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

Automated support for versioning compliance checking between workflow management and product lifecycle management (in Chinese)

With the development of enterprise informatisation, Product Lifecycle Management (PLM) systems have been widely deployed and applied in enterprises. This paper analyzes the requirement that conducting version operations on business objects as specified in process models should be compliant with the versioning policies imposed by product lifecycles. This leads to the introduction of the concept of versioning compliance, and the approach of compliance checking that we proposed in our earlier work, which comprises both syntactical compatibility and behavioural compatibility checking. The paper then focuses on the tool implementation for providing automated support to the versioning compliance checking. An empirical evaluation of the tool was also performed with industrial partners using the well-known questionnaire-based method. The evaluation and feedback from practitioners further evidence the practical significance of this research question in the PLM field and demonstrate that the proposed solution with its automated tool support possesses a high application potential.

Assurance of learning – are academics and senior management singing from the same hymn sheet?

Assurance of learning (AoL) is an important process in quality education, designed to measure the accomplishment of educational aims at the core of an institution’s programs, whilst encouraging faculty to continuously develop and improve the programs and courses. This paper reports on a study of Australian business schools to investigate current AoL practices through semi structured interviews with senior faculty leaders followed by focus group interviews with groups of senior program leaders and groups of academic teaching staff. Initial findings indicate there are significant challenges in encouraging academic staff to commit to the process and recognise the benefits of assuring learning. The differences in understanding between the various leaders and the academics were highlighted through the different focus groups. Leaders’ stressed strategic issues such as staff engagement and change, while academics focussed on process issues such as teaching graduate attributes and external accreditation. Understanding the differences in the perspectives of leaders and faculty is important, as without a shared understanding between the two groups, there is likely to be limited engagement, which creates difficulties in developing effective assurance of learning processes. Findings indicate that successful strategies developed to foster shared values on assurance of learning include: strong senior leaders’ commitment; developing champions among program and unit level staff; providing professional development opportunities; promoting and celebrating success and effectiveness; and ensuring an inclusive process with academics of all levels collaborating in the development and implementation of the process.

Four obstacles facing the management accounting professionals as they seek to step up as global leaders

No matter how aspirational they are, management accountants face a series of roadblocks in the course of building careers in organisations. Experts reveal the four key obstacles that need to be addressed in the course of becoming global leaders.

Measuring voluntary dietary change in response to exercise : a focus on dietary fat

Traditional treatments for weight management have focussed on prescribed dietary restriction or regular exercise, or a combination of both. However recidivism for such prescribed treatments remains high, particularly among the overweight and obese. The aim of this thesis was to investigate voluntary dietary changes in the presence of prescribed mixed-mode exercise, conducted over 16 weeks. With the implementation of a single lifestyle change (exercise) it was postulated that the onerous burden of concomitant dietary and exercise compliance would be reduced, leading to voluntary lifestyle changes in such areas as diet. In addition, the failure of exercise as a single weight loss treatment has been reported to be due to compensatory energy intakes, although much of the evidence is from acute exercise studies, necessitating investigation of compensatory intakes during a long-term exercise intervention. Following 16 weeks of moderate intensity exercise, 30 overweight and obese (BMI≥25.00 kg.m-2) men and women showed small but statistically significant decreases in mean dietary fat intakes, without compensatory increases in other macronutrient or total energy intakes. Indeed total energy intakes were significantly lower for men and women following the exercise intervention, due to the decreases in dietary fat intakes. There was a risk that acceptance of the statistical validity of the small changes to dietary fat intakes may have constituted a Type 1 error, with false rejection of the Null hypothesis. Oro-sensory perceptions to changes in fat loads were therefore investigated to determine whether the measured dietary fat changes were detectable by the human palate. The ability to detect small changes in dietary fat provides sensory feedback for self-initiated dietary changes, but lean and overweight participants were unable to distinguish changes to fat loads of similar magnitudes to that measured in the exercise intervention study. Accuracy of the dietary measurement instrument was improved with the effects of random error (day-to-day variability) minimised with the use of a statistically validated 8-day, multiple-pass, 24 hour dietary recall instrument. However systematic error (underreporting) may have masked the magnitude of dietary change, particularly the reduction in dietary fat intakes. A purported biomarker (plasma Apolipoprotein A-IV) (apoA-IV) was subsequently investigated, to monitor systematic error in self-reported dietary intakes. Changes in plasma apoA-IV concentrations were directly correlated with increased and decreased changes to dietary fat intakes, suggesting that this objective marker may be a useful tool to improve the accuracy of dietary measurement in overweight and obese populations, who are susceptible to dietary underreporting.

Operational semantics of aspects in business process management

Aspect orientation is an important approach to address complexity of cross-cutting concerns in Information Systems. This approach encapsulates these concerns separately and compose them to the main module when needed. Although there a different works which shows how this separation should be performed in process models, the composition of them is an open area. In this paper, we demonstrate the semantics of a service which enables this composition. The result can also be used as a blueprint to implement the service to support aspect orientation in Business Process Management area.

Dynamic weaving of aspects for business process management systems

Reducing complexity in Information Systems is a main concern in both research and industry. One strategy for reducing complexity is separation of concerns. This strategy advocates separating various concerns, like security and privacy, from the main concern. It results in less complex, easily maintainable, and more reusable Information Systems. Separation of concerns is addressed through the Aspect Oriented paradigm. This paradigm has been well researched and implemented in programming, where languages such as AspectJ have been developed. However, the rsearch on aspect orientation for Business Process Management is still at its beginning. While some efforts have been made proposing Aspect Oriented Business Process Modelling, it has not yet been investigated how to enact such process models in a Workflow Management System. In this paper, we define a set of requirements that specifies the execution of aspect oriented business process models. We create a Coloured Petri Net specification for the semantics of so-called Aspect Service that fulfils these requirements. Such a service extends the capability of a Workflow Management System with support for execution of aspect oriented business process models. The design specification of the Aspect Service is also inspected through state space analysis.