Articles: function.
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Accurate assessment of kidney function is essential for diagnosing and managing chronic kidney disease (CKD) and acute kidney injury (AKI), adjusting drug dosages, and predicting clinical outcomes. Despite its ubiquitous use, serum creatinine has significant limitations, necessitating the exploration of alternative and complementary biomarkers and technologies. ⋯ Furthermore, it highlights innovations in real-time glomerular filtration rate (GFR) measurement, such as transdermal monitoring using MB-102 and dual fluorescent tracers. We conclude with a discussion on the development, validation, and clinical integration of these advancements, which may redefine renal function assessment in the years to come.
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High occupational stress is generally associated with poorer mental health and reduced performance in military personnel, whereas access to support resources is associated with positive outcomes. However, little research has examined the unique stressors and supports experienced by sailors on ships while underway at sea. The objectives of this study were to (1) identify sailors' underway stressors and supports and (2) examine how these differ as a function of demographic and operational factors. ⋯ Sailors experience many stressors while underway. Increasing the resources available to underway sailors may be warranted, especially for female and enlisted personnel. Additional research is necessary to develop targeted interventions and resources. Possible recommendations include noise mitigation, berthing area improvements, sleep and/or scheduling interventions, improved access to mental and physical health care, and interventions to reduce the stigma associated with seeking mental health care.
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Pol. Arch. Med. Wewn. · Jan 2025
ReviewAnticoagulation in patients with a history of heparin-induced thrombocytopenia who require cardiovascular surgery: is it okay to use heparin?
Heparin‑induced thrombocytopenia (HIT) is an adverse drug reaction with significant thromboembolic risk. Though there are models for use of nonheparin anticoagulants, heparin remains the preferred anticoagulant in many operative settings, especially cardiovascular surgery and percutaneous cardiac intervention. ⋯ If procedures cannot be delayed, approaches include intraoperative bivalirudin or intraoperative heparin with pre- or intraoperative plasma exchange or a potent antiplatelet agent, sometimes in combination with intravenous immunoglobulin. In subacute HIT B (immunoassay positive, functional assay negative) and remote HIT (immunoassay negative, functional assay negative), brief exposure to heparin in the intraoperative setting with close monitoring postoperatively is suggested due to the low risk of recurrent HIT.
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More complex occupations during adulthood may be associated with better cognition in later life. We used data from the Brazilian Longitudinal Study of Aging (ELSI) and the Mexican Health and Aging Study (MHAS) to investigate the association between occupational complexity and cognitive function. Using a regression-based approach, participants were classified as cognitively impaired or not. ⋯ The odds of cognitive impairment decreased with higher occupation skill levels in the ELSI, but this trend was not seen in the MHAS, where the highest skill level was not associated with cognitive impairment. ELSI participants had a lower probability of cognitive impairment compared to MHAS participants with the same occupation skill level. The results of this study suggest that programs addressing the negative consequences of lower-complexity occupations need to be tailored to specific regional contexts, considering their unique socioeconomic, cultural, and occupational landscapes.