a limit to frailty occurred with FI = 0.7 which was not exceeded at any age or in any wave. There appears to be a demonstrable limit to the number of health problems that people can tolerate.

Purpose The purpose of this study is to accurately characterize the cephalic arch segments into four domains and to enable more specific evaluation of cephalic arch stenosis (CAS) and determine the frequency of stenosis in each domain. Methods After Institutional Review Board (IRB) approval, a retrospective chart review was done to define a population of patients receiving hemodialysis who developed CAS as apparent on clinically indicated radiologic imaging. A standardized approach was devised to categorize four domains of the cephalic arch. Domain I was defined as the peripheral portion of the arch and Domain IV was the distal portion of the cephalic vein near termination with the axillary vein. The magnitude of stenosis as measured by percentage was determined and compared in the four domains. Results The most frequent location for stenosis was found in domain IV when compared with domains II or I (p<0.01). The magnitude of stenosis differed across all domains (p<0.001) with the least common place for CAS in domain I. Treatment of CAS included angioplasty in all, thrombectomy in eight, and stent placement in five. Conclusions CAS occurs most commonly in the terminal portion of the arch. Four standardized domains have been defined; future work will validate these findings and determine the best intervention for each domain.

Microwave ablation is a recent development in the field of tumor ablation that uses electromagnetic waves to establish a microwave near-field with direct tissue heating. Some of the limitations of the earlier generation devices had been unpredictable size and shape of the ablation zones with changes in the surrounding tissue environment as well as differences across various different tissue types. The Emprint Ablation System with Thermosphere Technology (Covidien, Boulder, CO) is the most recent generation ablation system that attempts to produce predictable large spherical zones of ablation despite varying tissue environments across different tissue types such as liver, lung, and bone to name a few. This article will discuss these recent device developments as well as review some basic microwave characteristics.

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Automated assessment of older adult health is needed due to an impending demographic shift. Mobility is considered an indicator of health and is more tangible than some other health measures. Currently, many papers aim to examine a discrete movement in detail, but none describe one system of algorithms aiming to automatically identify discrete and continuous patient positions and transitions. This paper aims to develop such a system of algorithms. Discrete and continuous data were generated by 32 subjects performing a series of position-transition movements, captured by fiber-optic pressure sensor mats. Algorithm set 1 part 1 aimed to identify and distinguish between three positional states by extracting seven occupancy and dispersion features, then using 1-D and 2-D support vector machine (SVM) and linear classifiers to classify the data. Set 1 part 2 aimed to identify and distinguish between state transitions by calculating percentage pressure difference on a per sensor and large area basis, then monitoring these signals for pressure relief. The second set aimed to examine all movements by extracting six geometric features from center of pressure signals, then using 1-D and 2-D SVM and linear classifiers to classify two subtly different transitions. All methods resulted in at least a 98% identification accuracy, and some methods were able to shed light on the subtleties of transitions. The results suggest that, with more development, the presented algorithmic methods could be implemented in hospital settings to assist with identification and assessment of elderly patient mobility.

This publication includes the appropriate imaging modalities to assess suspected deep vein thrombosis in the upper extremities. Ultrasound duplex Doppler is the most appropriate imaging modality to assess upper-extremity deep vein thrombosis. It is a noninvasive test, which can be performed at the bedside and used for serial evaluations. Ultrasound can also directly identify thrombus by visualizing echogenic material in the vein and by lack of compression of the vein walls from manual external pressure. It can indirectly identify thrombus from altered blood-flow patterns. It is most appropriate in the evaluation of veins peripheral to the brachiocephalic vein. CT venography and MR venography are not first-line imaging tests, but are appropriate to assess the central venous structures, or to assess the full range of venous structures from the hand to the right atrium. Catheter venography is appropriate if therapy is required. Radionuclide venography and chest radiography are usually not appropriate to assess upper-extremity deep vein thrombosis.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.