. Nine papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that the Ottawa Clinical Decision Rule has a high sensitivity for the diagnosis of subarachnoid haemorrhage; however, there is limited robust evidence of international generalisability and no evidence of improved patient outcomes following implementation. Further prospective research is required in populations with variable prevalence to evaluate the safety and effectiveness of this intervention, compared with routine evaluation strategies.

Background: The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of a multiple pandemic waves, longitudinal data on the impact of COVID-19 is vital to ensure an adequate psychological response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in Emergency Medicine (EM), Anaesthetics and Intensive Care Medicine (ICM) doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported. Methods: A prospective online three-part longitudinal survey of frontline doctors across the UK and Ireland, administered at the acceleration, peak and deceleration of the COVID-19 first wave. Primary outcome measures were psychological distress and trauma, measured using the General Health Questionnaire-12 and the Impact of Events-Revised. Findings: Acceleration survey response rate was 15.9% (n=5440), of an estimated 34,188 doctors. Peak and deceleration response rates were 71·6% (n=3896) and 56·6% (n=3079) respectively. Prevalence of psychological distress was 44·7% (n=1334) during the acceleration, 36·9% (n=1098) at peak and 31·5% (n=918) at the deceleration phase. The prevalence of trauma was 23·7% (n=647) at peak and 17·7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12·6% (n=343) at peak and 10·1% (n=276) at deceleration. Worry of family infection due to clinical work was most strongly associated with both distress (R2 = 0·06) and trauma (R2 =0·10). Interpretation: Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a)provision of vital equipment to mitigate physical and psychological harm (b)increased awareness and recognition of signs of psychological distress and (c)the development of clear pathways to effective psychological care. Funding: Funding received from the Royal College of Emergency Medicine. Declaration of Interests: Many of the authors have been working as frontline clinicians during the COVID-19 pandemic. They have no competing interests to declare. Ethics Approval Statement: Ethical approval was obtained from the University of Bath (UK) and Children’s Health Ethics Committee (Ireland). Regulatory approval was obtained from the Health Regulation Authority (UK), Health and Care Research Wales. Participants provided electronic informed consent for each survey.

Safety Management Systems were initially developed two decades ago and some have stood the test of time well, having since been expanded to include health issues and later environmental issues. In 1994 OGP (the International Association of Oil & Gas Producers) presented a model for an Upstream Industry Health, Safety & Environmental Management System which has been adopted widely by member Companies and their Contractors. However, emerging knowledge and recent catastrophic events have highlighted the need not only for change, but for an encompassing management system to address all Operating Risks. This has application across the petroleum industry, both for large mature multinationals and for smaller newer ventures, not to mention support Companies. A simple but powerful model for an Operating Management System (OMS) will assist established Operators to address differences in embedded systems, to challenge thinking, and it will inspire newer Operators to develop their own systems in such a way as to treat risks holistically rather than in a compartmentalised or "silo" way of thinking. A framework management system model was published in April 2012 and this is being followed by roll-out of the full system and a virtual toolkit of good practice during late 2012/early 2013 along with collaboration with Stakeholder Organisations. Results and observations are therefore premature but there is a strong drive from OGP and IPIECA (the International Petroleum Industry Environmental Conservation Association) members to push the work forward. This joint OGP/IPIECA initiative is highly significant in moving risk management and operational performance forward at a time when the petroleum industry faces serious negative public concerns and regulatory challenges. Many of the OGP and IPIECA member Companies and other associations utilize the current model (Report 210) either directly or indirectly. The time is therefore ripe for change and the OGP Task Force has embraced that opportunity. This SPE paper looks from the Task Force Chairman's perspective at; the drivers for change in management systems thinking, the progression and direction of the OGP/IPIECA Task Force work and its modus operandi, the current status of the work and the future deliverables which can be anticipated along with the benefits which this should bring.

The objective of this paper is to share the development of the crisis/ emergency response system and how it effectively helped save human lives during the project phase by timely evacuations when required Yemen LNG Company faced the challenge to undertake the largest ever industrial investment project in Yemen – namely constructing an LNG terminal and pipeline to provide gas to the international markets from the remotest and poorest areas of Yemen. Yemen is ranked among the poorest countries in the world according to the World Bank indicators. Constant security threats, coupled with the omnipresent tribal conflicts make it a high risk context in which to operate. In spite of these major hindrances, the Company was able to complete the project in a safe manner in spite of having mobilized significant man-power (the peak being over 13,000 personnel), The multinational team of up to 67 nationalities at site gelled together to produce the end result and are proud of having achieved an undertaking whose safety record is one of the best of any major project being undertaken by a member company of the Internaqtional Association of Oil & Gas Producers (OGP). This was achieved by having developed a crisis / emergency response system which was in place from the early stages of the project. Emergencies both within the project area and also for humanitarian reasons were dealt with in an effective manner. The systems were developed/ implemented and were exercised in a way such that there was a constant improvement process ongoing which incorporated the learnings at all times. The importance of having such systems in place cannot be overstated, especially in a country like Yemen where the state emergency response infrastructure and facilities are not available to be called upon. Not only did the project people benefit from this initiative, but people outside the project locus also benefited, as a number of emergencies were dealt with on humanitarian grounds. The paper highlights the processes that were followed in order to achieve the results of evacuating personnel safely to secure destinations.

SUMMARY The main objective of this paper is to provide significant new knowledge and experience on conducting Labour Risk Audits and the implementation of Labour Risk Management Programmes in order to create and maintain labour stability and strengthen the operation's social license to operate. Unsatisfactory labour practices and welfare conditions pose an operational and reputational risk to all projects, in addition to potential labour instability and the resultant negative effects on project and operational efficiencies, the perceptions of local communities and their future support during the operations phase could be positively or negatively influenced by the experience of local workers on site, which, in turn, could affect the project's social license to operate. The Yemen Liquefied Natural Gas project (Yemen LNG) will be, at over $US4 billion, the largest project in the country's history and utilised Labour Risk Audits and Labour Risk Management in order to create workforce stability and to retain and strengthen their social license to operate. At the peak of construction up to 12,000 workers of at least 60 nationalities were present on site, which in its itself posed unique challenges to the management of labour relations in a culturally diverse context. The Labour Risk Audits covered areas such as organisational design, human resources administration and the terms and conditions of employment, while Labour Risk Management focused on legal compliance in terms of Yemeni Labour Law and related legislation, welfare (i.e. camp standards, living conditions and catering), demobilisation of workers, and the monitoring of labour risk indicators (e.g. grievances). The paper describes the results and ratifies the need for Labour Risk Audits and Labour Risk Management on similar projects, as all could benefit from a stable and productive workforce, which in turn will also enhance the company's reputation and ensure a continued social license to operate.

This paper describes Yemen LNG's innovative approach to managing Yemen's cultural heritage during construction of a liquefied natural gas (LNG) plant at Balhaf and a 320 km gas supply pipeline, both of which are located in one of the richest archaeological areas in a country with a rare and deep cultural history. Yemen LNG has developed a Cultural Heritage Action Plan (CHAP) to translate Yemen LNG's commitments and strategy for cultural heritage preservation and conservation in all its operational areas into practical actions. Although Yemen LNG-initiated cultural heritage actions should complement national cultural heritage management priorities to be effective, such a national strategy does not yet exist. Yemen LNG is therefore pioneering cultural heritage management in Yemen through its CHAP. Yemen LNG's presentation of the CHAP, and its objectives and actions to Government, and public and private stakeholders is discussed. The feedback it has received from stakeholders is also presented and evaluated.This paper summarises the:■ cultural heritage of the Balhaf plant site and along the pipeline corridor; ■ main goals and priority objectives for preserving and conserving the cultural heritage present; ■ methods and mechanisms for achieving these objectives in the form of an action list; ■ phased approach to implementing actions initially during construction and then during plant operations; and ■ status of implementation for the actions addressed in the CHAP.As cultural heritage preservation is not only an essential cultural consideration but also an increasingly important legal and economic requirement, the CHAP also addresses cultural heritage related matters in contexts beyond the Yemen LNG project area.

The main objective of this article is to provide significant new knowledge on the utilization of institutional and community focal points as a tool used in Yemen to communicate and manage information between the Company and its project neighbours to foster a stable and understanding environment. Taking into account that these institutional and community focal points are dedicated and voluntary stakeholders, the focal point system for communication is unique as it supports effective project implementation geared towards sustainable stability during the Operations phase of the Project. As the country's largest-ever industrial investment project, it is essential for Yemen LNG Company to raise awareness of the Project activities among affected communities, and to define and manage stakeholder issues and expectations. The Company has developed a Public Consultation and Disclosure Plan (PCDP) and Community Development Programs (CDPs) to support a stable operating environment, to develop long-term relationships with project stakeholders and to bring social and environmental benefits to key stakeholders which translate into long-term self-sustained development. The tribal context, local governance, institutional structures and socio-economic and socio-cultural conditions in the operating locus are challenging, and in-depth knowledge of these characteristics was essential to translate it into appropriate communication tools and messages to achieve the desired objectives. Throughout the Project, a great deal of experience, research and information about stakeholders, especially the neighbouring tribal communities and relations with them, their level of comprehension about the project and the social and cultural structures which govern behaviours and access to information have been gathered. Taking into account that effective communication tools have to be sensitive and appropriate, in order to ensure the participation of stakeholders, knowledge of the area in which the Project operates and its characteristics (including geographical information, tribal structures and affiliations, socio-economic and socio-cultural circumstances, as well as lessons learned from the Construction phase of the project) is important to optimize communication through community and institutional focal points to ensure social stability. This has much wider application for large construction projects in culturally sensitive areas.

Description - This paper describes how Yemen LNG has effectively managed the HSE aspects of contractor performance on a large construction project/operation in Yemen. Application - Contracted work with respect to the management of HSE presents a constant challenge for any company. Yemen LNG Ltd considers that dealing with contracted work is one of the Company's top priorities, in the sense that contractors should have HSE systems in place so that the work is carried out safely without any harm to staff, assets or the environment. Contractor management in Yemen presents many challenges as in many instances the indigenous workforce will have only a very basic knowledge of HSE, poor management systems and unskilled personnel. Results - Yemen LNG has over recent years been working on the improvement of the process applied to contracted work, from prequalification to the actual management of the selected contractor to carry out work. It encourages local contractors to participate in work and as part of their capacity development of the local company's works together with the companies to step by step enhance their competence. The capacity of local companies is also to build by partnering with other companies. The process which YLNG has adopted is to encourage local contractors to undertake jobs at the appropriate skill level and at the same time provide support through training & inspections/audits which are carried out at various stages of the contractual cycle. Significance - The basis of our prequalification is to determine how effectively potential contractors identify and manage hazards. We expect that potential contractors will develop a systematic approach and comprehensive plans to address such issues through documentation and work practices. Our goal is to actively encourage the alignment of our HSE cultures in a climate of continuous improvement. This is an area in which a large part of our effort is applied. If we feel that an individual contract doesn't meet the company's requirements or standards, we take the initiative to assist contractors both pre and post award to meet the company's standards

As the country's largest-ever industrial investment project, it is essential for Yemen LNG Company (hereinafter referred to as the Company) to raise awareness of the Project activities among affected communities, and to define and manage stakeholder expectations. This paper describes the formation and implementation of the Company's innovative Public Consultation and Disclosure Plan (PCDP).Implementing the PCDP is a continuous process to ensure ongoing consultation and engagement between the Company, the communities, Government, NGOs and the media. This has included the development of; a field-based community relations team, project awareness campaigns (school visits and village open houses), high-level open houses, press conferences, community newsletters and the formation of a grievance mechanism to ensure that all grievances are recognized, recorded and followed-up. The paper therefore has transverse application to similar large energy projects in developing countries which have poor indigenous educational and awareness standards.The Company developed the PCDP to guide and outline the consultation and stakeholder activities from the Project's pre- construction phase through to the operations and decommissioning phases. When formulating this PCDP, the specific circumstances in Yemen, associated challenges and the tribal-cultural environment had to be carefully considered. A consultative public participation process creates trust and builds relationships. Consulting with the communities plays a critical role in raising awareness of a project's impact and developing long-term stable relationships with those affected by the project, particularly the marginalized and vulnerable groups.Throughout the Project, a great deal of experience, research and information about the affected communities, their level of comprehension of the project and the social and cultural structures which govern behaviour and access to information have been gathered. This paper shows how the implementation of a well-informed, culturally relevant plan can effectively be used to manage, engage, inform and gather feedback from stakeholders in a collaborative manner and it evaluates how the challenges were addressed. The communication strategies, tools and lessons learned were significant, and they provide excellent examples to other projects of effective communication techniques which, when adapted to specific cultural circumstances, can be appropriately used in any large energy development project.

This paper describes the implementation of an innovative biodiversity management strategy in a difficult context. The paper has transverse application to similar large energy projects in third word countries where construction might impact sensitive ecosystems. The Biodiversity Action Plan (BAP) was developed in line with international standards and also to empathise with the objectives of the draft Yemeni biodiversity strategy and action plan. In addition, the company carried out biodiversity baseline survey, environmental and social impact assessment studies which translated into two World Bank compliant environmental and social management plans (ESMP) for the construction and operation phase of the project. The BAP describes the biodiversity status of Balhaf and the surrounding coastal area, setting targets for ecological conservation and outlining the mechanisms for achieving these targets, in addition to developing dynamic indicators, which will help to identify any beneficial effects. The BAP also contributes to the conservation of Yemeni biodiversity beyond the affected area. Furthermore, it deals with biodiversity and related socioeconomic aspects which will be implemented during construction, and longer term protection of biodiversity during the operation phase, in addition to promoting scientific development research and capacity building. Following pre-construction surveys, the little known coastline was discovered to be rich in very sensitive and diverse corals which play an important habitat role, contributing to the local artisanal fisheries, and a prime resource in this impoverished region. Nevertheless, Yemen lacks any specific legislation relating to biodiversity preservation, which would mandate significant new projects to develop a specific biodiversity management strategy. However, due to the ecological sensitivity of the site, Yemen LNG decided to voluntarily put in place a biodiversity action plan which is directed towards the conservation and sustainable development of biodiversity and the economic livelihood of local fisheries

This paper describes Yemen LNG approach to the preservation of cultural heritage during constructing of its project, which comprises a LNG plant and a 320km pipeline, both of which are located in one of the richest archaeological areas in a Country with a rare and deep cultural history, thus presenting a great challenge to control the impact of the project activities on cultural heritage. The Yemen LNG project and its locus are described in the paper noting that the Yemen LNG project is the largest industrial investment project ever implemented in Yemen. This paper also gives a short background describing the archaeological landscape of Yemen in general and the archaeological landscape of the project area. The paper then discusses the innovative cultural heritage preservation strategy and management plans which Yemen LNG has adopted to mitigate impacts to cultural heritage. The strategy is based on three principles: knowing archaeology, preserving it and monitoring cultural heritage during construction. Knowledge of cultural heritage is the starting point and the archaeological baseline surveys and studies highlight the sites in the plant and along the pipeline route. These surveys were followed by a comprehensive archaeological documentation covering all the archaeological sites in the project areas. Second is elimination or mitigation of potential impact on cultural heritage, a good example of this effort is that the pipeline was rerouted at several points to avoid damage to archaeological sites, equally, at the plant site at Balhaf, the plant layout was re-designed to preserve key sites (including a historic Cemetery) located inside the plant. To ensure that impacts are mitigated to ALARP, the third level of action is to ensure avoidance of direct or indirect damage to the archaeological sites, by conducting daily monitoring, additionally a team of archaeologists worked ahead of construction to monitor sensitive sites and to ensure that appropriate protection measures were taken before construction began. The paper shares lessons learned from 4 years of managing sensitive archaeological sites and it proposes learning points for future large energy projects which face challenges in sensitive cultural heritage environments. This subject is vitally important in a context where the expectations of stakeholders are that energy Companies should be sensitive to cultural heritage and should respect important archaeological sites.

Yemen is ranked among the poorest countries in the world, according to World Bank indicators. Constant security threats, coupled with persistent tribal conflicts make it a high risk context within which to operate. In spite of these major hindrances, the consortium of seven International Companies who are shareholders in Yemen LNG, led by Total, took on the challenge to undertake the largest ever industrial investment project in Yemen – namely constructing an LNG terminal and pipeline to provide gas to the international markets from an area which is one of the remotest and poorest of Yemen. The engineering resource, infrastructure and the human capital required to undertake this huge project have proven to be the biggest challenge. The mobilization required significant manpower (the peak being over 14,000 personnel); a large proportion of whom came from the local community. They had to be trained to come up from a "zero safety culture" in order to meet the required international standards and to be able to work together in spite of individual and tribal differences. The multinational team of up to 67 nationalities on the site gelled together to produce the end result and are proud of having achieved an undertaking, whose safety record is one of the best of any major project being undertaken by an OGP member company. This achievement in the face of the aforementioned challenges, not normally faced by businesses elsewhere, is a real credit to the team spirit and indomitable faith in project success. This could not have been possible without the safe working environment culture which was inculcated in the largely uneducated workforce, serving the needs of the project. Through capacity building and interface at grass root levels between the tribes, the government and the local nomadic communities, the stakeholders were encouraged to share a common platform. At the start of each phase regular dialogue, needs assessments and a follow-up mechanism were implemented. Training and development initiatives were undertaken with the local communities. From changing mindsets to introducing better practices and creating a harmonious work environment, the challenge has been considerable. The bottom line is that awareness of the benefits of working together in a safe environment brings safety success.

The paper commences by describing Yemen LNG's approach to the control of impacts on marine biodiversity, which mirrors its general 3-tier approach to managing social and environmental impacts. The paper recognises that some minor physical damages to corals may occur during the construction of a new LNG terminal in a sensitive coastal environment, in which detailed surveys have found the coral and fish populations to be particularly sensitive and diverse. The paper then discusses a unique and innovative approach which Yemen LNG has adopted to mitigate impacts to corals. Yemen LNG is working with internationally recognised coral transplantation experts to transplant sensitive corals away from the areas of construction activities, to new areas nearby, to promote new populations and new growth on natural substrata. The scale of this exercise is larger than has ever been attempted and the corals which have been transplanted represent particularly sensitive and diverse species. The largest coral transplanted so far has been recorded at 4000kg, believed to be the largest coral ever transplanted successfully. It is believed that this is the largest and most successful exercise in coral transplantation ever attempted by an energy company. The paper describes the positive results from this innovative transplantation project in which transplanted coral colonies of differing sensitive genus are regularly monitored and found to be healthy and repopulating on natural substrate. The paper also records the positive effect on fish populations whereby demersal species are seen to relocate to the new coral areas thus creating new and sustainable biomass. The conclusion is reached that coral transplantation, on a larger scale than has ever before been attempted, can be a successful mitigation measure when dealing with potential construction impacts. This offers a positive way forward when constructing installations in sensitive coastal marine environments.

Helicobacter pylori is believed to trigger neutrophil activation through several factors, including the H. pylori neutrophil-activating protein (HpNAP). The aim of this study was to characterise the factors within H. pylori cell-free extracts that stimulate neutrophil activation. Neutrophil activation was found to be dose-dependent and exhibited considerable variation between different clinical isolates. Activity was attributable to more than one protein factor. A low mol. wt fraction of

DNA-DNA hybridization studies have demonstrated the physical relatedness of the fertility inhibition gene, finO, among both FinO+ and FinO- F-like conjugative plasmids, viz. ColV2-K94, R100-1,R1drd19,R1,R6-5, UCR123, R386, p307, R453, R773, and pIP162-1. Furthermore, the data indicate that finO sequences on the FinO- plasmid ColV2-K94 map downstream of the transfer region, within 93.6-95.3 ColV2-K94.

The Yemen LNG plant construction started in September 2005 in Balhaf in the Gulf of Aden and lasted over 4 years. The 1 km2 plant, within a 10 km2 fenced site, lies along 7 km of coastline. This paper describes the approach of Yemen LNG along with its main shareholder Total E&P, concerning the protection of the coral biodiversity during marine construction activities in a sensitive environment. This approach was developed according to three stages: establishing biodiversity, monitoring coral communities and protecting the reef ecosystem with mitigation and compensation means. Knowledge of the coral biodiversity was an indispensable preliminary stage to evaluate the sensitivity of the site. The Environmental Baseline Studies have highlighted the richness of the marine ecosystem. The plant is bordered by a dense, diversified coral community forming a narrow reef extending from the shore to a depth of 15 metres. Almost 85 coral species occur in the reefs, colonizing about 85% of the substrate. The largest coral colonies are approximately 400 years old. Therefore, these corals are a valuable and delicate resource. Monitoring composition and diversity of corals communities is considered an integral part of biodiversity conservation. The monitoring plan allowed to measure several parametres: some of which were related to the natural environment, others measured the effects of the works on water quality and finally, most observations included a direct measurement of coral community health. Protecting the reef ecosystem by implementing mitigation and compensation measures is aimed at keeping reef biodiversity at its highest level by preventing and/or reducing the negative impacts on the ecosystem. Initially, part of the marine construction work encroached on existing coral outcrops. A planned, but not yet implemented, Marine Protected Area nearby also increased the pressure on the construction teams who had to fulfill the Social and Environmental Impact Assessment Study requirements as well as World Bank and IFC standards. It is recognized that some limited physical damage to corals occurred despite the implementation of these mitigation measures. Lessons learned from the monitoring will be used to provide feedback to the industry in general. This offers a positive way forward when constructing installations in sensitive coastal marine environments.