Vehicle Modification Resources for Families of Tucker’s House

Tucker\u27s House is a nonprofit providing construction, retrofitting, and home accessibility services for families of children with disabilities Mission: To create safer, more accessible homes and environments for children and young adults with disabilities Vision: For every child with disabilities to feel at hom

Ergotherapeutische Interventionen im Sonderschulsetting bei Kindern mit einer geistigen Beeinträchtigung : Abgrenzung zur Heilpädagogik

Durch frühzeitige ergotherapeutische Interventionen können die Fertigkeiten von geistig beeinträchtigten Kindern gefördert und die Auswirkung auf die Entwicklung verringert werden. Im Sonderschulsetting werden die betroffenen Kinder eng von Fachpersonen der Heilpädagogik und der Ergotherapie begleitet und unterstützt. Die Arbeit soll Auskunft über die in der Literatur beschriebenen ergotherapeutischen Interventionen im sonderschulischen Setting bei Kindern mit einer geistigen Beeinträchtigung geben. Gleichzeitig soll die Abgrenzung der Ergotherapie zur Heilpädagogik aufgezeigt werden. Mittels systematischer Literaturrecherche wurden drei Hauptstudien ausgewählt und kritisch beurteilt. Um die Inhalte auf den schweizerischen Kontext zu übertragen, wurden zusätzlich an zwei heilpädagogischen Schulen Experteninterviews geführt. Die Studien ergeben einen groben Überblick über ergotherapeutische Interventionen welche sich für Kinder mit einer geistigen Beeinträchtigung eignen. Spiel als therapeutisches Mittel, Sensorische Integration, Kommunikation und ein familienzentrierter Ansatz werden am häufigsten genannt. Die Evidenzlage ist gering und es bedarf der weiteren Forschung bezüglich der Interventionen. Die Heilpädagogik und die Ergotherapie überschneiden sich teilweise in ihrem Tätigkeitsbereich, sie haben aber auch klare Kernkompetenzen. Eine enge Zusammenarbeit der beiden Professionen steht im direkten Zusammenhang mit dem Therapieerfolg des Kindes

Ritardata attuazione delle direttive comunitarie e adeguata remunerazione dei medici specializzandi: tra prescrizione del diritto ed effettivit\ue0 della tutela

Nota alla sentenza del Tribunale Roma, sezione II, del 15 marzo 2011, per la quale, in caso di mancato o tardivo recepimento di una direttiva comunitaria, lo Stato \ue8 contrattualmente responsabile per inadempimento di un'obbligazione legale di natura indennitaria per attivit\ue0 non antigiuridica. La sentenza e il commento affrontano le diverse interpretazioni possibili sull'applicabilit\ue0 della prescrizione del diritto al risarcimento del danno al caso dei medici specializzatisi prima della trasposizione della direttiva, con la quale si \ue8 previsto in loro favore il diritto ad un'adeguata remunerazione

CH of masonry materials via meshless meso-modeling

In the present study a multi-scale computational strategy for the analysis of masonry structures is presented. The structural macroscopic behaviour is obtained making use of the Computational Homogenization (CH) technique based on the solution of the boundary value problem (BVP) of a detailed Unit Cell (UC) chosen at the meso-scale and representative of the heterogeneous material. The smallest UC is composed by a brick and half of its surrounding joints, the former assumed to behave elastically while the latter considered with an elastoplastic softening response. The governing equations at the macroscopic level are formulated in the framework of finite element method while the Meshless Method (MM) is adopted to solve the BVP at the mesoscopic level. The work focuses on the BVP solution. The consistent tangent stiffness matrix at a macroscopic quadrature point is evaluated on the base of BVP results for the UC together with a localisation procedure. Validation of the MM procedure at the meso-scale level is demonstrated by numerical examples that show the results of the BVP for the simple cases of normal and shear loading of the UC

Riparazione laparoscopica dell'ulcera peptica perforata: vantaggi e limiti della metodica

L'ulcera peptica perforata è la più comune indicazione per la chirurgia d'urgenza gastrica ed è associata a morbidità e mortalità elevate. L'outcome può essere migliorato utilizzando un approccio laparoscopico, ma non c'è unanimità sul prevalere de i benefici o degli svantaggi nella riparazione laparoscopica della PPU. Abbiamo revisionato le cartelle cliniche di 124 pazienti che sono stati sottoposti ad intervento chirurgico per PPU nel periodo 2002-2014. E' stata proposta e applicata una politica "laparoscopy-first" a 68 pazienti, 41 maschi e 27 femmine con età media di 58 anni (range 19-95). I principali criteri di esclusione utilizzati erano: stato di shock all'ammissione, severe comorbidità cardiorespiratorie e precedente intervento di chirurgia addominale maggiore. Il valore medio di Mannheim Peritonitis Index (MPI) era di 21 e la dimensione media dell'ulcera era di 1.1 cm. L'intervento è stato completato per via laparoscopica in 49 pazienti (72%) e comprendeva la lisi di aderenze e lavaggio peritoneale, la raffia della perforazione e omentopessi. La conversione a laparotomia è stata necessaria in 19 casi (28%). Il gruppo dei pazienti convertiti mostrava un MPI significativamente più elevato (24 vs 19; p < 0.05), dimensioni maggiori dell'ulcera (1.9 cm vs 0.6 cm; p < 0.01) e più frequente localizzazione della PPU sulla parete posteriore del duodeno (31% vs. 0%; p < 0.01). Nel gruppo laparoscopico la durata media dell'intervento era di 83,7 min (range 50-125), i tassi di morbidità e mortalità erano rispettivamente 10.2% e 2%. Per nessuno di questi pazienti è stato necessario un reintervento. La durata media dell'ospedalizzazione post-operatoria era di 7.1 giorni (range 5-20). In base alla nostra esperienza, la laparoscopia nella PPU sembra essere sicura ed efficace. Tuttavia può essere necessaria una particolare abilità nella gestione laparoscopica delle emergenze addominali da parte del chirurgo per il trattamento di pazienti con una severa contaminazione peritoneale dovuta ad una perforazione datata. Sono da considerarsi come i principali fattori di rischio per la conversione un MPI maggiore di 24, una dimensione dell'ulcera uguale o maggiore di 1.5 cm e una perforazione duodenale posteriore

The FE-Meshless multiscale approach applied to masonry structures

Heterogeneous structures have an overall response that is strongly dependent on the inelastic events developing at the local level. In these structures, the most relevant kinematical and mechanical phenomena take place at a scale which is small if compared to the dimensions of the entire structure. In literature, a mesoscopic and a macroscopic scales of interest are distinguished, directly linked to as many theoretical approaches. The mesoscopic approach [1] considers materials and their interfaces individually, but many difficulties arise in the mesh creation and a fine discretization of the structure is needed, which leads to prohibitive computational costs. The macroscopic approach considers the structure as constituted by a fictitious homogeneous and continuous material. The multiscale techniques belong to the second approach and couple different scales of interest by means of apposite transition laws capable to exchange informations between different consecutive scales [2]. This work relates with the multiscale first order computational homogenization technique applied to masonry structures. A unit cell (UC) is assumed constituted by an elastic bulk volume surrounded by weak joints, which are simulated by zero-thickness elasto-plastic interface models. At a single time step, the FE solution of the fictitious homogenized structure provides strains at all quadrature points. The corresponding macrostress field associated to the strain is obtained by solving a Boundary Value Problem (BVP) of the UC at the mesoscale level. The solution of the BVP is approached by means of a meshless strategy [3] instead of a classical finite element procedure, that is usually time-consuming. By imposing Taylor-Voigt type boundary conditions on the UC, the macroscopic stress is evaluated averaging the UC boundary tractions, according to the Hill-Mandel principle. Localization is faced at both the quadrature point level and at the element level. At the quadrature point level plastic bands are localized applying a continuous-discontinuous bifurcation theory [4] based on the spectral analysis of the acoustic tensor associated to the stiffness matrix. At the element level inelastic response is obtained smearing the plastic zones at the quadrature points over the element area, considering the localized and not localized fraction areas. The proposed model has been implemented on a research oriented finite element analysis pro- gram to run 2D simulations in plane-stress conditions for heterogeneous periodic structures. Quali- tatively good results are obtained in comparison with numerical data available in literature

A FE-Meshless Multiscale Approach for Masonry Materials

AbstractA FE-Meshless multiscale computational strategy for the analysis of running bond masonry is presented. The Meshless Method (MM) is adopted to solve the boundary value problem (BVP) at the mesoscopic level. The representative unit cell is composed by the aggregate and the surrounding joints, the former assumed to behave elastically while the latter are simulated as non-associated elastic-plastic zero-thickness interfaces with a softening response. Macroscopic localization of plastic bands is obtained performing a spectral analysis of the tangent stiffness matrix. Localized plastic bands are embedded into the quadrature points area of the macroscopic finite elements

On the use of EMI for the assessment of dental implant stability

The achievement and the maintenance of dental implant stability are prerequisites for the long-term success of the osseointegration process. Since implant stability occurs at different stages, it is clinically required to monitor an implant over time, i.e. between the surgery and the placement of the artificial tooth. In this framework, non-invasive tests able to assess the degree of osseointegration are necessary. In this paper, the electromechanical impedance (EMI) method is proposed to monitor the stability of dental implants. A 3D finite element model of a piezoceramic transducer (PZT) bonded to a dental implant placed into the bone was created, considering the presence of a bone- implant interface subjected to Young’s modulus change. The numerical model was validated experimentally by testing bovine bone samples. The EMI response of a PZT, bonded to the abutment screwed to implants inserted to the bone, was measured. To simulate the osseointegration process a pulp canal sealer was used to secure the implant to the bone. It was found that the PZT’s admittance is sensitive to the stiffness variation of the bone-implant interface. The results are promising because they show the potential of EMI method to (i) evaluate the material properties around dental implant, and (ii) promote a novel non-invasive monitoring of dental implant surgical procedure

Efficient finite difference formulation of a geometrically nonlinear beam element

The article is focused on a two-dimensional geometrically nonlinear formulation of a Bernoulli beam element that can accommodate arbitrarily large rotations of cross sections. The formulation is based on the integrated form of equilibrium equations, which are combined with the kinematic equations and generalized material equations, leading to a set of three first-order differential equations. These equations are then discretized by finite differences and the boundary value problem is converted into an initial value problem using a technique inspired by the shooting method. Accuracy of the numerical approximation is conveniently increased by refining the integration scheme on the element level while the number of global degrees of freedom is kept constant, which leads to high computational efficiency. The element has been implemented into an open-source finite element code. Numerical examples show a favorable comparison with standard beam elements formulated in the finite-strain framework and with analytical solutions