Availability Of Appropriate Equipment Research Articles

Treatment of choledocholithiasis: a review of clinical trials and current clinical guidelines

The review provides an analysis of clinical studies and current clinical guidelines from the MEDLINE database on the PubMed platform regarding the treatment of choledocholithiasis. Choledocholithiasis occurs in almost 20 % of patients with gallstone disease and is characterized by frequent dangerous complications, in particular, bile duct obstruction, cholangitis, and biliary pancreatitis. Therefore, common bile duct exploration is an important component of surgical treatment for gallstone disease, but discussions about the optimal treatment for choledocholithiasis have been ongoing for many years. Currently, there is no generally accepted standard of treatment, and various methods and approaches to the staging and sequence of surgical interventions on the gallbladder and common bile duct are used. In recent years, the leading methods of choledocholithiasis treatment are minimally invasive endoscopic and/or laparoscopic interventions, which have almost completely replaced open surgeries. For common bile duct exploration and normalization of biliary excretion, endoscopic transpapillary (retrograde) access is used mostly, which is characterized by a high risk of post-procedural immediate and long-term complications. Endoscopic management of common bile duct stones requires an additional intervention — laparoscopic cholecystectomy, which is most often performed at the second stage or simultaneously with endoscopic intervention. The optimal staging and sequencing of interventions requires further research. A good alternative to endoscopic interventions on common bile duct is its laparoscopic exploration through the cystic duct or by choledochotomy (antegrade), which can be performed simultaneously with cholecystectomy. However, this technique has not yet been widely adopted, and immediate and long-term results are conflicting that require further research into the effectiveness and safety of the method. The effectiveness of surgical treatment for choledocholithiasis depends not only on the individual characteristics of a patient, including biliary anatomy, the form and severity of the disease, but also on the local experience and availability of appropriate equipment, which must be taken into account when planning treatment.

Factors influencing adoption of organic matter management on smallholder farms in the Rwenzori region of Uganda

AbstractContext specific studies on the factors influencing the adoption of organic matter management (OMM) practices on smallholder farms could be crucial for soil fertility improvement. This study aimed to understand the factors influencing the adoption of OMM practices by smallholder farmers. A hybridized theoretical framework was used to map the farmers’ adoption process. This framework states: the adoption process of OMM practices can be facilitated if an individual’s characteristics and the institutional-related factors can support it; information about the OMM practices and the required inputs are available, and he/she can apply the required technology with ease. Data collection involved observations on 100 smallholder farms, interviews with 10 smallholder farmers and 18 experts, as well as two focus group discussions with 10 farmers each. The results indicated that a composite of technical, social, cultural, and economic-driven factors influence farmer adoption of OMM strategies. These factors included the farmer characteristics of age, education status, gender, culture, and knowledge about the use and application of an OMM practice; availability of labor and inputs; availability of appropriate equipment; the existence of supportive policy framework and social support. The factors cut across the adoption components of the hybridized theoretical framework: nature of technology, farmer characteristics, and input-related, information transfer-related and institutional-related adoption factors. The study findings can inform decision-makers to make investment decisions. Future studies should assess the feasibility of the hybridized theoretical framework before experts can apply it in devising strategies for the adoption of OMM practices on smallholder farms.

Necessary Products for the Prevention and Treatment of Pressure Injuries: Lessons Learned That Translate Beyond the COVID-19 Pandemic.

To identify the challenges encountered in obtaining the required support surfaces and products to meet pressure injury (PrI) prevention and treatment needs during COVID-19. The authors used SurveyMonkey to gather data on healthcare perceptions and the challenges experienced regarding specific product categories deemed necessary for PrI prevention and treatment in US acute care settings during the pandemic. They created three anonymous surveys for the target populations of supply chain personnel and healthcare workers. The surveys addressed healthcare workers' perceptions, product requests, and the ability to fulfill product requests and meet facility protocols without substitution in the categories of support surfaces and skin and wound care supplies. Respondents answered one of the three surveys for a total sample of 174 respondents. Despite specific instructions, nurses responded to the surveys designed for supply chain personnel. Their responses and comments were interesting and capture their perspectives and insights. Three themes emerged from the responses and general comments: (1) expectations differed between supply chain staff and nurses for what was required for PrI prevention and treatment; (2) inappropriate substitution with or without proper staff education occurred; and (3) preparedness. It is important to identify experiences and challenges in the acquisition and availability of appropriate equipment and products for PrI prevention and treatment. To foster ideal PrI prevention and treatment outcomes, a proactive approach is required to face daily issues or the next crisis.

Hospital clinicians' perspectives of using compression therapy on venous leg ulcers: a systematic qualitative review

To identify, from the published literature, reasons for variable implementation. Systematic review with narrative synthesis, including full papers in English with empirical qualitative data. Synonyms for venous leg ulcer, compression therapy and secondary care were searched across a range of health-related databases. The Critical Appraisal Skills Programme (CASP) checklist determined study quality, and meta-ethnography was used for data synthesis. 7040 titles and abstracts and 41 full-text papers were screened with four papers selected. Three key themes were generated: educational needs surrounding implementation of compression therapy, patient factors regarding adherence and organisational resources including availability of appropriate equipment and trained staff. Barriers at the ward level were identified. There is a need to better understand why hospitals are not addressing them.

Challenges Facing Small-scale Cashew Nut Processors in Ruangwa district, Tanzania: An Implication for Policy Change

This study was carried out to assess the challenges faced by small-scale cashew nut processors in Ruangwa District, Tanzania. The study employed a correlational research design using a survey on a sample of 180 small-scale cashew nut processors. Data were collected through questionnaire administration, focus group discussions, key informant interviews and documentary reviews. Quantitative and qualitative data were analyzed by using descriptive statistics and content analysis respectively. The study revealed the following challenges that face small-scale cashew nut processors: use of inefficient local processing tools, less availability of appropriate equipment and machine for processing, lack of money to acquire new technology, and lack of investment and working capital. Other challenges were the availability of raw materials, lack of market information on kernel, lack of reliable training facilities, and lack of government initiative support on cashew nut processing. The study recommends improvement and facilitation of modern processing equipment, training processors on improved processing techniques and improvement of domestic and international cashew nut markets.

Development of educational robotics: Problems and prospects

Introduction. The inclusion of schoolchildren in the development of robotics can serve as an effective method of popularising technical education and a means of vocational guidance work. Educational robotics can be viewed as a means of integrating science, technology, engineering and mathematics in the context of school education, as a tool for developing flexible skills in students. The problem of the lack and/or incompetence of teaching staff in this area is a limiting factor in the development of children’s technical creativity.Aim.Based on the analysis of the development of educational robotics (a popular and promising direction of children’s technical creativity), the current researchaimedto compare the trends of its implementation in different countries, identify problems arising on the way of integrating educational robotics into school and additional education, and outline ways to overcome these problems.Methodology and research methods. The methodological basis of the study was the theory of professional development of future teachers and the concept of forecasting the prospects in the field of education.The identification of problems and prospects for the integration of robotics into the education of schoolchildren was carried out by the method of thematic content-analysis of publications with a search depth of 10 years, placed in the Web of Science, Google Academy and eLibrary databases.The identification of the need for teachers in robotics in school and additional education was carried out on the basis of generalising the results obtained in the course of questioning the heads and teachers of children technical creativity centres. 275 respondents from 11 regions of Russia took part in the online survey based on Google forms.Diagnostics of teachers’ interests and readiness to receive additional education in educational robotics was carried out on the basis of a questionnaire survey of students in pedagogical areas of training. The study involved 185 students – future teachers from 6 universities in Russia. The equipment of the system of school and additional education in Russia and the availability of appropriate equipment for schoolchildren were studied on the example of one of the Russian regions. The authors obtained empirical data from the annual reports of educational institutions.The assessment of the availability and quality of methodological support for robotics classes was carried out by processing data from an online survey of teachers, in which 98 respondents took part.Results. Research papers on the development of educational robotics have been divided into three main groups: robotics as a means of STEM integration; robotics as a means of forming Soft Skills; robotics as a means of forming professional competencies among teachers. The most significant problems of integrating educational robotics into school and additional education are highlighted: weak material base for organising classes; absence or low qualification of existing teachers; lack of a clear systemic plan for the implementation of robotics in the education of schoolchildren; lack of educational and methodological support. As strategies for the provision of education with teachers in educational robotics, the following are proposed: introduction into the practice of professional training of teachers in the higher education system of the profile “Educational Robotics”; implementation of professional retraining under the “Educational Robotics” programme for teachers of computer science, mathematics, technology, physics and primary education; attracting students –future teachers to receive additional education at the stage of study at the university in the framework of professional training “Pedagogy of Additional Education: Robotics”.Scientific novelty. The problems of successful integration of robotics into school and additional education are identified and described, among which the leading one is the absence or low qualifications of existing teachers in educational robotics. The ways of overcoming the identified difficulties based on mutually beneficial cooperation of universities, schools and centres of additional education are outlined; the system-forming role of pedagogical universities in this process is outlined.Thepractical significanceof the study consists in the possibility of using its results to determine the prospects for the development of educational robotics, as well as to select the optimal ways of professional training and/or retraining of teaching staff for the implementation of this type of activity.

Recommendations for patient management after manual reduction of incarcerated inguinal hernia: a literature review

Introduction: Topic of this review is to provide a systematic overview of the current evidence on the management of patients after manual reduction of an incarcerated inguinal hernia. Methods: Available literature regarding incarcerated or strangulated inguinal hernias published until March 2019 was obtained and reviewed. 32,021 papers were identified, of which only 20 were of a sufficient value to be used in this review. Results: The terms ‘incarcerated’ and ’strangulated’ are used interchangeably in the literature making separate analysis of these two entities almost impossible, although manual reduction is very unlikely to be successful when the hernia has strangulated contents. Following successful manual reduction, mesh repair is generally superior compared to pure tissue repair with regard to recurrence rates. Nevertheless, mesh repair is associated with a significant increase in the surgical site infection (SSI) rate, especially when bowel necrosis is present. The laparoscopic approach provides the benefits of avoiding an unnecessary laparotomy and reducing associated morbidity, but it does require the availability of appropriate equipment and an appropriately skilled surgical team. Conclusion: A mesh repair is generally superior to a pure tissue repair in the surgical management of emergency inguinal hernias, reducing the recurrence rate, but can be associated with an increased risk of SSI depending on the level of contamination. The laparoscopic approach is recommended if an experienced surgical team and necessary equipment are available.

Influence of house bearing construction rigidi-ty of precast reinforced concrete on stress-strain state Continuous Flight Auger (CFA) piles foundations

At present, the tendency to build multi-storey residential buildings has become widespread in Ukraine. This is due to a number of reasons: significant increase in land prices in cities, dense urban development and the availability of appropriate equipment for the construction of such structures. One of the most common materials for multi-storey buildings is monolithic reinforced concrete. The main advantage of monolithic structures is the possibility of free spatial planning and the possibility of uniform redistribution of forces in the elements of the frame - the house works as one rigid entire structure. On the other hand, such structures require a long construction time and appropriate highly qualified control of monolithic works. Therefore, as an alternative, prefabricated reinforced concrete structures are used to accelerate the pace of construction.
 In this work, the influence of the rigidity of a precast reinforced concrete house on the stress-strain state of CFA piles foundation is investigated. The stress-strain state of a precast reinforced concrete building with two basement options is analyzed: precast and monolithic.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 The numerical modeling of the interaction of the system elements is used as a research method: soil base - foundation - aboveground structure.
 It was found that the replacement in a prefabricated house only one basement floor of precast concrete on a monolithic one affects the redistribution of forces, so the self-supporting wall is loaded 2.6 times, and the busiest wall, which rests on both sides of the floor slab, is unloaded to 2.1 times.
 It was found that in the case of a basement made of precast reinforced concrete with a precast basement the difference efforts in pile heads (under the load-bearing walls) can differ 1.98 times, and in the case of a monolithic one 1.17 times. So it is mean, the monolithic foundation redistributed of efforts between the piles is more uniform.
 It is established that the monolithic reinforced concrete basement, in comparison with the prefabricated one, reduces the uneven settlement of the foundation by 2.4 times.
 When designing large-panel houses, it is advisable to provide a basement floor monolithic - this will allow to load the fundamental constructions more evenly, which in its reduction reduces the relative deformation of buildings and reduces their cost.

Segmental endoprosthesis replacement in a resource-constrained setting.

Indications for the use of endoprosthesis have continued to expand over the years, especially as an alternative to ablative surgery. This mode of treatment which was initially limited to orthopaedic oncology is now being applied in complex trauma with significant bone loss and end-stage arthroplasty. However, use of endoprosthesis in a resource-constrained setting such as sub-Saharan Africa is limited by various factors. These factors include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field. Twelve patients who had segmental endoprosthetic replacement for various aetiologies were studied in this case series. Resection lengths, complications and functional outcomes were noted. The resection length varied between 12 and 27cm. Using the Henderson classification system, one patient (8.3%) had a Type 1A complication, one had a Type 3A complication (8.3%), and two patients had Type 4A complications (16.6%). Functional outcomes were graded using the MusculoSkeletal Tumour Society scoring system, and scores were good to excellent in ten patients, moderate in one and poor in one patient. Early results indicate fair outcomes; however, factors limiting the use of endoprosthesis still persist. These include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field.

Microlaryngeal Teaching Courses: A National Survey on Prevalence, Value, and Barriers to Implementation.

To assess the prevalence of microlaryngeal teaching course in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in an effort to evaluate the nature, perceived value and barriers to implementation of microlaryngeal courses. A 14-question survey to all ACGME-accredited otolaryngology programs in the United States. Out of 119 ACGME-accredited otolaryngology programs identified on the ACGME Fellowship and Residency Electronic Interactive Database, responses were received from 67 programs (56%). Although 90% of respondents indicated that instruction courses in one discipline or another existed at their institution for their otolaryngology residents, only 33% indicated that their program offers a hands-on instruction course in microlaryngeal surgery. Of those programs that offered a microlaryngeal surgery course, 100% felt the residents appreciated the course; 95% of those programs that did not have a course felt their residents would appreciate a microlaryngeal course at their institution if they were able to offer one. Among programs without a microlaryngeal teaching course, the largest perceived barriers were cost and availability of appropriate equipment. Microlaryngeal courses for otolaryngology residency training are limited in availability in the United States, and there is variability in training across the country. All respondents in our survey indicated the value in these courses for microlaryngeal surgical skill training. There is a clear role for increasing availability of low-cost microlaryngeal stations and courses.

ACCUMULATIVE REPETITIVE STRAIN INJURY AMONG BUSINESS PROCESS OUTSOURCING EMPLOYEES: A SURVEY STUDY

Objective: Computer overuse syndrome or repetitive strain injury is the most common problem among the people in all age groups. Several studies have found the adverse effect of using computers for a long duration. In the modern tech-savvy world, usage of computers is something unavoidable. The objective of this survey study is to find out the accumulative repetitive strain injury among the business process outsourcing employees.Methods: This study was conducted in different business process outsourcings in Noida, and a convenient sampling method was used to collect data through Neck Pain Disability Index (NPDI) and disabilities of the arm, shoulder and hand (DASH) questionnaire. The study comprised of total 230 subjects.Results: The mean and standard deviation (SD) of NPDI score was found to be 32.12 and 11.26, respectively, whereas the mean and SD for DASH score was 24.34 and 7.44, respectively. The Chi-square value for NPDI and DASH was found to be 263.043 and 139.461. The study shows that upper extremity pain is a common problem in employees working in the IT sector. The employees showed high rates of computer use–associated with upper extremity musculoskeletal symptoms and symptom-related functional limitation.Conclusion: The findings of the study suggest a need to begin to evaluate interventions and to reduce the risks of developing computer overuse syndrome such as developing upper extremity symptoms, disability, and disorders among employees working in the IT sector who use computers for more than 40 hrs/week. Intervention to reduce symptoms should include effective training in work rest patterns, good-working postures coupled with availability of appropriate equipment.

Profile of the Roche cobas® EGFR mutation test v2 for non-small cell lung cancer

ABSTRACTIntroduction: The discovery of driver mutations in non-small cell lung cancer (NSCLC) has led to the development of genome-based personalized medicine. Fifteen to 20% of adenocarcinomas harbor an epidermal growth factor receptor (EGFR) activating mutation associated with responses to EGFR tyrosine kinase inhibitors (TKIs). Individual laboratories’ expertise and the availability of appropriate equipment are valuable assets in predictive molecular pathology, although the choice of methods should be determined by the nature of the samples to be tested and whether the detection of only well-characterized EGFR mutations or rather, of all detectable mutations, is required.Areas covered: The EGFR mutation testing landscape is manifold and includes both screening and targeted methods, each with their own pros and cons. Here we review one of these companion tests, the Roche cobas® EGFR mutation test v2, from a methodological point of view, also exploring its liquid-biopsy applications.Expert commentary: The Roche cobas® EGFR mutation test v2, based on real time RT-PCR, is a reliable option for testing EGFR mutations in clinical practice, either using tissue-derived DNA or plasma-derived cfDNA. This application will be valuable for laboratories with whose purpose is purely diagnostic and lacking high-throughput technologies.

PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children.

To determine the safety and feasibility of an early mobilization program in a PICU. Observational, pre-post design. PICU in a tertiary academic hospital in the United States. Critically ill pediatric patients admitted to the PICU. This quality improvement project involved a usual-care baseline phase, followed by a quality improvement phase that implemented a multicomponent, interdisciplinary, and tiered activity plan to promote early mobilization of critically ill children. Data were collected and analyzed from July to August 2014 (preimplementation phase) and July to August 2015 (postimplementation). The study sample included 200 children 1 day through 17 years old who were admitted to the PICU and had a length of stay of at least 3 days. PICU Up! implementation led to an increase in occupational therapy consultations (44% vs 59%; p = 0.034) and physical therapy consultations (54% vs 66%; p = 0.08) by PICU day 3. The median number of mobilizations per patient by PICU day 3 increased from 3 to 6 (p < 0.001). More children engaged in mobilization activities after the PICU Up! intervention by PICU day 3, including active bed positioning (p < 0.001), and ambulation (p = 0.04). No adverse events occurred as a result of early mobilization activities. The most commonly reported barriers to early mobilization after PICU Up! implementation was availability of appropriate equipment. The program was positively received by PICU staff. Implementation of a structured and stratified early mobilization program in the PICU was feasible and resulted in no adverse events. PICU Up! increased physical therapy and occupational therapy involvement in the children's care and increased early mobilization activities, including ambulation. A bundled intervention to create a healing environment in the PICU with structured activity may have benefits for short- and long-term outcomes of critically ill children.

Abstract: Magnitude and Outcome of Resuscitation Activities at Rwanda Military Hospital for the Period of April 2013-September 2013

BackgroundPrior to April 2012, resuscitations were often ineffective resulting in poor patient outcomes. An initiative was implemented at Rwanda Military Hospital (RMH) to review root causes and plan strategies to improve patient outcomes. An interdisciplinary committee was developed to review this problem.MethodsThe purpose of this project was to analyze the frequency, obstacles, and outcomes of patient resuscitation following cardiac and/or respiratory arrest. A form was developed to record all actions taken during resuscitation including: response time, staff presence, and equipment and medications used. Collection of data was achieved through the use of a resuscitation flow sheet followed by an audit of the chart documentation. Analysis of all resuscitation data collected was performed.ResultsThe patient population requiring the most resuscitation efforts are the intensive care patients, most frequently the neonatal intensive care patients (42.8%). Despite having trained staff representatives, not all resuscitations followed protocol. Lack of compliance with drug administration guidelines was noted, particularly in the lack of initiating administration of specific drugs, despite the drug being available (59%).ConclusionBasic Life Support training for interdisciplinary staff resulted in more effective response to cardiac and/ or respiratory arrest at RMH. Obstacles to effective resuscitation included : number of staff, knowledge and skill level of staff, availability of appropriate equipment and medications, staff communication, and patient‘s Do not Attempt Resuscitation (DNR) status. More training in this area would be beneficial to improve patient outcomes.Key words: resuscitation, cardiac arrest, intensive care, Rwanda

Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms.

Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature.

Surveillance for action - managing foodborne Campylobacter in New Zealand.

Laboratory capacity is needed in central Viet Nam to provide early warning to public health authorities of respiratory outbreaks of importance to human health, for example the outbreak of influenza A(H1N1) pandemic in 2009. Polymerase chain reaction (PCR) procedures established as part of a capacity-building process were used to conduct prospective respiratory surveillance in a region where few previous studies have been undertaken.Between October 2008 and September 2010, nose and throat swabs from adults and children (approximately 20 per week) presenting with an acute respiratory illness to the Ninh Hoa General Hospital were collected. Same-day PCR testing and result reporting for 13 respiratory viruses were carried out by locally trained scientists.Of 2144 surveillance samples tested, 1235 (57.6%) were positive for at least one virus. The most common were influenza A strains (17.9%), with pandemic influenza A(H1N1) 2009 and seasonal H3N2 strain accounting for 52% and 43% of these, respectively. Other virus detections included: rhinovirus (12.4%), enterovirus (8.9%), influenza B (8.3%), adenovirus (5.3%), parainfluenza (4.7%), respiratory syncytial virus (RSV) (3.9%), human coronavirus (3.0%) and human metapneumovirus (0.3%). The detection rate was greatest in the 0-5 year age group. Viral co-infections were identified in 148 (6.9%) cases.The outbreak in 2009 of the influenza A(H1N1) pandemic strain provided a practical test of the laboratory's pandemic plan. This study shows that the availability of appropriate equipment and molecular-based testing can contribute to important individual and public health outcomes in geographical locations susceptible to emerging infections.

In vivo vs. ex vivo Magnetic Resonance Imaging In Mice

GENERAL COMMENTARY article Front. Neuroinform., 17 May 2012 https://doi.org/10.3389/fninf.2012.00019

Global positioning system and associated technologies in animal behaviour and ecological research

Biologists can equip animals with global positioning system (GPS) technology to obtain accurate (less than or equal to 30 m) locations that can be combined with sensor data to study animal behaviour and ecology. We provide the background of GPS techniques that have been used to gather data for wildlife studies. We review how GPS has been integrated into functional systems with data storage, data transfer, power supplies, packaging and sensor technologies to collect temperature, activity, proximity and mortality data from terrestrial species and birds. GPS 'rapid fixing' technologies combined with sensors provide location, dive frequency and duration profiles, and underwater acoustic information for the study of marine species. We examine how these rapid fixing technologies may be applied to terrestrial and avian applications. We discuss positional data quality and the capability for high-frequency sampling associated with GPS locations. We present alternatives for storing and retrieving data by using dataloggers (biologging), radio-frequency download systems (e.g. very high frequency, spread spectrum), integration of GPS with other satellite systems (e.g. Argos, Globalstar) and potential new data recovery technologies (e.g. network nodes). GPS is one component among many rapidly evolving technologies. Therefore, we recommend that users and suppliers interact to ensure the availability of appropriate equipment to meet animal research objectives.

The Impact of Obesity on Gynecologic Cancer Screening: An Integrative Literature Review

Evidence indicates lower rates of breast and cervical cancer screening among obese compared to nonobese women. This integrative review examines the association between gynecologic cancer screening and body weight, as well as potential barriers to screening. A literature search of standard computerized databases was conducted for peer-reviewed articles published between 1950 and January 2009. Twenty-three studies met the criteria for review. Of the 17 studies that evaluated rates of cervical cancer screening, 13 found obese women significantly less likely than their nonobese counterparts to have had a recent Papanicolaou test, a trend that was stronger in white women when compared to African American women. Eight of the 15 studies examining routine mammography found an inverse association between increasing body weight and recent screening, although findings generally pertained only to women who were white and/or severely obese. Possible barriers to care included embarrassment and perceived weight stigma in the clinical setting, lack of appropriately sized examination equipment, and poor patient-provider communication. Further research is needed to clarify the challenges that obese women face in accessing care and to evaluate strategies such as ensuring the availability of appropriate equipment and supplies, the use of alternative screening methodologies, and more culturally sensitive counseling approaches that may improve screening rates in obese women.

Emergent Aortic Endovascular Stent Grafts for Ruptured Aortoiliac Aneurysms

A ruptured abdominal aortic aneurysm is an emergency anywhere in the world. Physician expertise and clinical status of the patient drive the treatment modalities in the majority of cases. Independent of treatment choice, the goal of therapy is to stabilize the patient as quickly as possible in a manner that establishes maximum survival and minimum morbidity and provides a long-lasting, durable result. Endovascular aortic repair has become an acceptable alternative to open surgical repair in a subset of patients presenting with ruptured aortoiliac aneurysms. Patient selection, physician preference, institutional experience, and availability of appropriate equipment make up a majority of factors influencing treatment choices. Once the decision has been made to treat the patient via endovascular techniques, then experience, planning, and the ability to improvise solutions "on the fly" become vital components to the success of the procedure. Two separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature.