Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients.

(1) Background: Arteriovenous fistula (AVF) is the preferred type of vascular access for dialysis in patients with end-stage kidney disease (ESKD). However, the primary patency of AVF at one year is under 70% due to several risk factors and comorbidities. Leukocyte glucose index (LGI), a new biomarker based on blood leukocytes and glucose values, has been found to be associated with poor outcomes in cardiovascular disease. The aim of this study is to analyze the impact of LGI on the long-term primary patency of AVF following dialysis initiation. (2) Methods: We conducted a retrospective observational study in which we initially enrolled 158 patients with ESKD admitted to the Vascular Surgery Department of the Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis between January 2020 and July 2023. The primary endpoint was AVF failure, defined as the impossibility of performing a chronic dialysis session due to severe restenosis or AVF thrombosis. After follow-up, we categorized patients into two groups based on their AVF status: "functional AVF" for those with a permeable AVF and "AVF failure" for those with vascular access dysfunction. (3) Results: Patients with AVF failure had a higher prevalence of atrial fibrillation (p = 0.013) and diabetes (p = 0.028), as well as a higher LGI value (1.12 vs. 0.79, p < 0.001). At ROC analysis, LGI had the strongest association with the outcome, with an AUC of 0.729, and an optimal cut-off value of 0.95 (72.4% sensitivity and 68% specificity). In Kaplan-Meier survival analyses, patients in the highest tertile (T3) of LGI had a significantly higher incidence of AVF failure compared to those in tertile 1 (p = 0.019). Moreover, we found that patients with higher baseline LGI values had a significantly higher risk of AVF failure during follow-up (HR: 1.48, p = 0.003). The association is independent of age and sex (HR: 1.65, p = 0.001), cardiovascular risk factors (HR: 1.63, p = 0.012), and pre-operative vascular mapping determinations (HR: 3.49, p = 0.037). (4) Conclusions: In conclusion, high preoperative values of LGI are positively associated with long-term AVF failure. The prognostic role of the biomarker was independent of age, sex, cardiovascular risk factors, and pre-operative vascular mapping determinations.

Assessment of In-Use NOx Emissions from Heavy-Duty Diesel Vehicles Equipped with Selective Catalytic Reduction Systems.

This work evaluated the nitrogen oxide (NOx) emissions of 277 heavy-duty diesel vehicles (HDDVs) from three portable emission measurement system testing programs. HDDVs in these programs were properly maintained before emission testing, so the malfunction indicator lamp (MIL) was not illuminated. NOx emissions of some HDDVs were significantly higher than the certification standard even during hot operations where exhaust temperature was ideal for selective catalytic reduction to reduce NOx. For engines certified to the 0.20 g/bhp-hr NOx standard, hot operation NOx emissions increased with engine age at 0.081 ± 0.016 g/bhp-hr per year. The correlation between emissions and mileage was weak because six trucks showed extraordinarily high apparent emission increase rates reaching several multiples of the standard within the first 15,000 miles of operation. The overall annual increase in NOx emissions for the HDDVs in this study was two-thirds of what was observed in real-world emissions for HDDVs at the Caldecott Tunnel over the past decade. The vehicles at the Caldecott Tunnel would include those without proper maintenance, and the inclusion of these vehicles possibly explains the difference in the rate of emission increase. The results suggest that HDDVs need robust strategies to better control in-use NOx emissions.

Sensor systems for monitoring functional status in assisted living facility residents.

This article provides results of an expert review of data displays for a sensor system used to monitor functional abilities in older adults. The research took place at TigerPlace, an assisted living facility where the sensor system is currently being evaluated. A checklist of 16 heuristic criteria was used to evaluate the sensor data displays, with consideration to the users of the system: residents, their families, and health care providers. Results of this expert review indicate that flexibility and efficiency of use, help and documentation, navigation, and skills were not well developed in the sensor data displays. Conversely, sensor data displays were rated highly for their aesthetic value and the ample visual contrast on the main display components. Through the use of a sensor system, new ways of detecting functional decline in elderly residents of assisted living facilities can be accomplished.