Last year at the Re-Deploy conference, my partner Dr. Richard chef gave among the many cogent and also clear talks on descriptions of resilience and resilience design that I’ve yet to come across. I’m embedding the video clip below, however I’m likewise including an interactive transcript for those who choose reading fairly than watching and also listening.

If you’ve at all been interested in resilience and also Resilience Engineering, ns really carry out recommend spending the moment to check out this.

You are watching: The resilience of bone is thought to come from which of the following


I"d like to start by thanking Paul and Adrian, Mary, James the the AV folks right here the theatre for the job-related that they"ve done, putting together a conference and likewise trying to set the phase for us. I"m no going to talk about myself in ~ all due to the fact that it"s not very interesting, however I will put on this display my, my just political statement for the day. and if you have actually an attention in mine politics, you have the right to go look increase and also you"ll understand everything. The title of this speak is a couple of observations top top the marvelous resilience that bone and also resilience engineering. There"s a an extremely long, tiny print disclaimer here about all the things that I"m not going come do and the points that I execute do and also the points that ns shouldn"t do and that I"m discover here. And also a bunch of things around my past again and stuff. really interesting. This is a basic talk about complex systems and most of you room dealing with complexity in some form or other and trying to battle with, through the after-effects of that. and I"m going come talk about an area that exhibits all of these properties, but that is not your home base. I"m going to talk around bone and also I think in the finish that you will, my hope is the you will certainly come to believe that bone is no a version of resilience or a an allegory for resilience, but the archetype of what resilience is that when we try to understand resilience, the first thing the should pertained to mind would certainly be bone. and also if i succeed this day for you in the future when someone says, what is resilience, the example that friend will offer to them as bone. I"m likewise going to have to talk a little bit about resilience engineering since the engineering component of resilience engineering is, is a pretty facility sort the idea and also much more an overwhelming to pin under than just resilience itself. Okay. We"ll simply do those 2 things. That"s it. Nothing big. and also because my kids are all in advertising and they"re constantly telling me come cut to the follow in conclusion, let me speak this the, the, the bottom line below is pretty straight forward at least around bone and resilience and also how that works. Bonus repetitively remodeled. many of you probably are not aware of this, but your skeleton is replaced about every 10 years. and also that"s nice remarkable because from your perspective, the skeleton is a kind of static thing. It"s always there. You have actually it. and as lengthy as girlfriend don"t carry out too many bad things come it, that doesn"t change an extremely much. But in fact, your skeleton is constantly being replaced. The make of brand-new bone is in a dynamic balance with the destroying of old bone. and this is a procedure that"s energy requiring and also takes ar all the time. and also because it"s happening at this little level, girlfriend don"t notification it. but if ns were going to pick one point to remember from this talk, that is the idea the this dynamic balance between creation and destruction, i beg your pardon then gives the platform for every the resilience that we see. Resilience is continually present, it"s constantly enacted, it"s constantly inquiry energy and we space unaware the that since most the the time it"s happening in the background and also at a reasonably little level so that us don"t view it playing out. The other thing is the the demolition and construction that bone is directed by mechanically strain. and also this is yes, really important since resilience is concentrated on certain kinds of points in via via various sorts of instrument to achieve a details ends. We"ll speak a tiny bit about repair of some extr mechanisms. ns don"t want to talk about that in detail. Um, bone. but the other thing is that the device of bone is not just a skeletal device in the sense that that holds us up. It also provides other functions. It"s the primary store in our body for calcium and phosphorous, which room both very important minerals and also very, very challenging to obtain from the environment. And important come have. and it transforms out the calcium is the most crucial ion in the body. Finally, this idea about resilience is the it"s all about signaling. there is no understand controller and also resilience. There"s no high God the resilience, i beg your pardon directs everything and also organizes it. In fact, it"s a confusing layered network the is actually performing this functions and we"ll show you a small bit that the network also though it"s not yet fine understood and also there"s lots and also lots of crosstalk in this network and also a most cabinet level integration of the activities that room going on. cell respond in a method that makes this all possible. skeletal resilience is what ns would call Woodsian. And also this is after ~ Dave Woods. Dave Woods has, if you haven"t looked at it, you definitely should. The four concepts for resilience and the implications for the future of resilience engineering and also integrity engineering and system safety. however basically he"s got four various ideas about what resilience is and the last two are the most important. One is this idea of graceful extensibility, that the mechanism has, not a sharp boundary, but a quite soft boundary that that permits extension the its function. and also the various other is sustained adaptability. The idea that we space constantly adapting all the time, it"s a never ever stopping, never ever stopping process. And that, that"s what provides the totality thing go. The other thing around resilience is it"s expensive. it requires consistent and energy and source inputs. It"s delicate and also can it is in disrupted by ns of feedback. It"s at risk to disease and it"s limited. That doesn"t critical forever. ns don"t know if you recognize this, however you"re all going to die someday. and also so re"s a limitation there. There"s a type of a, a sell by date for this in, in this long lasting system as there are in many. Okay. So that"s, that"s for this reason the first thing I"ll allude out is that bone has both a complicated macro and micro architecture. on the left you see a snapshot of a section through a bone and also you check out the tough outer edge called compact bone. and also then the within bone, which is called cancellous bone, i beg your pardon is simply kind the woven thing with every these spicules. If you expand that a bit, you"ll look inside. You"ll check out that in truth there"s a micro style here which has acquired these central things which room canals. You watch them prominently displayed here through the circular cells, aligning them and creating this bony material. Bone chin is no living material. The is the bony, the strength component of bone stuff is hydroxyapatite crystals. They"re inorganic material, but they"re laid under by essential processes. but there is this structure and architecture here, i beg your pardon is, it has a D is various at different scales yet all integrates together. new bonus laid down along present lines. for this reason it turns out the bone has actually sensors that permit the detection of mechanical strain and redirect the process of chewing increase bone the is destroying old bone and also laying down brand-new bone so the the new bone is aligned follow me the lines of stream. This is a really important idea. Bone is expensive to make, difficult to maintain, really demanding of resources and energy and you don"t want it. It provides teleological feeling not to use too lot to perform this. for this reason we"re very sparing in the way that us make bone and also the constant strain the organisms suffer leads to a consistent pattern in the method that bonus set down. If friend look at the snapshot on the top left, which is a slice with a femur, the head the the femur there you deserve to see what looks favor a small boxlike point right at the reminder of the head of the femur. And also that box favor structure, i beg your pardon looks favor a little line going kind of that, that type of clues the diameter the the round there, that line and also that box that"s inside there space present since of the fads the strain that are brought about by locomotion, by being upright. and also it"s common throughout all of us to have that pattern there. also though it"s not programmed almost everywhere in molecular biology, there"s no, no gene that claims make bone and lay it under in this details pattern inside. It"s the continuous experience of stress, overload that causes the bone to it is in restructured in that way so the it becomes an effective and supports those loads. by the way, there might be an optimal strain experience. This goes probably a metaphorically to the issues of burnout and things choose that. You have the right to have too much strain. You deserve to accumulate fractures because that example, quicker than you have the right to heal them. and so we watch damages that come indigenous high loading over time. The remodeling of bone, this continuous process is going on in the lift is actually reasonably complicated. however the key thing is the it"s locally directed however globally modulated and it to produce the repair of microfractures the we"re accumulating all the time. for this reason the factor our signal skeletons are strong is not due to the fact that bonus, therefore impervious come damage, but because little damages are constantly gift repaired. This procedure of remodeling that"s going on is identifying and fixing these small fractures all the time. And also as a consequence, our experiences that bonus, solid and also durable that process fits into the recycling that calcium and also phosphorus as well because it transforms out the the chewing up of bone the happens in the little cells friend see below mostly at the left that the slide, i beg your pardon are referred to as osteoclast, is excellent by cheap of hydrochloric acid, which disappear the bone and then returns its mineral ions earlier into the circulation whereby it deserve to be used for various other purposes. Calcium is really crucial because all of our contractual activities, your heart, your muscles, and also in truth the within cell tasks all depend upon calcium function. Calcium is by far the most tightly regulation ion in the body. and so having actually a big supply the calcium, i m sorry is in brief a short supply civilization is actually very valuable. girlfriend have around a kilogram of calcium in your body and it"s most 99% of it is save in bone. The means calcium homeostasis has actually maintained is via of complicated thing that involves the kidney and also the gut and also absorption, vitamin D, parathyroid hormone and a range of various other things. yet basically there"s this very big complicated control network the is essentially regulating the level of calcium your body by acquisition calcium once it"s in low, as soon as it"s low in the, in the body, short in circulation and, and taking the from bone by increasing the quantity of osteoclastic activity and the return that calcium and depositing calcium once you have a surfeit that it right into bone, producing it at that time. And this wake up in tiny areas. The has, and also it also has very huge influences. The figure on the best is type of a schematic of several of the signaling the go on. And also I"ll just show you a perform of some of the signal that are here. and this is simply a partial perform of several of the signals that are involved. and they have funny names since of the means the research is going on and not all entirely meaningful or, or basic to follow. however there"s one here in particular I"d prefer you to pay fist to i beg your pardon is p T H R P, parathyroid, hormone connected protein, which is one of the signals that is affiliated in this process of directing the the consumption and remodeling that bone. Okay. Deep science. Let"s go to miscellaneous a little bit an ext straight forward. right here is a radiograph. This is one X beam taken the a 25 year old masculine who came to the emergency reporting that he had kicked a limp article in a to the right of anger and also later noticed he had quote, an obstacle wade unquote. You, you could be able to, even those of friend who room not median trained may be able to see in this snapshot some evidence of the difficulty that was affiliated in. and also although the report doesn"t encompass anything explicit about this one suspects that alcohol was involved here at some point. however what happens of course, is that you have the right to sustain a fracture prefer this. and then the fracture it s okay repaired. How countless of friend have broken a bone, substantial portion of the audience, at the very least half. and you will have actually noticed that as soon as you fractured the bone, the there was a period of time once it to be unstable. and then progressively it came to be that you felt a lump over there underneath the surface. If you touched it, you can feel that it was swollen and lumpy and that over the following year or so, that lump go away. and that process is pertained to the resilience the bone and the approaches of repair. and also you see below on the left when you first break a bone, you have a - you damaged the periostin, which is the cellular lining that covers the bone. And also then you have actually a hematoma, i m sorry isessentiallya bruise in the bone. and also this activity causes the flow of a whole bunch of various kinds the cells, significantly cartridge cartilage cells, which then to fill up the area and carry out a kind of quick termsort of connection between things. and then there"s this intrusion of the cartilage by these energetic elements the lay down bone and what of food they do with time as they put down fairly thick amount of bone that what"s dubbed a callus and that"s what friend were emotion in the year after ~ you damaged that bone. that lump there is referred to as the callus and it"s bone. It"s constant bone in the in the common sense, yet the procedure of remodeling i m sorry takes years later on or month to year afterwards. That procedure of sin, stress and strain slowly sculpts that callus down until it is back to very lot like what the bone was prior to that is detecting wherein the stress, overload is, reasons excess bone to be chewed up, brand-new bonus to adjust down, however only in the locations where the strain is high and also this remodeling process gradually restores the form of the bone and you"ll have actually noticed that your own callus gradually ended up being less and less until you ultimately didn"t notification it. That"s the remodeling procedure that"s going on every the time and it does take a lengthy time, yet it"s a really important one since again, that restores these functions. now this is other that"s to be going on for a really long time. it doesn"t turn out really well. Here"s a picture series of pictures from aa, one Indian excavation from about 1400 a D these are the bones from a interment site of, one elderly in ~ the time, 50 year old Indian woman who had damaged her femur. and you deserve to see the break here. It"s quite clear the there"s one that"s to be badly damaged in the other that"s not there appear. and also quite remarkable there"s the ar where the rest has developed is a an extremely large, special clumpy thing. and you"ll also notice that the new bone is the repaired bone is much much shorter than the various other one. This mrs would have walked if she walked in ~ all later on with a destructive limp since one leg was about an inch and also a half shorter 보다 the other. and the reason this happens is because the muscle that host together across the length of the bone, as soon as it"s broken, traction the bones, the bone ends throughout each other so they"re no longer aligned and also shorten the up. and also then of course the same healing procedure goes on and also it heals in the awkward position. Why is this no a problem for united state now? Well, in fact, currently we know this and also we protect against that. We understand that bone repair mechanisms will certainly knit broken pieces together, right? If you recognize that, if you"re walk to have actually a fracture, that the normal response to that will certainly be to knit those piece together. and the whole allude of this is come then develop a, one alignment before that wake up by what"s called reduction. That method reducing the fracture so that it just a now aligned and then maintaining those, the place of those bones relatively stationary loved one to each various other so the the healing procedure will end up restoring that original fictional form. and also as those of you that have broken something and also had a cast, no mechanical stabilization is the key. You have to keep the mechanically alignment of bone in place for a long sufficient duration of time that that will certainly heal and also be reasonably strong and also then you have the right to take it that actors or whatever"s stop it with each other off. Yeah. Uh, a reasonably substantial quantity of initiative has to be put right into this and also trying to find ways to, to carry out this stabilization and also reduction. There"s a thing dubbed external fixation. some of you may have actually seen someone with an exterior fixator on. This is no uncommonly offered if the bone if the injury has damaged the skin. however you can also do what"s dubbed internal permanent or an open up reduction and also interior fixation the w wherein you do a operation procedure, you check out this in the center where you reduced through the skin, you go under to the bone and also then you do something to host that bone together. You could put a plate and some screws in, or as you check out in the picture on the far right you can do what"s dubbed an intramedullary nail. This is a long spike. It"s about this long depending on how huge the person and it"s a large long, it looks favor a nail. And then what happens is girlfriend acquire the human in the right position, you reduce the fracture by placing traction on the leg, traction it apart choose this. So the the ends of the bone are currently in line and then you take a hammer and also you"d journey the nail down through the hip native the height as you check out all the way down and also cross that and bridge that broken area and also then you put a little pin in the optimal to hold it there so that doesn"t slide out. You deserve to see why I"m one anesthesiologist, yet in every these cases, the whole point of this is come to allow the natural healing processes to do the bone and also restore the bone place of duty that it remained in before. It"s the concern is what is that position and also what is the function? we don"t heal these things. We room not. The orthopedic surgeons perform not heal bone. What they execute is lock rearrange bone and also hold the in location for a long sufficient period of time the the herbal processes the are durable in bone will lead to a desirable result. Okay. This is a pretty necessary idea. In fact, physicians in basic are no healers, although they"re often defined that way. The body is the healer the doctor creates, if they"re lucky, a instance where the alignments and also the functions are such that the healing have the right to take it place. However we count upon that healing. And in fact, we recognize for instance, if you have deficiencies of nutrition or other diseases that the healing is, can be rather difficult. This idea about fixation is actually...and heal is actually fairly old. Here"s a snapshot on the left of part splints the were taken the end of aa tomb in Egypt and reported through George smith in 1908. And the British clinical journal, these are the most old splints that anyone has found. friend see few of the damaged bones there and the splints were wrapped about this. and also there"s a thing dubbed the Edwin smith papyrus Iris from around 1600 BC, which girlfriend see here on the right. And also this is a, the very first medical message that we know around and a section of this is specialized to taking care of damaged bones. Here, here"s it. Here"s the hieroglyphs composed on the left. and also and because I"m sure you"re a small rusty and you"re very hieroglyphics. I"ve included the translate into on the right. But here"s what that says. This is for a broken bone that the arm and it says that it should simply place him prostrate top top his earlier with something folded in between his two shoulder blades. though it should have spread out with his 2 shoulders in order to stretch his upper arm till the break falls into place. That"s the palliation we"re talking around though must us make for him 2 splints the linen and also that should us use for him. one of them both top top the within of his arm and the other of lock both top top the underside the his eight though must us tie it with your move. This is the word for plaster of Paris, yet Paris hadn"t been designed yet and treat it later on with love husband every work till that recovers. It"s pretty an excellent medical advice. and in fact there to be a groups of people in old Egypt and also ever due to the fact that who are bone setters whose role it is to produce reduction and also fixation and also enable or bone to heal. for this reason I would argue that this is a kind of resilience design that is, we understand the resilience that the device that we space dealing with and also we room act engineering. So the that resilience plays the end the long avenues which room desirable, that that create a desired result. The resilience isn"t ours. us didn"t develop it. We"re not the owner of it. We"re not the generators of it, yet we understand that it"s there. And interestingly enough and also enough study you, you, you room able to acquire this type of building that, the will permit you to exploit that and also heal in good function. So just to review, friend know, the entirety idea below is the that us are acquiring multiple features for bone. It"s a storehouse the calcium and other things. the plays a in reality a variety of different roles. it"s a constantly experience replacement and also there"s this balance that exists, this dynamic balance between the destruction and also construction and resilience engineering in this situation is applying engineering come a long lasting system that counts for that is success top top the presence of resilience. it requires of understanding just how the resilience dram out. It deserve to be successful even without knowledge much about the mechanisms of resilience and it services from greater understanding the the sources and also modulators the resilience. It was known fairly early, for instance, that nutrition is pretty necessary to bone healing. Well, nice good, huh? now the renowned Thomas Hughes wrote in his book, Tom Brown school holidays, institution days. Life isn"t all beer and also Skittles. bone is no perfect. There space a number of diseases that bone. One"s referred to as osteogenesis imperfecta. This is a problem, a inherited problem where bone doesn"t make the best calcium and also lay points down. There"s a disease called Paget"s condition where bonus actually took in too much. There"s osteoporosis. few of you may recognize this due to the fact that you may have elderly parental or you may be approaching old period yourself and also you may note that that osteoporosis is a major cause of morbidity. In the United claims there room cancers that bone. There"s one osteosarcoma, which few of you have actually heard about. There space problems associated with malnutrition. Because that instance, rickets, you see this in bowed-leg kids used to be really common in the united States, no seen an extremely much anymore. And then you have the right to have obstacle of the signaling, hyperparathyroidism can, which transforms on the osteoclast and also causes them come chew increase bone deserve to actually, you can have a tumor the the parathyroid the seats secretes too lot of this stuff. and out of control with the calcium regulation system causes the chewing up the bone and the destruction of bone leads to fractures and kidney stones. and also so I desire to take it one instance of this, i m sorry is osteoporosis. It"s a an extremely important clinical condition. ns don"t want to contact it a disease because it"s most likely a, a, a, a natural an effect of aging, yet it"s, it"s much more noticeable in larger people and also it"s particularly got a choice for women. you see below a collection of radiographs in reality that room from CTS the a item of a vertebra and also a typical person. And also then through osteoporosis. and also the process here is, is one that whereby the absorb of bone has become greater than the manufacturing the bone. and so you lose bone mass end time and also it"s, it"s in reality quite difficult to, to counter that. The goal would certainly be to block the, absorb the resorption that bone and, and also sort of turn down, modulate down the osteoclastic task or to boost the production of bone, turn up the osteoblastic activity in order to develop this sort of stuff. numerous of you will identify that the after-effects of osteoporosis, typically hip or vertebral fractures in yonsei women, ladies who room older, the usual person is a mrs that period 60 or 70, currently 70 or 80, who has a i know well fracture or a vertebral fracture. These space really not so much a trouble with the fracture per seas the reality that the bone has lost the strength as such imbalance in between creation and destruction. And there are two methods you have the right to fix this. One is friend can try and rotate down that, that process that"s chewing. and also the other method is friend can shot and boost the osteoblastic task that lays under bone. You"ll mental that ns talked to you earlier about the signaling organization that go on here and also that i asked you come pay attention to one certain signal, i m sorry is parathyroid hormone related protein. P, T, H, R, P. and also over the past five years, in reality the research goes back about 15 or an ext years or perhaps even much longer. There"s been a most interest in expertise the signaling, signaling processes and trying to usage them. and there are currently drugs significantly abaloparatide and also teriparatide, which room molecular signalers, which mimic PTHRP. There are molecularly arisen things the are favor parathyroid hormone changed the protein and also the presence of this at intervals, you have to do it, you have to develop the stimulus at intervals, generates a signal, which states basically turn up the osteoblastic task that makes bone and also you offer this stuff, it"s one injection you give it when a mainly or double a mainly to world who space at risk for it. And also interestingly enough, abaloparatide significantly reduces the incidence of vertebral fractures compared with placebo, through a hazard reduction of around 91%, i m sorry I will certainly tell you in the medical civilization is the big deal, right? we don"t gain that kind of risk reduction an extremely often. and so numerous people, specifically those at threat for osteoporosis notably, interestingly enough uh, white women, larger of a european extraction and also smokers specifically we"ll obtain this drug from their physicians. I want to point out that it"s still not all Skittles and also beer. Over there are, there are problems with these drugs in there and also at the very least in rats, at an extremely high doses, a consistent exposure come abaloparatide can produce some cancers. the is, you have the right to turn on these mechanisms in ways that command to damaging results. yet this is a kind of resilience engineering. Ns would, i would sell you this as a form of resilience engineering. It alters the underlying resilience mechanisms that are existing in the system. It depends for its success on a really deep knowledge of resilience. that is you have to actually understand and be able come manipulate the signaling by the method that medicine has provided in microgram amounts, right? so we"re talking, girlfriend know, points were only a couple of molecules the this room actually reaching the cells. it, it has tendency to retard the loss of the adaptive capacity of bone. And it also, by the way, generates brand-new types the hazard, i beg your pardon is miscellaneous those of united state interested in resilience design should most likely think around because work on resilience engineering may not all be Skittles and also beer. There may be part downside come this, which is related to our manipulation straight of these an effective mechanisms that involve signaling bone reminds us that resilience requires constant energy and resources. The history of bone shows up in that is structure. You have the right to tell what has happened come a human being by looking in ~ the structure of bone, which i think is a really interesting kind of thing. If you think in ~ the organizational level that your own place, you have the right to see the history of the organization and the style of the software. It has actually its own pathologies. It"s breakable to a number of disruptions, and it turns out the bone is a lot simpler to you. Bony resilience is a lot simpler to use than that is to develop this resilience design that i talked about. The very first kind that resilience engineering, you can speak to it resilience engineering form one, if friend like, but this first type that resilience design is engineering applied to a sturdy system. It counts for its success ~ above the visibility of resilience in the system. It can be successful also without understanding very much about the mechanisms the resilience. it does advantage from higher understanding the the sources and modulators the resilience, and that"s at least 3,500 years old. We"ve been doing resilience design for 3,500 years. There"s various other kinds of resilience engineering, the one where human being are using the modulation that the signaling in microgram quantities to transform the balance. the dynamic balance in between destruction and creation. the leads to a an ext or much less static looking photo of your skeleton is just around five years old. It is a direct, the is an attempt to directly transform the resilience of the life system. It"s therefore got some dangers attached come it, but also some an excellent possibilities, specifically the reality that micrograms deserve to be offered to influence. This tells you how an effective it is. It relies critically top top the success of for its success top top deep expertise of resilience. Girlfriend wouldn"t 3,500 years ago, 2000 years ago, a thousand year ago, even even 60 or 70 year ago, this would have been inconceivable. No one could possibly have actually imagined doing this. This is the result of many, plenty of hundreds of year of intense initiative to shot and know these instrument and also many, many brand-new techniques that have been carried to bear just in the past pair of decades. It does generate brand-new types of hazard, yet it"s an especially interesting to me because it"s, that is a different, it"s qualitatively a different kind of resilience design that is, I"m do the efforts to engineer the resilience fairly than you do design that exploits the resilience. and I think we regularly confuse these two or talk about these two as though they to be one. And also I think interestingly enough, many in civilization who room interested in resilience at first are interested in trying to enhance resilience or develop up resilience or make resilience stronger or find brand-new ways to create resilience. and also a totality bunch of various other sorts that descriptive terms, i m sorry is that resilience design that"s ~ above the appropriate hand side, right? It"s the modulation straight of resilience. but if us look in ~ it a bit much more closely, we would see in the background of your very own domain and also many others, the presence of resilience design over a much longer period of time. that is world understanding resilience is current in your system and also finding means to make use of that resilience to technician the means in which the resilience is carried to bear. and so ns would give you PagerDuty and Rundeck and also all the other sponsors that this conference as examples of resilience engineering, your attempts to carry the resilience, i m sorry is located in the civilization who room actually keeping your equipment to bear in methods that allow it to flow more effectively to restore that function. and also I think we offer that to perhaps some short shrift in, we"re so fascinated by the idea the resilience and creating resilience that us automatically want to do this thing over here. not recognizing the to execute that requires quite a deep understanding of the sources and operational characteristics of resilience. and that"s quite a big undertaking. yet I would indicate to you that you room doing resilience design in her work-related on a everyday basis. It might not acquire that brand or a title, but just what you room doing every work and, and like the orthopedics surgeons, you know enough about the resilience in the system to have the ability to engineer that such the the resilience will certainly play out in methods that space productive and functional. You recognize that you have to modulate that by giving the miscellaneous sorts of nutrition and raw resources and also other things. You recognize that those are, are essential for the resilience come play out and also enumerating and also understanding those things, which has been the heritage in orthopedic and orthopedics for at the very least a 3,500 year is an essential to make progress. over there is the opportunity of act this sort of resilience design the kind two or, or the other kind, the straight manipulation of resilience. yet I think it"s going to prove to be much more challenging for us since we will need to have a yes, really intimate expertise of what resilience is and how the works in these systems in stimulate to be able to do this very effectively. Well, as my psychiatrist friends see, I check out we"re comes close come the finish of our time together. therefore why is this important? i think you room the civilization who space most likely to be in a place to acknowledge and also perhaps to no control, but let"s to speak modulate the means resilience is used and also engineered the engineering around resilience come achieve details ends. ns think you"re also quite perceptible to the means in i beg your pardon resilience is vulnerable, the kinds of diseases, the collection, as with Paget"s disease and osteosarcoma and all those that we witnessed on bone there. There space pathologies in your organizations too that will often tend to Rob her skeleton of the resilience. And there are likewise uh, procedures in the background, i m sorry are, which are involve constant renewal such that we don"t really watch them, we view them as static. The new people comes to your organization to learn around systems, the old ones leaving, the restructuring of architectures, the call, rotors, all of those things space a type of background process of, of destruction and also renewal the creates a kind of dynamic balance the preserves resilience and also makes it easily accessible for managing the type of difficulties that you"re going to encounter. It"s therefore that i commend to you the idea that bone together a model for no as a model, as an archetype because that resilience. and I hope that when civilization say come you in the future, what, what is this resilience thing? What, call me what resilience is. What walk resilience mean? Or have the right to you provide me an instance of resilience or resilience engineering that the first example that will come to mind for you is bone. So ns think it"s yes, really beautiful. I think it"s, it"s acquired a quality to it the is, almost, challenge I say spiritual. That, that has actually so many of the facets of resilience developed into this one quite example, that trying out it and also understanding it is likely to prove to be very valuable for you in the future.

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