Outcomes following operative and non-operative management of humeral midshaft fractures: a prospective, observational cohort study of 47 patients

Background Although the non-operative management of closed humeral midshaft fractures has been advocated for years, the increasing popularity of operative intervention has left the optimal treatment choice unclear. Objective To compare the outcomes of operative and non-operative treatment of traumatic closed humeral midshaft fractures in adult patients. Methods A multicentre prospective comparative cohort study across 20 centres was conducted. Patients with AO type 12 A2, A3 and B2 fractures were treated with a functional brace or a retrograde-inserted unreamed humeral nail. Follow-up measurements were taken at 6, 12 and 52 weeks after the injury. The primary outcome was fracture healing after 1 year. Secondary outcomes included sub-items of the Constant score, general patient satisfaction, complications and cost-effectiveness parameters. Functions of the uninjured extremity were used as reference parameters. Intention-to-treat analysis was applied with the use of t-tests, Fisher’s exact tests, Mann–Whitney U-tests and adjusted analysis of variance (ANOVA). Results Forty-seven patients were included. The patient sample consisted of 23 women and 24 men, with a mean age of 52.7 years (range 17–86 years). Of the 47 cases, 14 were treated non-operatively and 33 operatively. The follow-up rate at 1 year was 81%. After 1 year, 11 fractures (100%) healed in the non-operative group and at least 24 fractures (≥89%) healed in the operative group [1 non-union patient (4%) and no data for 2 patients (7%)]. There were no significant differences in pain, range of motion (ROM) of the shoulder and elbow, and return to work after 6 weeks, 12 weeks and 1 year. Although operatively treated patients showed significantly greater shoulder abduction strength (p = 0.036), elbow flexion strength (p = 0.021), functional hand positioning (p = 0.008) and return to recreational activities (p = 0.043) after 6 weeks, no statistically significant differences existed in any outcome measure at the 1-year follow-up. Conclusions Our findings indicate that the non-operative management of humeral midshaft fractures can be expected to have similar functional outcomes and patient satisfaction at 1 year, despite an early benefit to operative treatment. If no radiological evidence of fracture healing exists in non-operatively treated patients during early follow-up, a switch to surgical treatment results in good functional outcomes and patient satisfaction. Keywords: Humeral shaft fracture, Non-operative treatment, Functional brace, Operative treatment, Unreamed humeral nail (UHN), Prospective, Cohort study

Putting the cart before the horse? Driving student engagement through first year career identity development in a large multidisciplinary creative industries cohort

It is now widely accepted that first year students benefit from pedagogies which mediate and support their transitions to university, and assist them to develop an adaptive student identity. We present an initiative which takes an alternative and additional approach to this way of viewing the first year experience. Based on research into creative industries career trajectories, this initiative focuses on the establishment of nascent career identity and professional self-concept amongst 600 first semester Bachelor of Creative Industries (BCI) students at QUT. The BCI is offered as a three year undergraduate program involving self-selection of majors, minors and electives, and also as a four year double degree with Business and Law faculties. Students engage in a scaffolded process of initial career visioning and reflective course planning, based on their own industry and careers research, guided by industry-active academic and careers staff, and drawing upon the experiences of final year students.

Shear strength of hollow flange channel beams with stiffened web openings

This LiteSteel beam (LSB) is a new cold-formed steel hollow flange channel section produced using a patented manufacturing process involving simultaneous cold-forming and dual electric resistance welding. The LSBs are commonly used as floor joists and bearers with web openings in buildings. Their shear strengths are considerably reduced when web openings are included for the purpose of locating building services. Shear tests of LSBs with web openings have shown that there is up to 60% reduction in the shear capacity. Hence there is a need to improve the shear capacity of LSBs with web openings. A cost effective way to eliminate the shear capacity reduction is to stiffen the web openings using suitable stiffeners. Hence numerical studies were undertaken to investigate the shear capacity of LSBs with stiffened web openings. In this research, finite element models of LSBs with stiffened web openings in shear were developed to simulate the shear behaviour and strength of LSBs. Various stiffening methods using plate and LSB stiffeners attached to LSBs using both welding and screw-fastening were attempted. The developed models were then validated by comparing their results with experimental results and used in further studies. Both finite element and experimental results showed that the stiffening arrangements recommended by past research for cold-formed steel channel beams are not adequate to restore the shear strengths of LSBs with web openings. Therefore new stiffener arrangements were proposed for LSBs with web openings. This paper presents the details of this research project using numerical studies and the results.

Stability and convergence of implicit numerical methods for a class of fractional advection-dispersion models

In this paper, a class of fractional advection-dispersion models (FADM) is investigated. These models include five fractional advection-dispersion models: the immobile, mobile/immobile time FADM with a temporal fractional derivative 0 < γ < 1, the space FADM with skewness, both the time and space FADM and the time fractional advection-diffusion-wave model with damping with index 1 < γ < 2. They describe nonlocal dependence on either time or space, or both, to explain the development of anomalous dispersion. These equations can be used to simulate regional-scale anomalous dispersion with heavy tails, for example, the solute transport in watershed catchments and rivers. We propose computationally effective implicit numerical methods for these FADM. The stability and convergence of the implicit numerical methods are analyzed and compared systematically. Finally, some results are given to demonstrate the effectiveness of our theoretical analysis.

The effectiveness of a four layer compression bandage system in comparison to Class 3 compression hosiery on healing and quality of life for patients with venous leg ulcers : a randomised controlled trial

There are an increasing number of compression systems available for treatment of venous leg ulcers and limited evidence on the relative effectiveness of these systems. The purpose of this study was to conduct a randomised controlled trial to compare the effectiveness of a 4-layer compression bandage system with Class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers. Data were collected from 103 participants on demographics, health, ulcer status, treatments, pain, depression and quality of life for 24 weeks. After 24 weeks, 86% of the 4-layer bandage group and 77% of the hosiery group were healed (p=0.24). Median time to healing for the bandage group was 10 weeks, in comparison to 14 weeks for the hosiery group (p=0.018). Cox proportional hazards regression found participants in the 4-layer system were 2.1 times (95% CI 1.2–3.5) more likely to heal than those in hosiery, while longer ulcer duration, larger ulcer area and higher depression scores significantly delayed healing. No differences between groups were found in quality of life or pain measures. Findings indicate these systems were equally effective in healing patients by 24 weeks, however a 4-layer system may produce a more rapid response.

Contextualising learning for a real-world university: how an inverted curriculum in the first year can help better student retention

An identified issue within higher education is the high rates of student attrition after the first year, especially in the STEM disciplines. To address this issue, it is essential to reexamine and redesign the first year curriculum to engage and retain the students' interests while also scaffolding their learning experience. This session reports on an initiative based on the principles of the “inverted curriculum” within the Bachelor of Technology (BIT) course at the Queensland University of Technology (QUT) that began in 2009 and has resulted in a reduction in first-year attrition rates from 18% in 2008 to 10% in 2009 and 2010 despite a growth in student intake of 15% to 40% in the past two years. We present the process and methods that helped achieve this and initiate a discussion on the innovations that are possible within this concept of inverted curriculum and how it can be implemented.

Evidence for carbonate platform failure during rapid sea-level rise; ca 14 000 year old bioclastic flow deposits in the Lesser Antilles

Bioclastic flow deposits offshore from the Soufrie`re Hills volcano on Montserrat in the Lesser Antilles were deposited by the largest volume sediment flows near this active volcano in the last 26 kyr. The volume of these deposits exceeds that of the largest historic volcanic dome collapse in the world, which occurred on Montserrat in 2003. These flows were most probably generated by a large submarine slope failure of the carbonate shelf comprising the south west flank of Antigua or the east flank of Redonda; adjacent islands that are not volcanically active. The bioclastic flow deposits are relatively coarse-grained and either ungraded or poorly graded, and were deposited by non cohesive debris flow and high density turbidity currents. The bioclastic deposit often comprises multiple sub-units that cannot be correlated between core sites; some located just 2 km apart. Multiple sub-units in the bioclastic deposit result from either flow reflection, stacking of multiple debris flow lobes, and/or multi-stage collapse of the initial landslide. This study provides unusually precise constraints on the age of this mass flow event that occurred at ca 14 ka. Few large submarine landslides have been well dated, but the slope failures that have been dated are commonly associated with periods of rapid sea-level change.

Characterisation of flexural bond strength in thin bed concrete masonry

This paper presents an experimental investigation of the flexural bond strength of thin bed concrete masonry. Flexural bond strength of masonry depends upon the mortar type, the techniques of dispersion of mortar and the surface texture (roughness) of concrete blocks. There exists an abundance of literature on the conventional masonry bond containing 10mm thick mortar; however, the 2mm polymer flue mortar bond is not yet well researched. This paper reports a study on the examination of the effect of mortar compositions, dispersion methods and unit surface textures to the flexural bond strength of thin bed concrete masonry. Three types of polymer modified glue mortars, three surface textures and four techniques of mortar dispersion have been used in preparing 108 four point flexural test specimens. All mortar joints have been carefully prepared to ensure achievement of 2mm layer polymer mortar thickness on average. The results exhibit the flexural bond strength of thin bed concrete masonry much is higher than that of the conventional masonry; moreover the unit surface texture and the mortar dispersion methods are found to have significant influence on the flexural bond strength.

Start Smart : QUT’s trial support program for commencing undergraduate students who have not completed year 12 in the past two years

Commencing students in undergraduate degrees who identify as mature age students experience particular issues when faced with enrolment into university as an adult learner (Bird & Morgan, 2003). In line with QUT’s commitment to “supporting all commencing students to adjust successfully to study at QUT by providing a strong transition experience” (QUT, 2008, 6.2.1), the Start Smart trial program was developed and implemented for Semester 1, 2012. The Start Smart trial program consists of an orientation event, wrapped around and supported by existing First Year Experience (FYE) and Retention strategies within QUT, namely the Student Success Program (SSP) and the Peer Programs Strategy (PPS). This report examines the motivations for designing a program as a response to the needs of a cohort that are unique amongst all commencing undergraduate students. Participants will be asked to consider the implications of delivering special and unique orientation events to specific cohorts, and the long term sustainability of such programs within their own university structures.