(P1-26) Abdominal Trauma: Arteriography versus Laparotomy

Selective non-operative management of abdominal visceral lesions is one of the most important and challenging changes that occurred in trauma patient care over the last 20 years. The main advantage of this type of management is the avoidance of unnecessary/non-therapeutic laparotomies. Trauma surgeons who deal with this type of treatment are worried of missed abdominal injuries. Modern diagnostic tools (spiral computed tomography, ultrasound, angiography, laparoscopy) allow trauma surgeons to accurately characterize the lesions to be addressed non-operatively. This presentation discusses the main elements of selective, non-operative management of principle solid visceral lesions (liver, spleen, and kidney). The advantages and limitations of the main diagnostic instruments used for evaluation of trauma patients allocated to non-operative management will be highlighted. Polytrauma patients in a Leve-1 trauma center over the last five years were selected and outcomes were analyzed. Pancreatic trauma remains an operative injury. However, surgeons must temper the enthusiasm for non-operative management of patients with solid organ injury, and exclude patients who would best be treated with surgery from this management scheme. Emergency care of the patients according the golden hour and team ability must be considere

Cognitive Skills Matter: The Employment Disadvantage of Low-Educated Workers in Comparative Perspective

It is now a widely acknowledged fact that the low-educated workers are facing important risks of labour market exclusion in modern economies. However, possessing low levels of educational qualifications leads to very different situations from one country to another, as the cross-national variation in the unemployment rates of these workers attest. While conventional wisdom usually blames welfare states and the resulting rigidity of labour markets for the low employment opportunities of low-educated workers, empirical evidence tends to contradict this predominant view. Using microdata from the International Adult Literacy Survey that was conducted between 1994 and 1998, we examine the sources of the cross-national variation in the employment disadvantage of low-educated workers in 14 industrialized nations. In particular, we test the validity of the conventional theories concerning the supposedly harmful effect of labour market regulation against a new and promising hypothesis on the importance of cognitive skills for the employment opportunities of the low-educated workers. Our findings support the latter and suggest that the greater the cognitive gap between the low-educated workers and those with intermediate education, the lower the chances of being employed for the former relatively to their higher educated counterpart

(P2-13) Pitfalls for Upper Limb Injuries in Emergency

Sternoclavicular dislocation usually requires a Computed Tomography (CT) scan and surgery. This injury is rare because costoclavicular ligaments are strong. They appear in motorcycle accidents and sports collisions. Compression of the neurovascular structures or trachea involving the vital prognosis is not rare. Practitioners must be aware of symptoms such as dysphagia, dyspnea, hoarseness, or neurologic disorders. On the printing of thoracic standards, the medial clavicle appears misplaced superiorly in previous dislocations and posterior inferior dislocations. Fracture of the scapula (less than 1% of all fractures) rarely requires surgery, but should not be ignored because they signal a very high-energy trauma. The posterior shoulder dislocation is 2-4% of all delayed dislocations. Diagnosis is most often attributed to inadequate x-ray photographs. The main causes of this dislocation are epilepsy and electrocution. Radiography in front and profile observed a duplication of the humeral head. Joint space is not completely in view, and the CT scan can confirm the diagnostic if there is any doubt. Fracture of the clavicle is common in young patients. Fractures with lesions of the clavicular vessels and nerves are common. Practitioners also must be wary of intermediate fragments, which can puncture skin. Pneumothorax should always be excluded by a complete chest auscultation. The stump of the shoulder must be minimized in young patients, or an active patient operative indication can have negative functional and aesthetic consequences. Neurovascular examination must be complete, and circonflex nerve damage should not be confused with injury of the rotator cuff. These two injuries reduce abduction. The elbow is complex and a number of lesions could be missed, including: (1) the tip of the coronoid process; (2) epitrochlea and epicondyle; (3) radial head fractures; or (4) pullout capitelu

Obscuration model of Variability in AGN

There are strong suggestions that the disk-like accretion flow onto massive black hole in AGN is disrupted in its innermost part (10-100 Rg), possibly due to the radiation pressure instability. It may form a hot optically thin quasi spherical (ADAF) flow surrounded by or containing denser clouds due to the disruption of the disk. Such clouds might be optically thick, with a Thompson depth of order of 10 or more. Within the frame of this cloud scenario (Collin-Souffrin et al. 1996, Czerny & Dumont 1998), obscuration events are expected and the effect would be seen as a variability. We consider expected random variability due to statistical dispersion in location of clouds along the line of sight for a constant covering factor. We discuss a simple analytical toy model which provides us with the estimates of the mean spectral properties and variability amplitude of AGN, and we support them with radiative transfer computations done with the use of TITAN code of Dumont, Abrassart & Collin (1999) and NOAR code of Abrassart (1999).Comment: to appear in Proc. of 5th Compton Symposium on Gamma-Ray Astronomy and Astrophysic