APPLICAZIONE DELLA MODELLIZZAZIONE NUMERICA ALL'ACQUIFERO COSTIERO COMPRESO TRA IL CANALE BURLAMACCA ED IL FOSSO DELLA BUFALINA (VERSILIA MERIDIONALE)

Il presente lavoro di tesi tratta lo studio dell'acquifero freatico costiero compreso tra il Canale Burlamacca ed il Fosso della Bufalina. Lo studio si articola in due fasi principali. Nella prima fase si procede alla realizzazione del modello concettuale che consiste in quadro descrittivo delle caratteristiche idrogeologiche e idrodinamiche del sistema con particolare attenzione alle condizioni al contorno ed ai flussi d'acqua da e verso la falda. In questa parte del lavoro vengono acquisiti i dati di letteratura sull'area in studio, elaborate le informazioni stratigrafiche puntuali, reperiti i dati meteoclimatici di precipitazione e temperatura ed effettuate prove in campo rivolte essenzialmente al calcolo dei parametri idraulici ed alla verifica dei parametri fisico-chimici attraverso log. verticali in alcuni piezometri. La seconda fase riguarda la modellazione matematica con l'elaborazione del modello di flusso tramite l'utilizzo del software Visual Modflow 2009.1. Il modello numerico consiste in una rappresentazione "semplificata" del sistema idrogeologico che permette di verificarne il funzionamento e di prevederne l'evoluzione nel tempo

Post-surgical scar assessment in rehabilitation: a systematic review

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Numerical modelling in the coastal aquifer between Burlamacca Canal and Bufalina Ditch, southern Versilia (Tuscany, Italy)

Groundwater numerical models are necessary instruments for management of water resources and for their protection, both in terms of quantity and quality. In this paper we present a study on an area located along the southern coastline of Versilia (Viareggio,LU) affected by marine intrusion. The main purpose of this work was to create a mathematical flow model based on a conceptual hydrogeological model defined by a multidisciplinary approach. For the realization of the numerical model the ModFlow code and the graphic interface Visual ModFlow was used. The procedure for defining the mathematical model involves a series of steps such as horizontal and vertical discretization of the space, the definition of the initial and boundary conditions, the assignment of the hydraulic properties of the cells and, finally, the definitions of external perturbations to the system (recharge, evapotranspiration, drainage and pumping wells). Implementation, development and calibration of the numerical flow model was performed both in steady and transient state. Both models were calibrated using the manual "trial and error adjustment" method using heads measurements. Moreover the model results gathered in transient state simulation were compared with the data continuously recorded by a piezometer of the monitoring network of the Regional Hydrological Service. There is a good correlation between the measured data and those calculated by the model which then turns out to be sufficiently representative and provides a solid basis for the development of a transport model that could be useful to control and manage the phenomenon of the salt water intrusion

Development and refinement of outcome measures and users' satisfaction in physical medicine and rehabilitation

In recent years, the interest in outcome measures has grown in the effort to improve quality of care and customer satisfaction. This thesis provides an overview of topics related to development and refinement of outcome measures and users' satisfaction measurement in Physical and Rehabilitation Medicine. The eight chapters - represented by original articles - are examples of the application of contemporary measurement approaches to some instruments commonly used in rehabilitation. These studies illustrate advances in measurement theory and methods that allow outcome indicators to be measured more accurately, including Rasch analysis. Their utility for researchers and clinicians are discussed. Chapter I focuses on the interpretation of the change scores of two common outcome measures for the upper limb: the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and its short version (QuickDASH). In this work the minimal clinically important difference (MCID) was calculated by a triangulation of distribution and anchor-based approaches for these two questionnaires. The MCID thresholds represents the smallest improvement considered worthwhile by a patient, and thus increase the interpretability of score changes at individual level observed in the clinical setting. Assessing patient progress is an integral part of clinical practice, and meaningful threshold change values of outcome tools are essential for decision making regarding a patient‟s status and to facilitate the communication of results in a concise and comprehensible fashion. Among the different tools used for the assessment of musculoskeletal disorders of the lower limb, the Foot and Ankle Ability Measure (FAAM) showed good psychometrics properties. However, it has not yet been made a translation into Italian. Chapter II shows how to conduct a translation and cross-cultural adaptation of a questionnaire according to the international guidelines for the forward/backward translation. The activities od daily living (ADL) module of the Italian FAAM (FAAM-I/ADL) was translated and then validated with the classical test theory, taking into consideration internal consistency, reproducibility, sensitivity to change and validity. Chapter III presents an example of the test-retest reliability analysis and normative data collection of the the Functional Dexterity Test (FDT). Among the available tests for fine finger dexterity, it has been indicated as a valid instrument to measure outcome in different conditions. FDT scores were collected on a large sample of subjects (N=698) stratified by sex and age. These data could be used, for example, to improve the diagnostic capacity of this test. Chapters IV, V and VI report the complex process of validation through the Rasch analysis. In particular, the aim of Chapter IV and V was to perform the translation and cross-cultural adaptation into Italian and Arabic of the recently revised version of the Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users' Survey (OPUS), and then analyze its psychometric properties using factor and Rasch analyses. The need for validated versions of this instrument into Italian and Arabic is documented by the fact that information on patient satisfaction with orthosis (PSwO) is crucial for verifying and enhancing orthotic quality, for clinical decision making, and for improving patient's quality of life. The aim of the study included in Chapter VI was to perform a comprehensive analysis of the psychometric properties and dimensionality of the Italian version of the Upper Limb Functional Index (ULFI) using both Classical Test Theory and Rasch analysis. The last two chapters - VII and VIII - are systematic reviews of the literature. Chapter VII reports a literature search aimed at identifying which validated questionnaires are used to investigate PSwO in limb orthotics, and analyse their main fields of clinical application, the orthosis-related features analysed by the questionnaires, and the strength of their psychometric properties. Chapter VIII covers the topic of post-surgical scar assessment in rehabilitation. The study is a systematic review that provides a critical appraisal of the most used and clinimetrically sound outcome measures currently available for this topic

Les chutes chez les personnes âgées (le syndrome post-chute et sa prise en charge)

PARIS-BIUP (751062107) / SudocSudocFranceF

The EdUReP approach plus manual therapy for the management of insertional Achilles tendinopathy

Insertional Achilles tendinopathy (IAT) is a challenging overuse disorder. The aim of this case report was to study the feasibility of a comprehensive rehabilitative approach according to the Education, Unloading, Reloading, and Prevention (EdUReP) framework combined with Instrument-Augmented Soft Tissue Mobilization (I-ASTM). An active 51-year-old man patient with chronic IAT was studied. Clinical assessment battery was composed by visual analogue scale for pain during the Achilles tendon palpation test, passive straight leg raise test, single leg hop test, Patient-Specific Functional Scale, and Foot and Ankle Ability Measure. The patient was treated over a 8 weeks period using the EdUReP guidelines plus 8 sessions of I-ASTM, applied with a solid instrument to the Achilles tendon and to the muscle fibrotic areas previously identified during evaluation. Clinically significant improvements were observed in all outcome measures, and a resume of patient's usual sports activities without pain or limitations was possible after treatment. Results lasted over a 6-month follow-up. To the best of our knowledge, this is the first study applying a comprehensive approach based on accurate physical assessment, and using the EdUReP theoretical model. The combination of the EdUReP model and manual therapy was effective in resolving the patient's symptoms and restore his usual sport activities. While these results cannot be generalized, the present findings could provide a valuable foundation for future researches