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Barriers and solutions for global access to osteoporosis management: a position paper from the international osteoporosis foundation
Get PDFOur ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fractures and osteoporosis in older age were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric definitions of osteoporosis, cementing the role of dual-energy X-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called “osteoporosis”, one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual’s absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them
Robustness requirement coverage using a Situation Coverage Approach for Vision-based AI Systems
Get PDFAI-based robots and vehicles are expected to operate safely in complex and dynamic environments, even in the presence of component degradation. In such systems, perception relies on sensors such as cameras to capture environmental data, which is then processed by AI models to support decision-making. However, degradation in sensor performance directly impacts input data quality and can impair AI inference. Specifying safety requirements for all possible sensor degradation scenarios leads to unmanageable complexity and inevitable gaps. In this position paper, we present a novel framework that integrates camera noise factor identification with situation coverage analysis to systematically elicit robustness-related safety requirements for AI-based perception systems. We focus specifically on camera degradation in the automotive domain. Building on an existing framework for identifying degradation modes, we propose involving domain, sensor, and safety experts, and incorporating Operational Design Domain specifications to extend the degradation model by incorporating noise factors relevant to AI performance. Situation coverage analysis is then applied to identify representative operational contexts. This work marks an initial step toward integrating noise factor analysis and situational coverage to support principled formulation and completeness assessment of robustness requirements for camera-based AI perception
Fretting wear in raceway-ball contact under wind turbine pitch bearing operating conditions
Get PDFThis paper investigates wear in wind turbine pitch bearings resulting from small-amplitude oscillations. The investigation focuses on assessing the impact of key parameters influencing wear damage. A new medium-scale test rig has been designed, enabling cost-efficient and accelerated tests to replicate fretting wear damage under simplified operating conditions of wind turbine pitch bearings. Through experimental result analysis, this study examines the influence of oscillation amplitude, contact force, oscillation frequency, presence of lubrication, and contact geometry on wear damage. A finite element model is also developed to obtain the frictional energy density to compare with experimentally measured wear depth to obtain new insights of the effect of the contact variables on wear damage. It has been found that most of the wear damage takes place at the location where the maximum sliding occurs but not at the location of the maximum contact pressure, while the contact geometry has an important impact on the wear damage. Controlling oscillation amplitude and contact pressure are effective ways to mitigate wear damage due to small-amplitude oscillations in wind turbine pitch bearings
Family history of fracture and fracture risk: a meta-analysis to update the FRAX® risk assessment tool
Get PDFSummary
In the largest meta-analysis of international cohorts to date, a family history of fracture is confirmed as a significant BMD-independent predictor of future fracture risk. Parental and sibling histories of fracture carry the same significance for future fracture, including the impact of family hip fracture on future hip fracture risk.
Purpose
We have undertaken a meta-analysis of international prospective cohorts to quantify the relationship between a family history of fracture and future fracture incidence.
Methods
The analysis dataset comprised 350,542 men and women from 42 cohorts in 29 countries followed for 2.8 million person-years. We investigated the relationship between family history of hip fracture or any fracture and the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture alone using an extended Poisson model in each cohort. Models were adjusted for current age, sex, BMD, and follow-up time.
Results
As no difference in influence of family history of fracture was seen between genders, results are presented for men and women combined. A parental history of hip fracture was associated with a higher risk of incident fracture across all fracture outcome categories, with a stronger relationship with future hip fracture (hazard ratios (HR, 95% CI) for hip and MOF 1.37, 1.23–1.52 and 1.19, 1.12–1.27, respectively). Associations were slightly reduced but remained significant when additionally adjusted for BMD and did not vary by baseline offspring age, follow-up time, or parent affected. In a more limited analysis, parental history of any fracture or a sibling history of hip or any fracture showed similar associations to those observed with parental history of hip fracture.
Conclusions
A family history of fracture is confirmed as a significant BMD-independent predictor of future fracture risk. While parental hip fracture appears the strongest factor for future hip fracture, a family history of other fractures might be appropriate for inclusion in future iterations of the FRAX tool
Dispersion behaviour of insoluble particles with different surface properties in non-aqueous media – biopolymer based oelogels
Get PDFParticles with some degree of hydrophilicity are known to aggregate when directly dispersed in nonaqueous media. Proteins are generally insoluble in oil and have complex surface properties, but they
may form networks in oil like more simple colloidal particles, depending on particle size and surface
hydrophilicity. Here, the particle size of pea protein isolate (PPI) particles in oil was reduced to
submicron sizes by stirred media milling. The rheology of milled PPI oil suspensions was compared to
dispersions prepared with two types of colloidal silica particles – hydrophobic and hydrophilic. PPI particles form structured aggregates in oil which break down under shear that, similarly to silica, can form an
elastic network like an oleogel system. As PPI size decreased, aggregation increased, shown by higher
apparent viscosities and gel strength. PPI particles with an average size of 1 mm exhibited elastic behaviour (G0 4 G00) at 11.2 wt%. Rheological scaling models obtained two fractal dimensions: a higher intra-floc dimension and a lower network backbone dimension, suggesting that colloidal PPI and silica
particles have an inhomogeneous microstructure with denser particle flocs compared to a relatively
sparse backbone. For smaller PPI particles the inter- and intra-floc fractal dimensions become like that
of hydrophobic silica, suggesting that the average ‘surface’ character of the PPI may be close to that of
the silica. Therefore despite the complexity of the protein surface, parallels can be drawn with simpler
colloidal systems. Pre-wetting the particles with ethanol tuned this behaviour, highlighting the role of
surface chemistry in gel formation
Restraint reduction during psychiatric intensive care: a controlled bi-phasic time series evaluation of a culture change intervention
Get PDFBackground
Restrictive practices (ie, physical restraint, rapid tranquilisation and seclusion) are used to manage risk of harm to self and/or others during inpatient psychiatric admissions. Restrictive practices can be physically and psychologically hazardous for both patients and staff, but there have been few well-controlled evaluations of interventions to reduce restrictive practices.
Objective
To conduct a controlled evaluation of the implementation of a culture change intervention on a psychiatric intensive care unit (PICU) compared with a control PICU on use of restraint.
Methods
A new staff role was created on the intervention PICU (ie, the reducing restrictive interventions advocate; RRIA). The RRIA met with patients/carers and advised, trained, supervised and debriefed the multidisciplinary team concerning restraint. Mixed methods evaluated the effectiveness of the RRIA role. Restraint outcomes on the intervention and the control PICU were compared pre (19 months) and post intervention (19 months). Qualitative interviews were conducted with the RRIA, the PICU ward manager and the RRI organisational lead.
Results
On the intervention PICU, there were significant reductions in the use of seclusion, full restraint and use of standing holds. Qualitatively, positive changes to the safety culture of the intervention PICU were reported, and these were consistently rated as important, impactful and unlikely without the RRIA role.
Conclusions
PICU safety culture can improve when specific roles focused on changing ward practices around restraints are implemented. More controlled evaluations of reducing restraint interventions on PICUs are needed
Impact of the spatial distribution of CAVs on stochastic traffic oscillations in mixed traffic flow
No full textExisting studies have demonstrated the potential of Connected and Automated Vehicles (CAVs) to optimise traffic flow and suppress disturbances. However, most current mixed traffic flow models adopt idealised deterministic approaches for modelling Human-Driven Vehicles (HDVs), and overlook the influence of the spatial distribution of CAVs on system performance. To address these limitations, this study introduces a novel metric (i.e., platoon intensity) to quantify the spatial clustering characteristics of CAVs within mixed traffic flow. This indicator enables a unified characterisation of CAV distribution patterns across various penetration rates, and theoretical bounds on pairwise vehicle probabilities under different traffic conditions are derived accordingly. A mixed traffic flow model is further developed, incorporating stochastic car-following behaviour of HDVs, behavioural degradation of CAVs, and a constraint on maximum platoon size. By introducing stochastic differential equations, the model successfully reproduces velocity fluctuations triggered by endogenous disturbances. Based on this framework, a series of systematic numerical experiments are conducted to comprehensively analyse traffic efficiency, stability, and energy consumption under varying CAV penetration rates and spatial distribution patterns. A quantitative relationship is established between platoon intensity and macroscopic traffic performance indicators. The main findings of this paper are as follows: (1) The spatial distribution of vehicles significantly impacts macroscopic traffic performance, with maximum differences of 9.70 %, 145.20 %, and 7.58 % observed in average speed, coefficient of variation of speed, and average energy consumption, respectively. (2) At a fixed CAV penetration rate, increasing platoon intensity enhances traffic efficiency and reduces average energy consumption, but exacerbates traffic instability. This research provides theoretical insights and practical implications for future CAV deployment strategies and traffic management measures
Phenotyping neurodisability in hospital records in England: a national birth cohort using linked administrative data
Get PDFBackground: Children with neurodisability often have complex healthcare and educational needs. Evidence from linked administrative health and education data could improve joint working between services.
Objective: To develop a diagnostic code list to identify neurodisability in hospital admission records; to assess the representativeness of this phenotype by characterising children with hospital-recorded neurodisability and their outcomes.
Methods: We developed a national cohort of singletons born in England between 2003 and 2009, including a nested cohort of children enrolled in primary school, using linked health and education data from the Education and Child Health Insights from Linked Data (ECHILD) database. With expert clinicians, we developed an algorithm based on diagnostic information from hospital records to phenotype children with hospital-recorded neurodisability. We described rates of mortality, planned/unplanned admissions up to 11 years old, and school-recorded special educational needs (SEN) provision, as proxy measures of the complexity of a child's needs, overall and for over 40 neurodisability subgroups.
Results: Of 3,580,225 children in the birth cohort, 3.6% had hospital-recorded neurodisability by age 11. The most frequent subgroups included developmental disorders, autism, epilepsy, perinatal brain injury, and cerebral palsy. Children with hospital-recorded neurodisability had higher mortality and planned/unplanned admission rates compared with their peers, and they accounted for 26% of all planned and 14% of all unplanned hospital admissions before age 11. The nested primary school cohort included 2,956,299 pupils (82.6% of all births), 3.7% of whom had hospital-recorded neurodisability. 75% of children with hospital-recorded neurodisability had any school-recorded SEN provision, and 39% had a record of more intensive provision (compared to 30% and 2.4%, respectively, for their peers).
Conclusions: We derived a phenotype for hospital-recorded neurodisability, which affects 1 in 28 primary school children in England, with high rates of hospital admissions and SEN provision. This phenotype and its subgroups can be used by service providers and researchers to examine inequalities and inform resource and service provision
Neuroimaging findings of adolescent depression: a review by the Research Domain Criteria (RDoC) framework
Get PDFThis review examines neuroimaging studies on adolescent depression (AD) within the Research Domain Criteria (RDoC) framework, focusing on fMRI, DTI, and EEG findings. The research highlights disrupted connectivity in several neural networks—such as the affective, reward processing, cognitive control, and default mode networks—that underpin emotional and cognitive dysfunctions in AD. Notably, hypoconnectivity in the affective and cognitive control networks correlates with deficits in emotional processing and executive functioning, while hyperactivity in the default mode network relates to excessive self-referential thoughts. Additionally, blunted reward responses and frontal–striatal connectivity are discussed alongside the therapeutic potential of cognitive behavioral therapy (CBT) to modulate these dysfunctional circuits. Despite these insights, variability in findings due to small sample sizes and diverse methodologies suggests a need for further research to validate neuroimaging biomarkers for treatment efficacy and to explore less studied treatments like ECT and TMS in this population. This review underscores the importance of integrating neuroimaging findings to enhance understanding and treatment of AD
Treatment-related changes in total hip bone mineral density are applicable to trials of varied study designs and to drugs with differing mechanisms of action: meta-regression results from the FNIH-ASBMR SABRE study
Get PDFEmerging anti-osteoporosis therapies might present varied mechanisms of action and demand active control groups or sequential therapies due to ethical or mechanistic reasons. We previously showed a strong association between treatment-induced changes in total hip bone mineral density(THBMD) at 12 and 24 mo and reduced fracture risk in placebo-controlled trials. We determined the surrogate threshold effect(STE): the minimum THBMD difference (active-placebo) in a trial that would predict a significant reduction in fracture risk in trials. In this analysis, we investigated whether these associations are influenced by drug mechanism of action or trial design, including treatment with an anabolic followed by an anti-resorptive compared to active control or placebo. We analyzed individual patient data from 22 randomized, placebo-controlled trials (17 anti-resorptive, 3 PTH analogues, 1 odanacatib, and 1 romosozumab placebo-controlled phase), and three trials of an anabolic followed by an anti-resorptive(1 PTH analogue and 2 romosozumab). We established treatment-related differences in THBMD changes, calculated fracture risk reductions for radiologic vertebral and all clinical fractures, and estimated study-level associations between these features via meta-regression. We found consistent associations between treatment-related THBMD changes and fracture risk reduction across different drug mechanisms and trial designs. Among placebo-controlled trials, the r2 values for vertebral fractures were 0.73(p = .0001) and 0.78(p = .0002) at 24 mo, and 0.59(p = .0003) and 0.70(p = .0007) at 12 mo for all drugs versus only anti-resorptive drugs, respectively. Similarly, for all clinical fractures, the r2 were 0.71(p < .0001) and 0.65(p = .0009) at 24 mo and 0.46(p = .0007) and 0.51(p = .002) at 12 mo for all drugs versus only anti-resorptive drugs. For trials of an anabolic followed by an anti-resorptive, the association between THBMD change and fracture risk reduction was similar to that for the placebo-controlled monotherapy trials. Our analyses indicate robust associations between treatment-induced THBMD changes and fracture risk reduction across various anti-osteoporosis therapies and trial designs, suggesting that treatment-induced changes in THBMD predict anti-fracture efficacy regardless of drug mechanism or trial design
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