Usefulness of clinical findings, nerve conduction studies and ultrasonography to predict response to surgical release in idiopathic carpal tunnel syndrome.

[EN] OBJECTIVES: To assess the usefulness of clinical findings, nerve conduction studies and ultrasonography performed by a rheumatologist to predict success in patients with idiopathic carpal tunnel syndrome (CTS) undergoing median nerve release. METHODS: Ninety consecutive patients with CTS (112 wrists) completed a specific CTS questionnaire and underwent physical examination and nerve conduction studies. Ultrasound examination was performed by a rheumatologist who was blind to any patient's data. Outcome variables were improvement >25% in symptoms of the CTS questionnaire and patient's overall satisfaction (5-point Likert scale) at 3 months postoperatively. Success was defined as improvement in both outcome variables. Receiver operating characteristics (ROC) curves and logistic regression analyses were used to assess the best predictive combination of preoperative findings. RESULTS: Success was achieved in 63% of the operated wrists. Utility parameters and area under the ROC curve (AUC) for individual findings was poor, ranging from 0.481 of the nerve conduction study to 0.634 of the cross-sectional area at tunnel outlet. Logistic regression identified the preoperative US parameters as the best predictive variables for success after 3 months. The best predictive combination (AUC=0.708) included a negative Phalen maneuver, plus absence of thenar atrophy, plus less than moderately abnormalities on nerve conduction studies plus a large maximal cross-sectional area along the tunnel by ultrasonography. CONCLUSION: Although cross-sectional area of the median nerve was the only predictor of success after three months of surgical release, isolated preoperative findings are not reliable predictors of success in patients with idiopathic CTS. A combination of findings that include ultrasound improves prediction.

Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgerys

[EN] OBJECTIVE: To determine the value of ultrasonography in the assessment of patients with idiopathic carpal tunnel syndrome (CTS) and poor outcome after carpal tunnel release. METHODS: A total of 88 consecutive patients with CTS (104 hands) underwent open surgical release of the median nerve. Ultrasound (US) examination was performed blind to any patient's data. The median nerve area at tunnel inlet and outlet, the retinaculum distance, and the flattening ratio were measured. The main outcome variable was the patient's overall satisfaction using a five-point Likert scale (1 = worse, 2 = no change, 3 = slightly better, 4 = much better, 5 = cured) at 3 months postoperatively. Pre- and postoperative ultrasonographic findings in relation to clinical outcome were analysed. RESULTS: Improvement (scores 4 or 5 on the Likert scale) was recorded in 75 hands (72%). After carpal tunnel release, the cross-sectional area at tunnel inlet decreased from a mean of 14.2 to 13.3 mm2 in the group with clinical improvement and also from a mean of 12.5 to 11.6 mm2 in the group with no change or slight improvement. No significant changes in the cross-sectional area at tunnel outlet, retinaculum distance, and flattening ratio were observed. CONCLUSION: Reduction of the median nerve cross-sectional area at tunnel inlet at 3 months after carpal tunnel release was similar in patients reporting cure or great improvement and in those with slight or no improvement. Ultrasonography is of limited value in assessment of patients with poor outcome after median nerve release.

Analisi e valutazione delle performance acustiche degli aeromobili nella fase di atterraggio

Nella tesi si analizzano le principali fonti del rumore aeronautico, lo stato dell'arte dal punto di vista normativo, tecnologico e procedurale. Si analizza lo stato dell'arte anche riguardo alla classificazione degli aeromobili, proponendo un nuovo indice prestazionale in alternativa a quello indicato dalla metodologia di certificazione (AC36-ICAO) Allo scopo di diminuire l'impatto acustico degli aeromobili in fase di atterraggio, si analizzano col programma INM i benefici di procedure CDA a 3° rispetto alle procedure tradizionali e, di seguito di procedure CDA ad angoli maggiori in termini di riduzione di lunghezza e di area delle isofoniche SEL85, SEL80 e SEL75.

Shape design optimization of road acoustic barriers featuring top-edge devices by using Genetic Algotithms and Boundary Elements

[EN] This paper presents a Boundary Elements (BE) approach for the efficiency improvement of road acoustic barriers, mora specifically, for the shape design optimization of top-edge devices in the search for the best designs in terms of screening performance, usually represented by the insertion loss (IL).

Pushover analysis of an existing reinforced concrete bridge:Jamboree Road Overcrossing in Irvine, California

The work for the present thesis started in California, during my semester as an exchange student overseas. California is known worldwide for its seismicity and its effort in the earthquake engineering research field. For this reason, I immediately found interesting the Structural Dynamics Professor, Maria Q. Feng's proposal, to work on a pushover analysis of the existing Jamboree Road Overcrossing bridge. Concrete is a popular building material in California, and for the most part, it serves its functions well. However, concrete is inherently brittle and performs poorly during earthquakes if not reinforced properly. The San Fernando Earthquake of 1971 dramatically demonstrated this characteristic. Shortly thereafter, code writers revised the design provisions for new concrete buildings so to provide adequate ductility to resist strong ground shaking. There remain, nonetheless, millions of square feet of non-ductile concrete buildings in California. The purpose of this work is to perform a Pushover Analysis and compare the results with those of a Nonlinear Time-History Analysis of an existing bridge, located in Southern California. The analyses have been executed through the software OpenSees, the Open System for Earthquake Engineering Simulation. The bridge Jamboree Road Overcrossing is classified as a Standard Ordinary Bridge. In fact, the JRO is a typical three-span continuous cast-in-place prestressed post-tension box-girder. The total length of the bridge is 366 ft., and the height of the two bents are respectively 26,41 ft. and 28,41 ft.. Both the Pushover Analysis and the Nonlinear Time-History Analysis require the use of a model that takes into account for the nonlinearities of the system. In fact, in order to execute nonlinear analyses of highway bridges it is essential to incorporate an accurate model of the material behavior. It has been observed that, after the occurrence of destructive earthquakes, one of the most damaged elements on highway bridges is a column. To evaluate the performance of bridge columns during seismic events an adequate model of the column must be incorporated. Part of the work of the present thesis is, in fact, dedicated to the modeling of bents. Different types of nonlinear element have been studied and modeled, with emphasis on the plasticity zone length determination and location. Furthermore, different models for concrete and steel materials have been considered, and the selection of the parameters that define the constitutive laws of the different materials have been accurate. The work is structured into four chapters, to follow a brief overview of the content. The first chapter introduces the concepts related to capacity design, as the actual philosophy of seismic design. Furthermore, nonlinear analyses both static, pushover, and dynamic, time-history, are presented. The final paragraph concludes with a short description on how to determine the seismic demand at a specific site, according to the latest design criteria in California. The second chapter deals with the formulation of force-based finite elements and the issues regarding the objectivity of the response in nonlinear field. Both concentrated and distributed plasticity elements are discussed into detail. The third chapter presents the existing structure, the software used OpenSees, and the modeling assumptions and issues. The creation of the nonlinear model represents a central part in this work. Nonlinear material constitutive laws, for concrete and reinforcing steel, are discussed into detail; as well as the different scenarios employed in the columns modeling. Finally, the results of the pushover analysis are presented in chapter four. Capacity curves are examined for the different model scenarios used, and failure modes of concrete and steel are discussed. Capacity curve is converted into capacity spectrum and intersected with the design spectrum. In the last paragraph, the results of nonlinear time-history analyses are compared to those of pushover analysis.

Separation control by means of oriented DBD plasma actuators: an experimental analysis in a wind tunnel

This thesis provides an experimental analysis of the effectiveness of oriented DBD plasma actuators over a NACA 0015 airfoil at low Reynolds numbers. Tests were performed in partnership with the Department of Electrical Engineering of Bologna University, in the wind tunnel of the Applied Aerodynamics Laboratory of Aerospace Engineering faculty. Lift coefficient measurements were carried out in order to verify how an oriented plasma jet succeeds in prevent boundary layer separation. Both actuators’ chord wise position and plasma jet orientation angle have been investigated to examine which configurations lead to the best results. A particular attention has been paid also to the analysis of results in steady and unsteady plasma actuation. Questa tesi offre un’analisi sperimentale sull’efficacia di attuatori al plasma orientabili, basati su una tecnologia DBD, installati su un profilo alare NACA 0015, a bassi numeri di Reynolds. Le prove sono state condotte in collaborazione con il Dipartimento di Ingegneria Elettrica dell’Università di Bologna, nella galleria del vento del Laboratorio di Aerodinamica Applicata della Facoltà di Ingegneria Aerospaziale di Forlì. Per verificare come un getto orientabile di plasma riesca a prevenire la separazione dello strato limite, sono state eseguite misure sul coefficiente di portanza. Sono state indagate sia la posizione degli attuatori lungo la corda che l’angolo con cui è orientato il getto di plasma, per vedere quali configurazioni conducono ai migliori risultati. Una particolare attenzione è stata riservata all’analisi dei risultati ottenuti con plasma continuo e pulsato.

Pavement and alignment design of a new rural road in the province of Bologna

This thesis aims to give a general view of pavement types all over the world, by showing the different characteristics of each one and its different life steps starting from construction, passing by maintenance and arriving until recycling phase. The flexible pavement took the main part of this work because it has been used in the last part of this thesis to design a project of a rural road. This project is located in the province of Bologna-Italy (‘Comune di Argelato’, 26 km in the north of Bologna), and has 5677, 81 m of length. A pavement design was made using the program BISAR 3.0 and a fatigue life study was made, also, in order to estimate the number of loads (in terms of heavy vehicles axle) to cause road’s failure . An alignment design was made for this project and a safety study was established in order to check if the available sight distance at curves respects the safety norms or not, by comparing it to the stopping sight distance. Different technical sheets are demonstrated and several cases are discussed in order to clarify the main design principles and underline the main hazardous cases to be avoided especially at intersection. This latter, its type’s choice depends on several factors in order to make the suitable design according to the environmental data. At this part of the road, the safety is a primordial point due to the high accident rate in this zone. For this reason, different safety aspects are discussed especially at roundabouts, signalized intersections, and also some other common intersection types. The design and the safety norms are taken with reference to AASHTO (American Association of State Highway and Transportation Officials), ACT (Transportation Association of Canada), and also according to Italian norms (Decreto Ministeriale delle Starde).

Fattori di rischio biomeccanico e valori limite di esposizione (TLV-ACGIH®) nell’ambito dello studio di coorte della sindrome del tunnel carpale occupazionale

OBIETTIVI: Per esplorare il contributo dei fattori di rischio biomeccanico, ripetitività (hand activity level – HAL) e forza manuale (peak force - PF), nell’insorgenza della sindrome del tunnel carpale (STC), abbiamo studiato un’ampia coorte di lavoratori dell’industria, utilizzando come riferimento il valore limite di soglia (TLV©) dell’American Conference of Governmental Industrial Hygienists (ACGIH). METODI: La coorte è stata osservata dal 2000 al 2011. Abbiamo classificato l’esposizione professionale rispetto al limite di azione (AL) e al TLV dell’ACGIH in: “accettabile” (sotto AL), “intermedia” (tra AL e TLV) e “inaccettabile” (sopra TLV). Abbiamo considerato due definizioni di caso: 1) sintomi di STC; 2) sintomi e positività allo studio di conduzione nervosa (SCN). Abbiamo applicato modelli di regressione di Poisson aggiustati per sesso, età, indice di massa corporea e presenza di patologie predisponenti la malattia. RISULTATI: Nell’intera coorte (1710 lavoratori) abbiamo trovato un tasso di incidenza (IR) di sintomi di STC di 4.1 per 100 anni-persona; un IR di STC confermata dallo SCN di 1.3 per 100 anni-persona. Gli esposti “sopra TLV” presentano un rischio di sviluppare sintomi di STC di 1.76 rispetto agli esposti “sotto AL”. Un andamento simile è emerso per la seconda definizione di caso [incidence rate ratios (IRR) “sopra TLV”, 1.37 (intervallo di confidenza al 95% (IC95%) 0.84–2.23)]. Gli esposti a “carico intermedio” risultano a maggior rischio per la STC [IRR per i sintomi, 3.31 (IC95% 2.39–4.59); IRR per sintomi e SCN positivo, 2.56 (IC95% 1.47–4.43)]. Abbiamo osservato una maggior forza di associazione tra HAL e la STC. CONCLUSIONI: Abbiamo trovato un aumento di rischio di sviluppare la STC all’aumentare del carico biomeccanico: l’aumento di rischio osservato già per gli esposti a “carico intermedio” suggerisce che gli attuali valori limite potrebbero non essere sufficientemente protettivi per alcuni lavoratori. Interventi di prevenzione vanno orientati verso attività manuali ripetitive.