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Fragility fractures – a global cause for concern

Matt Costa, Professor of Orthopaedic Trauma at the University of Oxford and President elect of the Fragility Fracture Network (FFN), explains the need for global action to provide better care for people suffering from hip fractures and other fractures that result from increased fragility.

The global population is currently undergoing the greatest demographic shift in the history of humankind. A direct consequence of this “longevity miracle” – if left unchecked – will be an explosion in the incidence of chronic diseases afflicting older people.

A new Global Call to Action for better care for people suffering from hip fractures and other fractures that result from increased fragility illustrates that for the first time, the leading organisations in the world have recognised the need for collaboration on an entirely new scale.

The UK has recognised the need for multi-disciplinary care for patients with fragility fracture and has the world’s largest national hip fracture database (NHFD). These are essential parts of our response to the coming fragility fracture crisis, but we need to do more. Here in Oxford, we will use the World Hip Trauma Evaluation (WHiTE) research project to collect research data from around the world to improve quality of life for patients everywhere.

In the absence of systematic and system-wide interventions, this tsunami of need is poised to engulf health and social care systems throughout the world. Osteoporosis, falls and the fragility fractures that follow will be at the vanguard of this battle which is set to rage between quantity and quality of life.

By 2010, the global incidence of one of the most common and debilitating fragility fractures, hip fracture, was estimated to be 2.7 million cases per year. Conservative projections suggest that this will increase to 4.5 million cases per year by 2050. While all countries will be impacted, in absolute terms, Asia will bear the brunt of this growing burden of disease, with around half of hip fractures occurring in this region by the middle of the century. And the associated costs are staggering: in Europe in 2010, osteoporosis cost Euro 37 billion, while in the United States estimates for fracture costs for 2020 are US$22 billion.

If our health and social care systems are to withstand this assault, a robust strategy must be devised, and an army of health professionals amassed to deliver it. This strategy must transform how we currently treat and rehabilitate people who have sustained fragility fractures, in combination with preventing as many fractures from occurring as possible. The latter can be achieved in part by ensuring that health systems always respond to the first fracture to prevent second and subsequent fractures. In short, let the first fracture be the last.

A major step towards making this aspiration a reality has occurred today with publication of a Global Call to Action to improve the care of people with fragility fractures. Endorsed by 80 leading organisations from around the world, covering the fields of medicine and nursing for older people, orthopaedic surgery, osteoporosis and metabolic bone disease, physiotherapy, rehabilitation medicine and rheumatology, the case for transformation of the following aspects of care has been made:

• The surgical and medical care provided to a person hospitalised with a hip fracture, a painful fracture of the spine and other major fragility fractures.
• Prevention of second and subsequent fractures for people who have sustained their first fragility fracture.
• Rehabilitation of people whose ability to function is impaired by hip fractures and other major fragility fractures, to restore their mobility and independence.

The Call to Action was conceived at an annual congress of the FFN, when six leading organisations came together to determine how they could most effectively collaborate to improve fracture care globally. The lead author of the publication, Professor Karsten E. Dreinhöfer said 'Fragility fractures can devastate the quality of life of people who suffer them and are pushing our already overstretched health systems to breaking point.' He added 'as the first of the baby boomers are now into their seventies, we must take control of this problem immediately before it is too late.'

The Global Call to Action proposes specific priorities for people with fragility fractures and their advocacy organisations, individual health workers, healthcare professional organisations, governmental organisations and nations as such, insurers, health systems and healthcare practices, and the life sciences industry. The World Health Organisation (WHO) has declared the years 2020-2030 to be the “Decade of Healthy Aging” and later this year the United Nations (UN) will hold its Third High-level Meeting on Non-Communicable Diseases. The authors highlight the opportunity for WHO and UN to consider the recommendations made in the Global Call to Action as an enabler for their global initiatives.

Image credit: Shutterstock

How robotic skies are changing the world

Lanisha Butterfield | 6 Jul 2018

The pace of technological development has outrun policy discussions at both a national and international level in recent years. Drone use in particular has improved the efficiency of data collection, allowing teams to monitor and survey large areas without impacting the landscape, day to day life, or their own safety. However, there are some concerns, particularly around ethics, long-term safety and security.

In view of such change, Oxford University’s Centre for Technology and Global Affairs joined forces with drone companies such as Measure, to explore potential governance models for how civil airspace and how the skies in general could be best regulated moving forward.

The Centre, a pioneering interdisciplinary research outlet focused on understanding how technology influences business and governance today, held its first Robotics Skies Workshop: The Role of Private Industry and Public Policy in Shaping the Drones Industry’ (June 21st and 22nd).

The event brought together practitioners, policymakers, and experts from industry, government, and academia to assess the governance and regulatory challenges associated with the burgeoning global Unmanned and Autonomous Aerial Vehicles (UAVs & AAVs) industry.

Lucas Kello, Director of The Centre for Technology and Global Affairs, said: ‘Recent technological advances have outpaced policy discussions. In view of such a development, the Centre's researchers are undertaking interdisciplinary research at the intersection of technology, industry, and government policy.’

The programme included discussions around the latest developments in the sector, such as; the use of drones-as-a-service, Unmanned Traffic Management (UTM), technological advances in geo-fencing, industry-led initiatives in raising safety awareness of drones users, as well as the interplay between data, digitalization, and automation in facilitating future commercialization of UAV and AAV technologies.

High-level speakers at the workshop included Matthew Baldwin, Deputy Director-General of Mobility and Transport from the European Commission, Pavel Abdur-Rahman, Data Scientist and Partner at IBM, Jessie Mooberry, Head of Deployment with Altiscope from Airbus, Christian Struwe, Head of Public Policy Europe at DJI, among others.

The Centre's Founding Donor, Artur Kluz, reflected: "I am pleased to see that the first workshop on the future of autonomous drones perfectly fulfils the Oxford Centre's long-term vision to serve as a powerful policy-building hub for the beneficial development of breakthrough technologies."

Attendee Ludovic Drouin, Science and Technology Officer from the French Embassy in London commented on the value of the workshops, describing it as ‘a tremendous opportunity to witness the state of the art in UAVs, the workshop is foremost in shaping a potential regulatory framework and in understanding inherent challenges associated with the future of the industry.’

Jessie Mooberry from Airbus added: ‘By convening industry, government, academia, and civil service, Robotic Skies fostered necessary deep and wide conversations about the role of automation in our airspace as well as the physical and digital infrastructure required to enable this future.’

Image credit: Diego AvesaniWorkshop attendees smile for the camera drone. Image credit: Diego Avesani

As a global research and policy-building initiative focused on the impact of technology on international relations, government, and society, The Centre serves as a bridge between researchers and the worlds of technology and policymaking, intended to facilitate policy resolution around pressing problems across six technological dimensions: Artificial Intelligence, Robotics, Cyber Issues, Blockchain, Outer Space, and Nuclear Issues. Artur Kluz is Founding Donor of the Centre for Technology and Global Affairs and the Centre was supported by core funding from Kluz Ventures.

Brandon Torres Declet from Measure – who collaborated with the Centre on the workshop, said: ‘It was an honor to participate with Oxford University and drone experts from industry and government to begin an important discussion at the intersection of UAV technology and government policy.’

Robotic Skies is the first in a series of planned events at the Centre, aimed at creating a sustainable forum for inter-sectoral dialogue and driving wide-spread knowledge exchange across industries and disciplines.

Image credit: Shutterstock

Nathalie Seddon, Professor of Biodiversity & NERC Knowledge Exchange Fellow at Oxford’s Department of Zoology, discusses the launch of her new Nature-based Solutions Initiative , which took place at the Adaptation Futures 2018 Conference, in Cape Town last week. Through policy advice and advocacy, the interdisciplinary, research-led programme aims to increase the use of natural solutions in the fight against climate change.

Climate change, biodiversity loss and poverty are inextricably linked. Not only do communities from the poorest nations suffer the worst effects of climate change, they also experience the highest rates of loss and damage to their natural ecosystems. However, nature is our best line of defence against harmful environmental change. In particular, it is becoming increasingly clear that the protection and restoration of nature can be the most cost-effective way of dealing with both the causes and consequences of climate change.

For example, one recent study indicates we could achieve a 30-40% reduction in CO2 emissions by restoring natural habitats across the globe; while another shows how natural coastal habitats have protected millions of dollars’ worth of property during recent hurricanes in America

In other words, there is growing evidence that nature-based solutions not only help to slow warming, but shield us from the impacts of change and protect the ecosystems on which our health, wealth and wellbeing so fundamentally depends.

Despite this, nature-based solutions are not being implemented across the globe, and they receive very little funding. There are three major reasons for this. First, evidence for the benefits of nature in a changing world is very scattered. Second, there is a lack of knowledge exchange between scientists, policy makers and practitioners: too much ecosystem science is done in isolation from the end-users, and too many adaptation policy decisions are made without considering the science. And third, more broadly, there is a general lack of appreciation in business and government of our fundamental dependency on nature, especially in a warming world.

To address these issues, alongside partners from the conservation and development sectors, we have co-created a new interdisciplinary programme of research, research translation, policy advice and advocacy called the Nature-based Solutions Initiative.

The initiative was launched last week at the Adaptation Futures 2018 conference in Cape Town, which is the largest annual gathering of researchers, practitioners and policy makers looking for long-term sustainable solutions to the impacts of climate change.

Our presentation included the release of a new interactive online science to a policy platform, which makes information about climate change adaptation planning across the globe openly available, easy and interesting to explore.

The platform includes country by country details of who is doing what, in terms of incorporating nature-based solutions into their adaptation plans, and is linked to an extensive database of scientific evidence for the effectiveness of such approaches.

This initial version showcases adaptation plans in the climate pledges of all signatories of the Paris Agreement, and highlights the prominence of Nature-based Solutions to climate change hazards. Through this work we aim to facilitate the global stock-take of the Paris Agreement and provide a baseline against which changes in ambition for Nature-based Solutions to climate change adaptation can be monitored and increased.

By helping decision makers and practitioners access and understand evidence for the effectiveness of nature-based approaches to dealing with the impacts of climate change, our aim is  to tackle the twin challenges of conserving biodiversity and building socio-ecological resilience in a warming world.


Sound waves

Shamit Shrivastava, a post-doctoral researcher in the Department of Engineering Science, writes about a recent finding that has far-reaching consequences for the fundamental understanding of the physics of the brain. The research was conducted in partnership with Professor Matthias F Schneider at the Technical University in Dortmund, Germany.

The findings, published in the Journal of Royal Society Interface, provide the experimental evidence that sound waves propagating in artificial lipid systems that mimic the neuron membrane can annihilate each other upon collision – a remarkable property of signals propagating in neurons that was considered to be inaccessible to an acoustic phenomenon.

Nerve impulses are believed to propagate in a manner similar to the conduction of current in an electrical cable. However, for as long as the electrical theory has been around, scientists have also been measuring various other physical signals that are equally characteristic of a nerve impulse, such as changes in the mechanical and optical properties that propagate in sync with the electrical signal. Furthermore, several studies have reported reversible temperature changes that accompany a nerve impulse, which is inconsistent with the electrical understanding from a thermodynamic standpoint.

To address these inconsistencies, researchers had previously proposed that nerve pulse propagation results from the same fundamental principles that cause the propagation of sound in a material and not the flow of ions or current. In this framework, the electromechanical nature of the nerve impulse, also known as an action potential, emerges naturally from the collective properties of the plasma membrane, in which the sound or the compression wave propagates. Thus the characteristics of the wave are derived from the principles of condensed matter physics and thermodynamics, unlike the emphasis on molecular biology in the electrical theory.

The suggestion has been highly controversial because of the well-accepted and widely successful nature of the electrical basis of nerve pulse propagation in spite of its few inconsistencies. As a wave phenomenon, nerve pulse propagation has remarkable properties, such as a threshold for excitation, non-dispersive (solitary) and all-or-none propagation, and annihilation of two pulses that undergo head-on collision. Moreover, sound waves are generally not associated with such characteristics, rather sound waves are known to spread out, disperse, dissipate, superimpose and interfere, which is counter-intuitive given the properties of nerve impulses.

Therefore, experimental evidence for such a phenomenon was crucial, which was provided by us in 2014. We showed that sound or compression waves can indeed propagate within a molecular thin film of lipid molecules, mimicking action potentials in the plasma membrane. Remarkably, even in such a minimalistic system that is devoid of any proteins and macromolecules other than lipids, these waves behave strikingly similar to nerve impulses in a neuron, including the solitary electromechanical pulse propagation, the velocity of propagation and all-or-none excitation. These characteristics were shown to be a consequence of the conformational change or a phase transition in the lipid molecules that accompany the sound wave. Thus only when sufficient energy is provided to cause a phase change in the lipids (fluid to gel-like), the entire pulse propagates otherwise nothing propagates, the so-called all-or-none propagation.

Now, in research published in the Journal of Royal Society Interface, we have shown that these waves can even annihilate each other upon collision, just like nerve impulses. Even from a purely acoustic physics perspective, this is a remarkable finding. The amplitudes of two sound pulses colliding head-on typically superimpose linearly before passing each other unaffected. Even nonlinear sound pulses, such as solitons, typically remain unaffected upon collision, which was a major criticism of the proposed acoustic theory of nerve pulse propagation.

With the observation of annihilation of colliding sound pulses in the model lipid system, we have shown that qualitative characteristics of the entire phenomena of nerve pulse propagation can be derived solely from the principles of condensed matter physics and thermodynamics without the need for molecular models or fit parameters of the electrical theory. We have demonstrated a unique acoustic phenomenon that combines all the observable characteristics that define the propagation of nerve impulses. This strongly suggests that the underlying physics of propagation of sound and nerve impulses is indeed one and the same.

Sound wave propagationSound waves propagating in artificial lipid systems that mimic the neuron membrane can annihilate each other upon collision.

Image credit: Shutterstock

As MPs give Heathrow Airport's proposed third runway the green light, Professor David Banister, Emeritus Professor of Transport studies at Oxford University, sheds light on the issue of transport inequality and just why the proposed expansion has sparked such controversy.

London Heathrow (LHR) is the busiest airport in the UK with 48 million passengers beginning or ending their journeys in London, and an additional 28 million passengers making interconnecting flights to other destinations. The 3rd Runway will increase the total capacity to 130 million (+71%) and the number of flights will increase to 740,000 per annum (+56%). But who will be the new passengers flying from LHR?

About half the population of Great Britain has flown in the last year (47%), and this figure has been stable over the last 15 years. Most of those that do fly make one or two trips a year (31%). This means that 10% make about 60% of all flights, and as might be expected these people are mainly from the highest income groups. The richest 10% make 6.7 times as many trips by air as the poorest 10% of the population. The inequality in air travel in Great Britain is far higher than any other form of travel with the exception of High Speed Rail (10.3 times). Figures for the other forms of transport are much lower, with the difference for car travel being 2.75 times and for the bus the poor make more trips than the rich.

Some might argue that low cost airlines have helped rebalance this inequality, but the evidence would suggest that cheaper flights have enabled those already flying to travel more frequently and possibly to save money. Inequality is important as it reflects on societal values and the argument that society as a whole should gain. But it is equally important to identify who are the winners and who are the losers – it is about fairness and justice. This is particularly the case when large amounts of public money are involved. The new runway is estimated to cost £14 billion, with a similar amount being needed to improve road and rail links to the airport. A substantial part of this funding will come from Government and Transport for London.

It is likely that low income people will make only limited use of the new runway, but they will also be impacted by it indirectly through additional CO2 emissions. Overall, the richest 10% of households produced 3 times the levels of CO2 emissions than those from the poorest 10% of households, but for transport the difference is between 7-8 times and 10 times for aviation. New runway capacity at LHR will increase this difference, as more rich people fly further and more frequently. Local pollutants (e.g. NOx) and the noise impact are also likely to increase from the additional planes (and traffic). This means that it becomes much harder to meet CO2 reduction targets and improve local air quality, and air quality around LHR is already very poor.

Even the argument about the importance of increased airport to the local and national economies is weak. Business air travel accounts for about 20% of all passengers in Great Britain, with the figure for LHR being higher (30%). This market has been relatively stable, as the growth in air travel has come from leisure travel and visiting friends and relatives. In addition, UK residents are spending more overseas than others do coming to the UK. In 2016, there were 71 million overseas visits from UK residents and the total spend was £43.8 billion. There were 38 million visits to the UK and the total spend was £22.5 billion.

The clear conclusion is that on grounds of inequality, environment and spend, building additional airport capacity at LHR does not add up, as it will enable the richest 10% to fly even more and spend their money overseas. It will be the poorest 10% that stay in the UK, and they will suffer from even higher levels of CO2 emissions and poorer levels of air quality.

This analysis is based on National Travel Survey data (2002-2012) and Air Passenger Surveys carried out for the Civil Aviation Authority.

Read the full article on The Conversation here

This analysis of air travel in the UK forms part of Professor Banister’s new book Inequality in Transport, which will be published by Alexandrine Press on 12th July.