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Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk–benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes.

Osteoporotic fractures are one of the major problems facing healthcare systems worldwide. Undoubtedly, fragility fractures of the hip represent a far greater burden in terms of morbidity, mortality, and healthcare costs than other fracture sites. However, despite the significant impact on the health and quality of life of older adults, there is a general lack of awareness of osteoporosis, which results in suboptimal care. In fact, most high-risk individuals are never identified and do not receive adequate treatment, leading to further fragility fractures and worsening health status. Furthermore, considering the substantial treatment gap and the proven cost-effectiveness of fracture prevention programs such as Fracture Liaison Services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are adequately assessed and treated. Based on this evidence, the aim of our review was to (i) provide an overview and comparison of the burden and management of fragility fractures, highlighting the main gaps, and (ii) highlight the importance of using alternative approaches, both surgical and non-surgical, with the aim of implementing early prevention of osteoporotic fractures and improving the management of osteoporotic patients at imminent and/or very high risk of fracture.

Shared virtual memory is key in heterogeneous systems on chip (SoCs) that combine a general-purpose host processor with a many-core accelerator, both for programmability and performance. In contrast to the full-blown, hardware-only solutions predominant in modern high-end systems, lightweight hardware-software co-designs are better suited in the context of more power- and area-constrained embedded systems and provide additional benefits in terms of flexibility and predictability. As a downside, the latter solutions require the host to handle in software synchronization in case of page misses as well as miss handling. This may incur considerable run-time overheads. In this work, we present a novel hardware-software virtual memory management approach for many-core accelerators in heterogeneous embedded SoCs. It exploits an accelerator-side helper thread concept that enables the accelerator to manage its virtual memory hardware autonomously while operating cache-coherently on the page tables of the user-space processes of the host. This greatly reduces overhead with respect to host-side solutions while retaining flexibility. We have validated the design with a set of parameterizable benchmarks and real-world applications covering various application domains. For purely memory-bound kernels, the accelerator performance improves by a factor of 3.8 compared with host-based management and lies within 50% of a lower-bound ideal memory management unit., ACM Transactions on Embedded Computing Systems, 16 (5s), ISSN:1539-9087, ISSN:1558-3465

Ultrasound imaging is one of the most important medical diagnostic methods. The bulkiness of state-of-the-art high-quality ultrasound devices, however, drastically limits their usability in important application scenarios. In this paper, we show how a portable medical ultrasound device can be built using many-core technology and programmable logic, combining low power consumption with high flexibility. We discuss a typical ultrasound image reconstruction algorithm and how it can be parallelized using a pipelined design that efficiently partitions the workload among heterogeneous processing elements. A special focus lies on the limited memory resources and data bandwidth between components. To tackle both problems, we use floating window buffers and approximate computations, and we minimize lookup table sizes using on-the-fly calculations. We evaluate the design on the Adapteva Parallella platform, which contains a power-efficient 16-core Epiphany coprocessor and a Zynq SoC including a dual-core ARM A9 processor and programmable logic. Experimental results show that parallel beamforming of 128 input channels to a 288x 128 pixel ultrasound image can be achieved on the Parallella at a rate of 5.3 frames per second consuming only 2 watt of dynamic power.