Initial Access Research Articles

Initial entry via the left upper quadrant with an optical trocar in laparoscopic bariatric surgery.

Laparoscopic bariatric surgery (BS) is not readily performed in Japan. To facilitate safe initial access to the abdominal cavity, we insert an optical viewing trocar at a unique site in the left upper quadrant (LUQ). Herein, we describe the technique, its advantages, and outcomes. Briefly, the optical trocar is inserted just below the left subcostal margin, 8cm from the midline. On insertion, layers of the abdominal wall are visualized on the monitor. Depending on the angle of insertion, five, seven, or eight layers are seen. In assessing our initial entry technique, used in 21 obese patients undergoing laparoscopic sleeve gastrectomy, we found median insertion time to be 25 seconds. There were no related complications. In nearly all (20/21) patients, the abdominal wall was visualized as seven layers: subcutaneous fat, anterior rectus sheath, rectus abdominis muscle, posterior rectus sheath, transverse abdominis muscle, transversalis fascia, and peritoneum. Understanding the layers of the abdominal wall visualized during optical trocar insertion in the LUQ will provide for safe and rapid initial entry in patients undergoing laparoscopic BS and can further the widespread acceptance of laparoscopic BS.

Initial Access & Beam Alignment for mmWave and Terahertz Communications

The initial access in Millimeter wave (mmWave) 5G communications is very challenging and time consuming. In general, mmWave and terahertz communications require the use of directional antennas to seek narrow beams. However, due to this directionality, many issues can impact the beam alignment between transmitter and receiver. In this paper, we present a comprehensive survey of beam alignment and initial access in mmWave and terahertz 5G/6G systems. First, we present a detailed overview of initial access methods, techniques, and beam management procedures. Then, we classify recent works related to beam alignment based on their objective functions (i.e., latency, power allocation, QoS, energy consumption, cost). We also highlight the beam alignment in terahertz 6G, where we find that deep learning and reconfigurable intelligent surface are the two protagonists that help to achieve fast beam alignment.

Multibeam Scanning Antenna System Based on Beamforming Metasurface for Fast 5G NR Initial Access

Fifth-generation (and beyond) networks are characterized by ever more demanding requirements in terms of speed, bandwidth, and number of servable users. Fast and reliable access to the main network is mandatory, requiring technologies and procedures that ensure high performing cell search and initial access (IA). Existing phased array antennas (PAAs) are limited by the single beam scanning approach and complex feeding systems. In this paper, a beamforming metasurface that shifts the field manipulation from an electric level to an electromagnetic one is proposed for speeding up the IA procedure with respect to a traditional system using PAAs. The main advantage is given by the simultaneous transmission of multiple signals in different directions. The numerical results demonstrate that a much faster IA with similar success probability can be reached. Our system provides high gain, parallel computation, and scalability for larger systems, becoming a relevant candidate in the new radio and smart electromagnetic environment context.

ATHE 2021 Presidential Remarks

ATHE 2021 Presidential Remarks Chase Bringardner (bio) I join you all today from Auburn University in Auburn, Alabama, built on the unceded Indigenous homelands and resources of the Muscogee/Creek people, the past, present, and future caretakers of this land. I would like to start my remarks today with some expressions of gratitude. Thank you to all the outgoing members of the Governing Council, as well as to all of those Focus Group Representatives, Conference Planners, Members at Large, graduate student representatives, and others who so graciously volunteered their time and energies in service to their Focus Groups, ATHE, and the larger fields of theatre and performance. Your willingness to serve in these particularly challenging times speaks not only to your graciousness of spirit, but also to your commitment to the various fields we traverse. I also want to thank our Executive Director, Aimee Zygmonski, for all her labor. She, along with Devon Binder and Sean Franklin Sewell, worked diligently over the last year to transition a second conference in a row to a fully digital platform. I am grateful for Aimee’s passion and commitment to the organization and her care and integrity in helping to realize its work. I also want to thank Vice President for Conference 2021 Ann Haugo and her entire committee. This conference has been a stirring success, with 298 individual sessions on the virtual schedule—the most ever for an ATHE conference. The breadth and depth of programing speaks to the attention and thoughtfulness that Ann and her committeem as well as the Focus Group Representatives and Conference Planners, put into the entire proceedings. Their conscientious curation is evidenced in the vibrant, engaged discussions and roundtables, perceptive paper presentations, panels, workshops, demonstrations and readings, the active, vital plenaries, the thoughtful and energizing keynote, and the urgent, challenging performances. Finally, I want to thank outgoing president Josh Abrams. His steady leadership through the seemingly constant pivots allowed ATHE to persevere, as other organizations struggled with financial solvency. His thoughtfulness, attention to detail, and global perspective enriched the organization and will continue to influence ATHE for years to come. So again, Thank You to everyone for all of your efforts. And for those new and continuing leaders, I look forward to collaborating with you. As an organization that operates almost entirely on volunteer labor, we must never take that labor for granted, and must always work to create and sustain practices that honor those efforts. When I found out that I had the privilege of serving ATHE as president, I did not imagine that I would make my first real remarks from a chair at a table in my office. I believed I would be addressing you all from a hotel ballroom in Austin, Texas—the very city where as a very green graduate student at UT Austin, fresh out of undergrad, I first heard about ATHE. [End Page 1] I had the extreme privilege of arriving at the university in the same year that Jill Dolan arrived and established the Performance as Public Practice Program alongside Oscar Brockett, Charlotte Canning, Ann Daley, Omi Osun Joni L. Jones, Lynn Miller, and Stacy Wolf. I found my way to UT Austin at the insistence of my undergraduate mentor (and former ATHE Vice President, Advocacy) Ann Marie Costa. I vividly remember Jill, a former president of ATHE, speaking of the importance of attending, sharing research, and engaging in the important work done by the organization. Excited and eager to participate and inspired by legacies of ATHE leadership I found in my mentors, I pored over the call for papers for the 2001 ATHE conference in San Diego and found a perfect panel seeking participants. I submitted my abstract and promptly didn’t get in. And yet, in that moment, Jill realized the importance of attending, of being in the room, and found a way to piece together some leftover funding, granting me the access that allowed me to attend. From that moment and with that initial access, I have served in a variety of positions and come to appreciate the possibilities inherent in ATHE. None of us could have imagined all that has occurred over the past almost...

Recognising our community as we head towards JEB's centenary in 2023.

Recognising our community as we head towards JEB's centenary in 2023.

A comparative study of air pyelogram and contrast pyelogram for initial puncture access and to see its efficacy during percutaneous nephrolithotomy.

The current investigation was aimed to compare the safety, efficacy, adverse effects, and outcome of air pyelogram versus contrast pyelogram for percutaneous nephrolithotomy. This was a cross-sectional study conducted from August 2018 to November 2020, which included 400 patients with a clinical diagnosis of renal calculus and randomly (1:1) assigned into Group I (air pyelogram) and Group II (contrast pyelogram). Air was injected in Group I and diatrizoate meglumine 76% was used in Group II for PCS identification. In the case of difficulty in visualization in either group, a mixture of contrast and air was used. The following parameters were assessed: duration of access, total duration of radiation exposure during access, total attempts needed to puncture the desired calyx, failure rate, complications, and outcomes. Both the groups were comparable including renal calculus characteristics. The mean (standard deviation) duration of access was 3.08 (1.21) and 5.23 (1.02) min (P < 0.0001) in Groups I and II, respectively; in 85% and 57.5% of patients (P < 0.0001), respectively, the caliceal puncture was done in a single attempt. The duration of radiation exposure was more in Group II (P < 0.0001). The failure rate (22%) was higher and statistically significant in Group II. The stone clearance rate was not statistically significant between the groups (P = 0.380). No patient had hypoxia, cardiopulmonary complications, and air embolism in perioperative period. Air contrast is effective and safe, and it reduces the duration of caliceal puncture and radiation exposure with lower failure rate. If both air and contrast fail, a combination of both may be effective.

Clinico-Epidemiological Profile of Dialysis Services in Karnataka, India - A Multicentric Exploratory Study.

Introduction:New challenges in dialysis care delivery confront caregivers with the rise in dialysis numbers. There are significant lacunae in the knowledge and efficient application of dialysis therapy in the absence of a dialysis registry. This multicentric study was conducted by the Nephrology Association of Karnataka to systematically study patient demographics and dialysis characteristics in Karnataka state, India, as a basis for a statewide dialysis registry.Material and Methods:Data were collected from the consenting dialysis centers after institutional ethics board clearances. Residents of Karnataka state, who were confirmed prevalent patients with end-stage renal disease, on either maintenance hemodialysis (HD) or peritoneal dialysis were included. Demographic data of patients and details of dialysis as well as dialysis facilities were collected on an online platform. Statistical analysis was done using SPSS software Version 16.Results:Thirty-two centers contributed to the data of 2,050 patients (males 70.3%, mean age 53.49 ± 14.09 years). Most patients were on HD (95.3%). Diabetes was the commonest cause of chronic kidney disease. About 72% of patients had temporary venous catheters as initial vascular access. In all, 1,156 patients (59.9%) were on thrice weekly HD. Around 65% of the centers were in private hospitals. The majority (90%) of the centers reused dialyzers, 56% reprocessed dialyzers mechanically, and 66% tested viral serology quarterly.Conclusions:This study was one of the initial attempts to capture dialysis data across Karnataka, and it offers useful insight into the existing dialysis demographics and care delivery. Participation of more centers and continued effort to form a dialysis registry for deriving meaningful clinico-epidemiological insight are desirable.

Apexification in non-vital tooth with open apex: A case report

Apexification is a technique for inducing closure of the non-vital permanent teeth at the apex. In apexification a mineralized barrier is induced with long-term calcium hydroxide (CH) or created artificially with mineral trioxide aggregate (MTA) plug.Method: Two patients presented for evaluation of central incisor with discoloration with mild swelling and a non-traceable sinus tract. Both have a history of trauma. After intraoral examination and radiographic assessment a diagnosis of pulp necrosis with open apex was made. At the initial visit access cavity preparation and biomechanical preparation was done and calcium hydroxide dressing was placed. In the next appointment MTA plug was made and obturation was done after 72 hours and the tooth was build up with composites and a porcelain fused to metal crown was delivered. MTA is used for creating an apical plug, the functional goal of this procedure is to provide a hard tissue barrier that will provide an apical stop which will provide a platform for effective obturation of the canal allowing the patient to maintain the tooth.Conclusion: MTA can be used effectively for creating a hard calcific barrier in cases of open apex. MTA also has low cytotoxic and superior biocompatibility as compared to calcium hydroxide used before.

Rural Broadband and Precision Agriculture: A Frame Analysis of United States Federal Policy Outreach under the Biden Administration

Global food security requires sustainable and resource-efficient agricultural production. Precision agriculture may provide the tools needed to intensify agricultural production while prioritizing sustainability; however, there are barriers such as initial investments, knowledge gaps, and broadband access that may hinder adoption. Many rural areas in the United States lack the appropriate infrastructure for broadband access needed for precision agriculture, indicating government policies are needed to expand broadband access. The purpose of this qualitative research study was to develop a conceptualization of the current frames used by the Biden administration in communications related to rural broadband and precision agriculture. The methodological framework used was frame analysis. Data were initially analyzed inductively for overall gestalt and subsequently analyzed with abductive coding. Five overarching frames were identified during the data analysis process: broadband access and economic issues, garnering support for broadband expansion, urgency and equity surrounding broadband, expanding beyond the rural, and broadband infrastructure and the agricultural sector. The findings revealed broadband access associated with the Biden administration expanded beyond rural areas, recognizing that cities also face broadband access and affordability issues. There was a lack of discourse, however, surrounding rural broadband policy and precision agriculture, which may downplay its importance in agricultural sustainability.

A Review of Millimeter Wave Device-Based Localization and Device-Free Sensing Technologies and Applications

The commercial availability of low-cost millimeterwave (mmWave) communication and radar devices is starting to improve the adoption of such technologies in consumer markets, paving the way for large-scale and dense deployments in fifthgeneration (5G)-and-beyond as well as 6G networks. At the same time, pervasive mmWave access will enable device localization and device-free sensing with unprecedented accuracy, especially with respect to sub-6 GHz commercial-grade devices. This paper surveys the state of the art in device-based localization and device-free sensing using mmWave communication and radar devices, with a focus on indoor deployments. We overview key concepts about mmWave signal propagation and system design, detailing approaches, algorithms and applications for mmWave localization and sensing. Several dimensions are considered, including the main objectives, techniques, and performance of each work, whether they reached an implementation stage, and which hardware platforms or software tools were used. We analyze theoretical (including signal processing and machine learning), technological, and implementation (hardware and prototyping) aspects, exposing under-performing or missing techniques and items towards enabling a highly effective sensing of human parameters, such as position, movement, activity and vital signs. Among many interesting findings, we observe that device-based localization systems would greatly benefit from commercial-grade hardware that exposes channel state information, as well as from a better integration between standardcompliant mmWave initial access and localization algorithms, especially with multiple access points (APs). Moreover, more advanced algorithms requiring zero-initial knowledge of the environment would greatly help improve the adoption of mmWave simultaneous localization and mapping (SLAM). Machine learning (ML)-based algorithms are gaining momentum, but still require the collection of extensive training datasets, and do not yet generalize to any indoor environment, limiting their applicability. Device-free (i.e., radar-based) sensing systems still have to be improved in terms of: improved accuracy in the detection of vital signs (respiration and heart rate) and enhanced robustness/generalization capabilities across different environments; moreover, improved support is needed for the tracking of multiple users, and for the automatic creation of radar networks to enable largescale sensing applications. Finally, integrated systems performing joint communications and sensing are still in their infancy: theoretical and practical advancements are required to add sensing functionalities to mmWave-based channel access protocols based on orthogonal frequency-division multiplexing (OFDM) and multi-antenna technologies.

Risk of Stroke with Impella Placement Is Not Associated with Access Vessel.

Objective: The Impella heart pump is an intravascular microaxial device that provides short-term mechanical circulatory support and can be placed through the femoral, axillary, or central vessels. One of the most feared complications is stroke. It is unclear if patient stroke risk varies based on access vessel. Methods: A retrospective review of consecutive patients who underwent Impella placement at an academic institution from January 1, 2007, through September 15, 2018, was performed. Four groups were compared: (1) minimally invasive Impella (femoral or axillary access), (2) minimally invasive Impella upgraded to another minimally invasive Impella, (3) minimally invasive Impella upgraded to a central Impella (ascending aorta), and (4) central Impella. Patient charts were reviewed to identify baseline characteristics. Outcome measures included length of stay, stroke, and mortality. Results: A total of 349 patients (or 407 Impellas) were identified, and the majority of the devices were inserted through a minimally invasive approach (n = 248, 60.9%), while the remainder were implanted via central access (n = 159, 39.1%). Minimally invasive Impellas were upgraded in 44 patients. The risk of stroke for the entire cohort was 10.3% (n = 36), with no difference observed in any particular group. Overall mortality was 44.4% (n = 155). Of the patients who initially received a minimally invasive Impella, those who were upgraded had higher rates of mortality (56.8% vs 39.4%, P = 0.03), postoperative dialysis (50.0% vs 27.4%, P < 0.01), and sepsis (43.2% vs 20.0%, P < 0.01). Conclusions: This study found no statistically significant difference in rates of postoperative stroke based on initial access vessel.

Double progressivity of infrastructure financing through carbon pricing — Insights from Nigeria

Carbon taxes and fossil fuel subsidy reforms have been recognized as an efficient means to mobilize substantive domestic resources for sustainable development. Yet, despite their advantages compared to other taxes, concerns about potential adverse impacts on poverty and inequality have discouraged many countries from such fiscal reforms. This paper estimates which absolute and relative equity effects a comprehensive carbon pricing reform would have on households within and between income groups in Nigeria. We further analyze the distributional effects of revenues being recycled into basic infrastructure development and social safety nets. We assess the expected consumption effects of six policy packages across rural and urban income groups, combining environmental-extended input-output data with detailed household survey data. Our results suggest that, relative to their income, lower-income households would bear a smaller consumption burden from carbon pricing than high-income households, while enjoying greater gains from uniform cash transfers or access to improved water, sanitation, electricity, or telecommunication infrastructure. Additionally, if spent efficiently, such investments could disproportionally benefit the overall poorer rural population due to larger initial access gaps.

Random Access Optimization for Initial Access and Seamless Handover for 5g-Satellite Network

Random Access Optimization for Initial Access and Seamless Handover for 5g-Satellite Network

Kidney trajectory charts to assist general practitioners in the assessment of patients with reduced kidney function: a randomised vignette study

ObjectiveTo investigate the decisional impact of an age-based chart of kidney function decline to support general practitioners (GPs) to appropriately interpret estimated glomerular filtration rate (eGFR) and identify patients with...

Deep Contextual Bandits for Fast Neighbor-Aided Initial Access in mmWave Cell-Free Networks

Access points (APs) in millimeter-wave (mmWave) and sub-THz-based user-centric (UC) networks will have sleep mode functionality. As a result of this, it becomes challenging to solve the initial access (IA) problem when the sleeping APs are activated to start serving users. In this paper, a novel deep contextual bandit (DCB) learning method is proposed to provide instant IA using information from the neighboring active APs. In the proposed approach, beam selection information from the neighboring active APs is used as an input to neural networks that act as a function approximator for the bandit algorithm. Simulations are carried out with realistic channel models generated using the Wireless Insight ray-tracing tool. The results show that the system can respond to dynamic throughput demands with negligible latency compared to the standard baseline 5G IA scheme. The proposed fast beam selection scheme can enable the network to use energy-saving sleep modes without compromising the quality of service due to inefficient IA

High Efficiency Beam Alignment Based on Multi-Modal Beam Patterns for Massive MIMO Antenna Systems

Multiple-input multiple-output (MIMO) is considered as the key technology for 5G wireless communications networks. In the millimeter-wave (mmWave) frequency bands, directional beamforming is essential to the establishment of an efficient radio link for signal transmission. However, in wireless mobile environments, the effective beam direction is generally unavailable in the initial access phase. Hence, beam alignment (BA) is crucial for link establishment in initial access. In this work, we propose an efficient BA technique, referred to as the multi-modal pattern BA scheme, to improve the performance and efficiency of initial access in massive MIMO systems. Unlike the conventional sequential search scheme using single-modal patterns, the transmission of synchronization signals in the proposed scheme is based on the use of multi-modal patterns, each of which specifies multiple main lobes with distinguishable directions. Incomparison with the conventional scheme, our scheme can greatly enhance the achieved angular resolution after BA under the use of a fixed number of synchronization signals. As a result, the signal-to-noise ratio (SNR) of the established link is significantly improved. By contrast, if the same angular resolution is desired, the proposed scheme can greatly reduce the number of required synchronization signals to conserve the radio resources, including transmission power and bandwidth, and to decrease the searching delay in the BA procedure. In addition, considering multi-modal pattern construction for the transmission using a single radio-frequency (RF) chain, we propose an effective approach to generate the desired beamforming vectors fulfilling the essential constant amplitude constraint.

Saving lives and livelihoods: The Paycheck Protection Program and its efficacy

In March 2020, the COVID-19 pandemic, caused by the SARS-CoV-2 virus, swept through the United States. The necessary but costly non-pharmaceutical interventions (NPIs) including social distancing, stay-at-home orders, and the closing or restriction of most businesses greatly increased the unemployment rate, and put millions of Americans at risk for eviction and bankruptcy. As a part of the relief efforts to mitigate the economic consequences of the shutdown orders, the United States Congress passed The Coronavirus Aid, Relief, and Economic Security Act, also known as the CARES Act, which created the Paycheck Protection Program (PPP). The PPP, administered by the Small Business Administration (SBA), was intended to help small business keep employees on their payroll through loans guaranteed by the SBA that are forgivable if certain conditions are met. This paper, using publicly available data released by the SBA of loans worth $150,000 or greater, analyzes the effectiveness of the program through multiple avenues. On the overall effectiveness of the program, we explore the types of business that received PPP funding, the ranges of loan amounts provided, the types of banks that processed the loans, the cost-effectiveness of jobs saved based on the loan range, and the racial distribution of loan recipients. We also analyze the geographical distribution of loans based on congressional district to look at the influence race and political party had on how much PPP funding each congressional district received. Finally, we look at the how the PPP fit into the context of the COVID-19 pandemic by looking at the number of COVID-19 cases in each state at the time the program was initially closed, the amount of PPP funding for each state and analyzing the relationship between the loan amount per COVID-19 case and the date of reopening in each state, the relationship between the number of PPP loans received, and how long it took until a state reopened. We note that states that received more loans tended to delay their reopening, as a result, one of the main goals of the PPP, limiting the spread of COVID-19 by keeping people at home, was successful in that regard. We determine that the program, while a critical lifeline in a desperate, unprecedented time, had flaws in its deployment related to a lack of preparedness, a lack of equity in which recipients had initial access and how much funding recipients received, and noticeable gaps in the data. Finally, we recommend policy solutions and fixes going forward to bolster our preparedness response at the state and federal level and ensure that going forward, we can do better to meet the missed marks during the acute phase of the coronavirus pandemic.

Validation of an ecological momentary assessment to measure processing speed and executive function in schizophrenia

Cognitive impairments are a core feature of schizophrenia that have negative impacts on functional outcomes. However, it remains challenging to assess these impairments in clinical settings. Smartphone apps provide the opportunity to measure cognitive impairments in an accessible way; however, more research is needed to validate these cognitive assessments in schizophrenia. We assessed the initial accessibility, validity, and reliability of a smartphone-based cognitive test to measure cognition in schizophrenia. A total of 29 individuals with schizophrenia and 34 controls were included in the analyses. Participants completed the standard pen-and-paper Trail Making Tests (TMT) A and B, and smartphone-based versions, Jewels Trail Tests (JTT) A and B, at the single in-lab visit. Participants were asked to complete the JTT remotely once per week for three months. We also investigated how subjective sleep quality and mood may affect cognitive performance longitudinally. In-lab and remote JTT scores moderately and positively correlated with in-lab TMT scores. Moderate test-retest reliability was observed across the in-lab, first remote, and last remote completion times of the JTT. Additionally, individuals with schizophrenia had significantly lower performance compared to controls on both the in-lab JTT and TMT. Self-reported mood had a significant effect on JTT A performance over time but no other significant relationships were found remotely. Our results support the initial accessibility, validity and reliability of using the JTT to measure cognition in schizophrenia. Future research to develop additional smartphone-based cognitive tests as well as with larger samples and in other psychiatric populations are warranted.

Abstract 12819: Feasibility of Transradial Primary Percutaneous Coronary Intervention for STEMI Complicated by Cardiac Arrest

Introduction: The American Heart Association recommends a “radial-first” strategy in patients with ST-elevation myocardial infarction (STEMI). It is uncertain whether the benefits of transradial (TR) access extends to high-risk patients who present with STEMI and cardiac arrest (CA). Methods: Consecutive patients with STEMI complicated by CA who underwent percutaneous coronary intervention (PCI) within 24 hours at the Cleveland Clinic between 2011-2018 were included. TR-PCI was implemented as the standard approach during the study period (2014). Temporal changes in the use and technical success rates of TR-PCI were assessed, and procedural outcomes were compared with those who underwent transfemoral (TF)-PCI as the initial attempted approach. To evaluate for predictors of major bleeding, variables were assessed in univariable logistic regression and those with p&lt;0.10 were included in multivariable analysis. Results: Among 216 patients, TR-PCI use increased from 2.9% in 2011 to 87.1% in 2018 (p&lt;0.001). TR-PCI was successful in 80/91 (87.9%) patients. Door-to-balloon-time (90 [68, 116] vs. 105 [76, 141] minutes, p=0.03) and contrast volume (150 vs. 153 mL, p=0.03) were significantly lower in TR-PCI relative to TF-PCI with no differences in fluoroscopy dose, mechanical circulatory support use (30.8% vs. 41.6%, p=0.14), or in-hospital mortality (13.2% vs. 19.2%, p=0.32). After adjusting for peripheral arterial disease, diabetes, fluoroscopy dose, mechanical circulatory support, and total femoral access, TR-PCI was an independent predictor for less major bleeding {OR=0.34 (95% CI [0.11-0.93], p=0.045)}. Conclusions: Among patients with STEMI and CA, TR-PCI is feasible and can be successfully adopted via implementation of a “radial-first” strategy. With a high technical success rate, no adverse effect on door-to-balloon-time, and reduced major bleeding, TR-PCI should be the initial access strategy in high-risk patients with STEMI and CA.

Predictors of Mortality within 24 Months of Initial Arteriovenous Access Creation

End Stage Renal Disease is increasingly common, with approximately 785,880 patients currently dialysis dependent in the United States. 86% of these patients utilize hemodialysis. Arteriovenous (AV) access with either a fistula or graft is preferred over a catheter due to lowered complication risk. The purpose of this paper is to identify mid- term predictors of mortality to guide the type of AV access in patients with suboptimal cephalic veins. This is a retrospective review of patient characteristics at the time of initial AV access placement. All patients receiving first time AV access were reviewed. Mortality data was found via electronic medical records review, social security death index review, and internet search. Patients in whom mortality data could not be found were excluded from the final analysis. Univariate analysis using Chi-Squared testing and Student T-Test was performed. Binary logistic regression analysis was also performed for multivariate investigation. A total of 176 patients underwent first time AV access during the study period. Two year mortality data was available for 149 of these patients. Mortality occurred within 2 years for 27% of patients. Advanced age (70 vs. 61, P < 0.01), arrhythmia (48% vs. 24%, P < 0.01), abnormal EKG (36% vs.14%, P < 0.01), CHF (47% vs. 24%, P < 0.01), white, non-Hispanic race (51% vs. 22%, P < 0.01) and history of smoking (48% vs. 15%, P < 0.01) were statistically significant univariate predictors of 2-year mortality. Advanced age, white race and smoking were multivariate predictors with smoking having the largest impact (multivariate adjusted OR 11.8, P < 0.001). History of tobacco smoking has a profoundly negative effect on two year survival in patients undergoing initial AV access. Absence of smoking history provides significant 2-year mortality protection and thorough attempt at autologous AVF creation should be made in these patients. Cardiac disease and advanced age continue to be lead predictors of mortality in ESRD patients.