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Background: Proximal humeral fractures (PHFs) are common, especially in the elderly, and account for 4% to 10% of all fractures, with women more often affected than men. Treatments include conservative methods, internal fixation and arthroplasty, with surgical approaches increasingly being used due to technological advancements. This study analyzes the evolution of PHF treatments in Italy from 2001 to 2022, using data from the Italian Hospital Discharge Records (HDRs) Database, and includes a stratified analysis by age and sex. Methods: Using HDR data from 2001 to 2022, records with ICD9-CM codes for proximal humeral fractures (812.0 and 812.1) among diagnoses were selected and categorized into three treatment groups: arthroplasty, fixation and conservative. Time series were analyzed with stratification by sex and age. Results: The extracted data included 486,368 records of PHFs, with 223,742 cases treated surgically (arthroplasty or internal fixation) and 262,626 treated conservatively; the average patient age was 66.6 years, with a higher proportion of women, especially among arthroplasty patients. Over time, the use of fixation and arthroplasty increased from 20% of treatments in 2001 to over 60% in 2022, with fixation becoming the most common treatment method by 2014 and arthroplasty significantly increasing among women, particularly in the 65–74 and 75–84 age groups. Conclusions: The study shows that in Italy, over the past two decades, treatment for PHFs has shifted from conservative methods to a preference for internal fixation and increasingly for arthroplasty, particularly among women and patients aged 65–84, reflecting evolving trends and technological improvements. [ABSTRACT FROM AUTHOR]

Probability of detection (POD) is an acknowledged mean of evaluation for many investigations aiming at detecting some specific property of a subject of interest. For instance, it has had many applications for Non-Destructive Evaluation (NDE), aimed at identifying defects within structural architectures, and can easily be used for structural health monitoring (SHM) systems, meant as a compact and more integrated evolution of the former technology. In this paper, a probability of detection analysis is performed to estimate the reliability of an SHM system, applied to a wing box composite spar for bonding line quality assessment. Such a system is based on distributed fiber optics deployed on the reference component at specific locations for detecting strains; the attained data are then processed by a proprietary algorithm whose capability was already tested and reported in previous works, even at full-scale level. A finite element (FE) model, previously validated by experimental results, is used to simulate the presence of damage areas, whose effect is to modify strain transfer between adjacent parts. Numerical data are used to verify the capability of the SHM system in revealing the presence of the modeled physical discontinuities with respect to a specific set of loads, running along the beam up to cover its complete extension. The POD is then estimated through the analysis of the collected data sets, wide enough to assess the global SHM system performance. The results of this study eventually aim at improving the current strategies adopted for SHM for bonding analysis by identifying the intimate behavior of the system assessed at the date. The activities herein reported have been carried out within the RESUME project. [ABSTRACT FROM AUTHOR]

Robotic-assisted hip and knee arthroplasty represents significant advancements in orthopedic surgery. Artificial intelligence (AI)-driven chatbots, such as ChatGPT, could play a significant role in healthcare education. This study aims to evaluate the quality of responses provided by ChatGPT to the top 20 questions concerning robotic-assisted hip and knee arthroplasty. We have asked ChatGPT to select the top 20 questions on Google concerning robotic hip and knee arthroplasty and to provide a detailed answer to each of them. The accuracy and completeness of the information provided were examined by three orthopedic surgeons with scientific and clinical experience in hip- and knee-replacement surgery. The accuracy was assessed through a 5-point Likert scale (from 1—completely incorrect to 5—correct); the completeness through a 4-point Likert scale (from 0—comprehensiveness not assessable for completely incorrect answers to 3—exhaustive information) on two different occasions to ensure the consistency of the assessment. Our analysis reveals that ChatGPT provides a relatively high degree of accuracy; moreover, the explanations can be considered satisfying, especially for factual questions. The findings suggest that ChatGPT can serve as a valuable initial resource for general information on robotic hip and knee arthroplasty but the integration with human expertise remains essential. [ABSTRACT FROM AUTHOR]

(1) Background: Vulvodynia is characterized by vulvar pain for at least three months and may have related variables, one of these being pelvic floor hypertonus. The purpose of this study was to compare the therapeutic effectiveness of two weekly sessions of pelvic floor rehabilitation and 5 mg of vaginal diazepam daily vs. pelvic floor rehabilitation alone in individuals with vulvodynia. (2) Methods: A single-center, not-blind, randomized study enrolled 20 vulvodynic patients: A total of 10 were treated with dual therapy (intravaginal diazepam and pelvic floor rehabilitation), and 10 were treated with only pelvic floor rehabilitation. All of them underwent a pelvic floor ultrasound examination and VAS pain and Marinoff scale assessments before the beginning of therapy as well as three and six months later. (3) Results: The elevator plate angle ranged from 8.2 to 9.55 (p = 0.0005), hiatal area diameter ranged from 1.277 to 1.482 (p = 0.0002), levator symphysis distance ranged from 3.88 to 4.098 (p = 0.006), anorectal angle ranged from 121.9 to 125.49 (p = 0.006), Marinoff scale ranged from 2.3 to 1.4 (p = 0.009), and VAS scale ranged from 5.8 to 2.8 (p < 0.001). (4) Conclusions: This pilot study demonstrates that the suggested treatment improves the hypertonicity of the pelvic floor, as measured by ultrasound parameters, correlating with a reduction in symptomatology. [ABSTRACT FROM AUTHOR]

In recent years, there has been a significant increase in the use of structural health monitoring (SHM) technologies as systems for monitoring the integrity of aircraft's structures. The use of compact and embeddable sensor networks, like the ones based on fibre optics (FO), is particularly attractive from the perspective of releasing an integrated structural system with intrinsic sensing capacity. Usually, an SHM system architecture is completed by a dedicated algorithm that processes the data gathered from the sensors to elaborate on the level of damage currently suffered by the structure, with the further possibility of providing information to the relevant specialists involved with its supervision. One of the main SHM applications that is attracting major interest is related to the inspection and detection of anomalies in bonded joints, which is extremely relevant in many composite realizations. Aeronautical regulations allow the use of bonded joints on an aircraft's primary structure but require the implementation of a means to ensure their absolute safety, such as the introduction of further mechanical links aimed at stopping the propagation of a possible flaw or the availability of Non-Destructive Inspection (NDI) systems to prove the absence of relevant damaged areas. Generally, the main typical defects occurring during the manufacturing of bonded joints include adhesive curing, kissing bonds, poor porosity, and poor surface preparation. The current NDI systems more widely used and available to detect defects are still inaccurate due to the lack of standard procedures for the creation of representative defects in a controlled manner, which would allow for the development of reliable methodologies and tools able to ensure the safety of a bonded joint, as required by safety regulations. This paper shows the results relative to the implementation of an SHM system developed by the Italian Aerospace Research Centre (CIRA) aimed at monitoring the bonding lines between spar caps and panels of a typical composite wingbox section and detecting faults in location and length. The work was performed during typical ground static tests by using a fibre optical sensing network embedded within relevant adhesive paste layers during the manufacturing process of the structure. In the reported investigation, the SHM system assumed the function of an NDI system tool. The results show that the developed SHM system has good reliability for the detection of both the position and size of damage areas that were artificially inserted within the test article during the bonding phase, showing its potential as a candidate to be used as a tool to verify the conditions of a bonded joint, as required by aviation authorities' regulations. [ABSTRACT FROM AUTHOR]

This article discloses the activity developed in the framework of the research project "GRID" aiming at the feasibility demonstration of a fiber optic sensing system (FOS), based on fiber Bragg gratings (FGB), embedded in the ribs of a conical grid structure demonstrator in composite material (CFRP), manufactured by means of dry robotic winding, liquid resin infusion and oven curing. This structure represents an optimized and highly efficient conical adapter for satellite applications that was designed under the same requirements of a conventional CFRP benchmark solution in order to evaluate possible mass savings. Specific interfaces were conceived in order to facilitate the insertion of the fiber optics in the center of helical ribs—pausing the automated deposition phase of the dry preform—and secure them to the structure. Representative grid articles were produced and tested to select the materials and evaluate the preliminary feasibility of the integrated system in conjunction with the infusion process. The proper functioning and use of the sensing system were finally proven during the various phases of the mechanical testing campaign of the demonstrator. Such a campaign included stiffness and strength evaluations and culminated with the catastrophic failure of the structure. The significant amount of data collected from several sensors embedded in the ribs and from conventional sensors glued outside the ribs helped us to better understand the structural behavior and to validate the design and analysis models. The main steps of the design, manufacturing and tests of this project are here addressed. [ABSTRACT FROM AUTHOR]

Featured Application: This work can find application in the field of the mitigation of the environmental impact of rotorcraft since it focuses on a system to reduce power consumption and, thus, pollution at specific flight regimes. In this work, the modeling of a demonstrator of a morphing system aimed at altering the twist of a rotorcraft blade is presented. The device was conceived for two different representative environments: the wind tunnel plant of the University of Bristol and the whirl tower facility of the DLR, for tests in fixed and wing rotary configurations, respectively. The concept, conceived and matured within the European Project of SABRE, is based on shape memory alloys, SMA. This technology was selected for its intrinsic compactness and solidity, which better meet the requirements of a typical blade structure, being extremely flexible and subjected to relevant inertial loads. A dedicated structural layout was conceived to favor the working modality of the SMA torsional system; this architecture was tailored both to absorb the typical actions occurring onto a blade and to assure a certain level of pre-twist necessary for the SMA strain recovery. The activation of the SMA was performed through an electrothermal helicoidal coil wrapped around it. A dedicated network of sensors was integrated within the structure to measure the impact of the different actions on the blade system. This subsystem, functional to shape reconstruction operations, is capable of splitting the contribution of the loads to pure twist and flapping. At first, the requirements imposed by the two test facilities were elaborated together to the operational needs, arriving at the issue of the most relevant specifications. Secondly, the conceptual and advanced design were considered, demonstrating, first, the feasibility of the concept and, then, its compliance with the test environment. The work ends with two different layouts, conceived respectively for the tests in fixed and rotary wing configurations. For both of them, a performance estimate was addressed, and a discussion on the advantages and disadvantages was presented. [ABSTRACT FROM AUTHOR]

Introduction: Total knee arthroplasty is an effective operation. Post-surgery rehabilitation, based on early and intensive progressive exercise programs, plays a substantial role and telerehabilitation can be an effective safe option. This retrospective study aimed to compare traditional in-presence rehabilitation and telerehabilitation for total knee arthroplasty, based on our experience during the Italian COVID-19 lockdown. Materials and methods: We retrospectively analyzed 164 patients (94 females and 70 males) enrolled in 2020 within 2 weeks after total knee replacement to perform post-operative outpatient rehabilitation. The clinical results of 82 patients (mean age 66.8 ± 10.2 years) performing telerehabilitation with those obtained from a similar cohort of 82 patients (mean age 65.4 ± 11.8 years) performing traditional in-presence outpatient rehabilitation were compared. Clinical outcomes were examined by comparing the gait speed (Time Up and Go-TUG test), the range of motion, the pain intensity (VAS), the functional status (Oxford Knee Score—OKS and Knee injury and Osteoarthritis Outcome Score—KOOS) and the overall satisfaction (Self-administered patient satisfaction scale) 12 weeks after the beginning of the physiotherapeutic protocol. Results: Telerehabilitation was non-inferior to traditional in-presence rehabilitation in all of the investigated areas and no statistical difference in terms of effectiveness was detected at 12 weeks, as confirmed by the respective patient-reported outcome scores such as TUG test (reduced from 20 ± 2 s to 12 ± 1.5 s for the telerehab cohort and from 18 ± 1.5 s to 13.1 ± 2 s for the in-presence rehabilitation one), pain VAS, OKS (improved from 22 ± 1.3 to 36 ± 2.7 for the telerehab cohort and from 23 ± 2.1 to 35.1 ± 4.2 for the in-presence group), KOOS (improved from 46.2 ± 10.2 to 67.4 ± 3.8 for the telerehabilitation cohort and from 48.4 ± 8.4 to 68.3 ± 6.6 for the other group), and the Self-administered patient satisfaction scale (more than two-thirds of patients globally satisfied with the results of their surgery in both groups). Conclusion: The telerehabilitation program was effective after total knee replacement and yielded clinical outcomes that were not inferior to conventional outpatient protocols. [ABSTRACT FROM AUTHOR]

The final objective of the study herein reported is the preliminary evaluation of the capability of an original, real-time SHM system applied to a full-scale wing-box section as a significant aircraft component, during an experimental campaign carried out at the Piaggio Lab in Villanova D'Albenga, Italy. In previous works, the authors have shown that such a system could be applied to composite beams, to reveal damage along the bonding line between a longitudinal stiffening element and the cap. Utilizing a suitable scaling process, such work has then been exported to more complex components, in order to confirm the outcomes that were already achieved, and, possibly, expanding the considerations that should drive the project towards an actual implementation of the proposed architecture. Relevant topics dealt with in this publication concern the application of the structural health monitoring system to different temperature ranges, by taking advantage of a climatic room operating at the Piaggio sites, and the contemporary use of several algorithms for real-time elaborations. Besides the real-time characteristics already introduced and discussed previously, such further steps are essential for applying the proposed architecture on board an aircraft, and to increase reliability aspects by accessing the possibility of comparing different information derived from different sources. The activities herein reported have been carried out within the Italian segment of the RESUME project, a joint co-operation between the Ministry of Defense of Israel and the Ministry of Defense of Italy. [ABSTRACT FROM AUTHOR]

Statistical based reconstruction methods and signal processing tooling techniques are implemented and used to detect delaminations or debondings within composite complex items with very high precision. From the literature, it appears that although a single procedure for the estimation of structural health is a fast solution, multiple analyses based on different reconstruction methods or different damage parameters are the way to achieve maturation assessments of the methodology. This highlights the fact that the hardware and software parts of an SHM system need two different assessment and maturation ways. This work focuses on the software part by proposing a way to start assessing the outcomes. In this paper, the damage detection and localization strategy in CFRP plate-like structures with elastic guided waves excited and acquired with a circular array PWAS network is considered. Previous outcomes are compared by new analyses using a new post-processing approach based on a cross-correlation-based technique in terms of the BVID (Barely Visible Impact Damage) surface position and its center of mass. The advantage of this specific study is hopefully to enable confidence in the transition from R&D to field implementation. In addition, this work tries to evidence an improvement in terms of cost efficiency and reduced complexity while maintaining the same accuracy. [ABSTRACT FROM AUTHOR]

In the aeronautical field, the damage that occurs to a carbon-fibre-reinforced polymer (CFRP) structure analysis is a crucial point for further improving its capability and performance. In the current the state of the art, in fact, many issues are linked to the certification process more than to technological aspects. For the sake of clarity, it should be added that regulations call for technological solutions that are invasive (in terms of weight and manufacturing costs) or exploit technologies that are not fully mature. Thus, the truth is in between the above statements. One of the possible solutions to bypass this issue is the assessment of a structural health monitoring system (SHM) that is sufficiently reliable to provide a full-state representation of the structure, automatically, perhaps in real-time, with a minimum intervention of specialized technicians, and that can raise an alert for safe maintenance whenever necessary. Among the different systems that have been proposed in the scientific and technological literature, SHM systems based on strain acquisitions seem very promising: they deduce the presence of flaws by analysing the variations of the intimate response of the structure. In this context, the SHM using fibre optics, supported by a dedicated algorithm, seems to be able to translate the effects of the damage reading the strain field. This means that is necessary to have a full comprehension of the flaws' effects in terms of strain variation to better formulate a strategy aimed at highlighting these distortions. It should be remarked that each type of damage is distinct; imperfections of the bonding line are herein targeted since the quality of the latter is of paramount importance for ensuring the correct behaviour of the referred structure. This presents paper focuses on a deep investigation on the strain field peculiarities that arise after the imposition of irregularities in the adhesive region. The aim is to explore the damage dimension versus its effect on the strain map, especially when bonding connects different parts of a complex composite beam. By means of finite element method applied on a typical aeronautical beam, a parametric numerical simulation was performed in order to establish the influence of a debonding dimension on a reference strain map. This work provides evidence that these effects on strain flaw decrease the distancing itself of the damage. The knowledge of these effects can be highly helpful during the design of a preliminary phase of an SHM system in order to choose the most suitable sensor in terms of reading sensitivity error, the number to be used, and their location. [ABSTRACT FROM AUTHOR]

The present paper reports the outcomes of activities concerning a real-time SHM system for debonding flaw detection based on ground testing of an aircraft structural component as a basis for condition-based maintenance. In this application, a damage detection method unrelated to structural or load models is investigated. In the reported application, the system is applied for real-time detection of two flaws, kissing bond type, artificially deployed over a full-scale composite spar under the action of external bending loads. The proposed algorithm, local high-edge onset (LHEO), detects damage as an edge onset in both the space and time domains, correlating current strain levels to next strain levels within a sliding inner product proportional to the sensor step and the acquisition time interval, respectively. Real-time implementation can run on a consumer-grade computer. The SHM algorithm was written in Matlab and compiled as a Python module, then called from a multiprocess wrapper code with separate operations for data reception and data elaboration. The proposed SHM system is made of FBG arrays, an interrogator, an in-house SHM code, an original decoding software (SW) for real-time implementation of multiple SHM algorithms and a continuous interface with an external operator. [ABSTRACT FROM AUTHOR]

Structural health monitoring has multifold aims. Concerning composite structures, the main objectives are perhaps reducing costs by shifting from scheduled to on-demand maintenance and reducing weight by removing redundant precautions as the insertion of chicken fasteners to for ensuring joint safety in cases of bonding layer fail. Adhesion defects may be classified along different types, for instance distinguishing between glue deficiency or de-bonding. This paper deals with a preliminary numerical characterization of adhesive layer imperfections on a representative aircraft component. The multipart composite spar is made of two plates and two corresponding C-beams, bonded together to form an almost squared boxed section beam. A numerical test campaign was devoted to extract relevant information from different defect layouts and to try to assess some parameters that could describe their peculiarities. A focus was then given to macroscopic evidence of fault effects behavior, as localization, reciprocal interference, impact on structural response, and so on. A proprietary code was finally used to retrieve the presence and size of the imperfections, correlating numerical outcomes with estimations. Activities were performed along OPTICOMS, a European project funded within the Clean Sky 2 Joint Technology Initiative (JTI). [ABSTRACT FROM AUTHOR]

This paper focuses on the development and demonstration of a novel blade morphing system within a whirl tower facility. The scope is to investigate the behavior of the proposed architecture under representative loads, demonstrating its capability to alter the blade original shape in operation under centrifugal, aerodynamic, and internal forces. The morphing concept was developed inside the European project "Shape Adaptive Blades for Rotorcraft Efficiency", SABRE, and consists of a shape memory alloy system able to change the original twist law and, in this way, enhance rotor performance at certain specific regimes, such as hover and vertical flight. These phases, indeed, are generally penalized with respect to other more extended flight regimes (cruise). The work starts with an overview of the research in the field of morphing, with specific reference to the researches envisaging rotary wing demonstrations. Then, an overview of the morphing twist concept is provided, with particular attention paid to those features particularly suited for the whirl tower representative test environment. The laboratory characterization and commissioning operations are illustrated. Then, the task of the installation of the prototype on the whirl tower facility is described together with the testing modality adopted. Finally, the results of the test campaign are illustrated and critically discussed, providing the reader with insights and possible future steps to be taken in further research. The impact on the morphing capability of the following different parameters was investigated: the number of the prototype segments switched on, the speed and thus the centrifugal actions, and the angles of attack. The stiffening effect due to centrifugal actions was quantified through the measurement of the actual twist and the internal deformation. The link between speed, angle of attack at root, and twist and flap angles was also tracked, building a database useful for the comprehension of the phenomenon, and for the assessment of numerical predictive models. The achieved results highlighted the capability of the system to produce a twist angle matching the target of 8° per blade radius; this figure is related to a potential power saving of 10% in hover and vertical flight and an improvement of about 1% on the over-all efficiency of the rotorcraft. [ABSTRACT FROM AUTHOR]

This paper presents a cross-correlation function-based method applied to a spatially shifted differential strain readout vectors using distributed sensors under backscattering random noise and impact excitations. Structural damage is generated by low/medium energy impact on two aeronautical 24-ply CFRP (carbon fiber reinforced plastic) stiffened panels. Two different drop impact locations, two different sensor layouts and two different post-impact solicitations are provided for a skin-stringer debonding detection and length estimation. The differential signal with respect to an arbitrarily selected grounding is used. Then the effects of noise filtering are evaluated post-processing the differential signal by cross-correlating two strain vectors having one sensor gauge position lag. A Rayleigh backscattering sensing technology, with 5 mm of spatial resolution, is used to log the strain map. The results show a good coherence with respect to the NDI (nondestructive inspection) performed by ultrasonic C-scan (an ultrasonic imaging system) flaw detector. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate a novel ultrasonographic scoring system for the diagnosis of PAS and the prediction of maternal and neonatal outcomes. In this retrospective study, 138 patients with at least one previous caesarean section (CS) and placenta previa were included. They were divided into four groups ranging from Group 0 (Non PAS) to Group 3 (Placenta Percreta) according to the histological or surgical confirmation. Their ultrasound examinations during pregnancy were reviewed according to the nine different ultrasound signs reported by the European Working Group on Abnormally Invasive Placenta. For each parameter, 0 to 2 points were assigned. The sum of the points reflects the severity of PAS with a maximum score of 20. The scoring system revealed good performances in evaluation metrics, with an overall accuracy of 94%. In addition to this, patients' characteristics and surgical and neonatal outcomes were analyzed with an evidence of higher incidence of complications in severe forms. Our study suggests that antenatal ultrasonographic diagnosis of PAS is feasible with sufficient level of accuracy. This will be important in identifying high-risk patients and implementing preventive strategy. [ABSTRACT FROM AUTHOR]

The work at hand focuses on the modeling, prototyping, and experimental functionality test of a smart actuator based on shape memory polymer technology. Particular attention is paid to the specific modeling approach, here conceived as an effective predictive scheme, quick and, at the same time, able to face those nonlinearity aspects, strictly related to the large displacements shape memory polymers usually undergo. Shape memory polymer composites (SMPCs) may play a critical role for many applications, ranging from self-repairing systems to deployable structures (e.g., solar sails, antennas) and functional subcomponents (e.g., pliers, transporters of small objects). For all these applications, it is very important to have an effective tool that may drive the designers during the preliminary definition of the main parameters of the actuation system. For the present work, a SMPC plate sample has been conceived and realized in view of aerospace applications. An external fibre optic sensor has been then fixed with special adhesive. The temperatures needed for the activation of the Shape Memory Polymer (SMP) and strain storing have been provided by a thermo-gun and complete load–unload cycles, including strain storing, have been performed. Experimental displacements and strains have been used to validate a dedicated predictive theoretical approach, suited for laminates integrated with SMP layers. [ABSTRACT FROM AUTHOR]

The work at hand focuses on an adaptive system aimed at improving the soundproof performance of car door seals at specific regimes (cruise), without interfering with the conventional opening and closing operations. The idea addresses the necessity of increasing seal effectiveness, jeopardized by aerodynamic actions that strengthen as the speed increases, generating a growing pressure difference between the internal and the external field in the direction of opening the door, and then deteriorating the acoustic insulation. An original expansion mechanism driven by a shape memory alloy (SMA) wire was integrated within the seal cavity to reduce that effect. The smart material was activated (heated) by using the Joule effect; its compactness contributed to the realization of a highly-integrable and modular system (expanding cells). In this paper, the system development process is described together with the verification and validation activity, aimed at proving the functionality of the realized device. Starting from industrial requirements, a suitable solution was identified by considering the basic phenomenon principle and the allowable design parameters. The envisaged system was designed and its executive digital mock-up (CAD, computer-aided design) was released. Prototyping and laboratory tests showed the reliability of the developed numerical models and validated the associated predictions. Finally, the system was integrated within the reference car. To demonstrate the insulation effect, the experimental campaign was carried out in an anechoic room, achieving significant results on the concept value. [ABSTRACT FROM AUTHOR]