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This study examined the factor structure of the Detroit Tests of Learning Abilities, Fifth Edition (DTLA-5) using principal axis factoring, multiple factor extraction criteria, and the Schmid-Leiman orthogonalization procedures not utilized by test publishers. Results suggest that the publisher's six-factor structure model was over factored. Although there is support for five group factors and a hierarchical general factor that correspond with some of the test's most reliable composites, there was no evidence warranting a distinction between the test's hypothesized Reasoning Abilities and Processing Abilities domains or separation of Acquired Knowledge and Verbal Comprehension subdomains. Some test users may prefer to interpret the four DTLA-5 subdomains that correspond to some of our basic findings in a profile indicating intra-individual strengths and weaknesses. Based on our hierarchical factor analysis and omega statistics, we believe that the DTLA-5 should be interpreted as a measure of psychometric g and not used to examine intra-individual strengths and weaknesses for most test-takers.

The given text is a compilation of case reports and studies related to toxicology and poisoning. It covers a range of topics, including medication overdoses, adverse effects of substances, and the management of toxic exposures. The document provides valuable insights into the complexities of toxicology and highlights the importance of prompt and individualized treatment approaches. It can be a useful resource for library patrons conducting research in this field. [Extracted from the article]

Objectives: Guideline recommended treatments for chronic conditions are thought to reduce ED presentations. Method: We used data from 1958 ED patients with dyspnoea to describe medication use in patients with chronic conditions. Results: A total of 1233 (63.5%) patients had one or more of: chronic obstructive pulmonary disease 547 (28%), asthma 454 (23%), atrial fibrillation 368 (19%) or heart failure 401 (21%). Approximately, 70% were prescribed appropriate preventative medication for their chronic condition when they presented to ED with dyspnoea. Conclusion: Prescription of guideline recommended therapies for chronic conditions in patients presenting to the ED in Australasia with acute dyspnoea is similar or higher than reported previously. [ABSTRACT FROM AUTHOR]

Objective: Acetylcysteine (NAC), an effective antidote for paracetamol poisoning, is commonly associated with adverse reactions. This has been postulated to be related to the rapid initial infusion rate (150 mg/kg over 1 h) of the traditional three-bag protocol. We hypothesized that a slower rate would result in fewer adverse reactions. Our institution in Western Sydney moved to a modified two-bag protocol in February 2015 - first bag: 200 mg/kg over 4 h (50 mg/kg/h) and second bag: (100 mg/kg over 16 h). Methods: Data was extracted from our database on paracetamol overdoses treated with NAC from August 2010 to September 2016. We compared adverse reactions in patients receiving the modified two-bag protocol with a historical control (traditional three-bag regimen with initial bolus of 150 mg/kg/h). Results: Over the study period 1011 paracetamol poisonings presented to our toxicology service, of which 476 required NAC (three-bag = 313, two-bag = 163). Demographic characteristics of the two groups were similar. Fewer anaphylactoid reactions (itch, rash, and swelling) occurred using the two-bag regimen (14% versus 5%, p = .002), a relative reduction of 66%. Similarly, there were fewer prescriptions of anti-allergy medications in the two-bag group (11% versus 4%, p = .01). There was no difference in incidence of hepatotoxicity. Conclusions: Adverse reactions to NAC were less common with the two-bag regimen. These results add to the accumulating evidence that reducing the initial NAC infusion rate reduces the risk of adverse reactions. [ABSTRACT FROM AUTHOR]

Objectives:In Australia, the treatment guideline for patients with repeated supratherapeutic ingestion (RSTI) of paracetamol recommends an abbreviated acetylcysteine regimen if the paracetamol concentration is low (<10 mg/L) and alanine aminotransferase (ALT) is normal or static after 8 hours of infusion. There are currently no studies of this recommendation. Method:A retrospective review of paracetamol overdose presentations from October 2009 to August 2016 in two hospital toxicology networks was performed. All cases of RSTI treated with acetylcysteine were extracted. Results:Of the 2249 paracetamol overdose presentations, 91 cases of RSTI were treated with acetylcysteine. Median time to initial blood tests was 6 hours post-last paracetamol dose (IQR 4–6). Sixty-three (69%) presentations had an initial detectable paracetamol concentration, median 30 mg/L (IQR 18–60). Median ALT on presentation was 48 IU/L (IQR 18–109). After 8 hours of acetylcysteine infusion, median ALT was 34 IU/L (IQR 16–71) in those receiving abbreviated treatment and 74 IU/L (IQR 40–231) in those continuing acetylcysteine. Thirty-nine presentations (43%) had an abbreviated regimen. Nine (10%) patients had an initial ALT ≥50 IU/L and subsequently developed hepatotoxicity (ALT >1000 IU/L). No patients with an initial ALT <50 IU/L developed hepatotoxicity. Median duration of acetylcysteine infusion for those receiving a non-abbreviated regimen was 20 hours (IQR 20–25) vs. 10.4 hours (IQR 4.8–12.0) who received an abbreviated regimen. There were no re-presentations with hepatotoxicity. Conclusions:An 8-hour acetylcysteine infusion regimen for treatment of paracetamol RSTI may be safe and is likely to reduce length of stay for patients at low risk of hepatotoxicity. Larger prospective studies are needed to examine the efficacy of this abbreviated acetylcysteine protocol. [ABSTRACT FROM PUBLISHER]

Introduction:Paracetamol concentration is a highly accurate risk predictor for hepatotoxicity following overdose with known time of ingestion. However, the paracetamol–aminotransferase multiplication product can be used as a risk predictor independent of timing or ingestion type. Validated in patients treated with the traditional, "three-bag" intravenous acetylcysteine regimen, we evaluated the accuracy of the multiplication product in paracetamol overdose treated with a two-bag acetylcysteine regimen. Methods:We examined consecutive patients treated with the two-bag regimen from five emergency departments over a two-year period. We assessed the predictive accuracy of initial multiplication product for the primary outcome of hepatotoxicity (peak alanine aminotransferase ≥1000IU/L), as well as for acute liver injury (ALI), defined peak alanine aminotransferase ≥2× baseline and above 50IU/L). Results:Of 447 paracetamol overdoses treated with the two-bag acetylcysteine regimen, 32 (7%) developed hepatotoxicity and 73 (16%) ALI. The pre-specified cut-off points of 1500 mg/L × IU/L (sensitivity 100% [95% CI 82%, 100%], specificity 62% [56%, 67%]) and 10,000 mg/L × IU/L (sensitivity 70% [47%, 87%], specificity of 97% [95%, 99%]) were highly accurate for predicting hepatotoxicity. There were few cases of hepatotoxicity irrespective of the product when acetylcysteine was administered within eight hours of overdose, when the product was largely determined by a high paracetamol concentration but normal aminotransferase. Conclusions:The multiplication product accurately predicts hepatotoxicity when using a two-bag acetylcysteine regimen, especially in patients treated more than eight hours post-overdose. Further studies are needed to assess the product as a method to adjust for exposure severity when testing efficacy of modified acetylcysteine regimens. [ABSTRACT FROM PUBLISHER]

Background: Immunocompromised individuals are not optimally protected by COVID-19 vaccines and potentially require additional preventive interventions to mitigate the risk of severe COVID-19. We aimed to characterise and describe the risk of severe COVID-19 across immunocompromised groups as the pandemic began to transition to an endemic phase., Methods: COVID-19-related hospitalisations, intensive care unit (ICU) admissions, and deaths (01/01/2022-31/12/2022) were compared among different groups of immunocompromised individuals vs the general population, using a retrospective cohort design and electronic health data from a random 25% sample of the English population aged ≥12 years (Registration number: ISRCTN53375662)., Findings: Overall, immunocompromised individuals accounted for 3.9% of the study population, but 22% (4585/20,910) of COVID-19 hospitalisations, 28% (125/440) of COVID-19 ICU admissions, and 24% (1145/4810) of COVID-19 deaths in 2022. Restricting to those vaccinated with ≥3 doses of COVID-19 vaccine (∼84% of immunocompromised and 51% of the general population), all immunocompromised groups remained at increased risk of severe COVID-19 outcomes, with adjusted incidence rate ratios (aIRR) for hospitalisation ranging from 1.3 to 13.1. At highest risk for COVID-19 hospitalisation were individuals with: solid organ transplant (aIRR 13.1, 95% confidence interval [95% CI] 11.2-15.3), moderate to severe primary immunodeficiency (aIRR 9.7, 95% CI 6.3-14.9), stem cell transplant (aIRR 11.0, 95% CI 6.8-17.6), and recent treatment for haematological malignancy (aIRR 10.6, 95% CI 9.5-11.9). Results were similar for COVID-19 ICU admissions and deaths., Interpretation: Immunocompromised individuals continue to be impacted disproportionately by COVID-19 and have an urgent need for additional preventive measures beyond current vaccination programmes. These data can help determine the immunocompromised groups for which targeted prevention strategies may have the highest impact., Funding: This study was funded by AstraZeneca UK., Competing Interests: ST, SD, SA, SV, LC, CF, RM are employees of and may own stocks or shares in AstraZeneca. RY is an employee of P95 Epidemiology & Pharmacovigilance, which received a consultancy fee for the conduct of the current study from AstraZeneca. YL, MY, KE, SG, NJ are employees of Evidera, which received funding for the conduct of the current study from AstraZeneca. EB reports receiving research grant from Vaccitech, consulting fee from AstraZeneca and Vaccitech, owning shares in Perspectum Diagnostics, and holding patents in HBV and HCV Viral Vectored Vaccine work. SB reports receiving consulting fees from AstraZeneca. RAE reports receiving funding from Evidera for providing advice throughout the current study, research grants from NIHR, UKRI, Wolfson Foundation, Genetec/Roche to her institution for works not related to current manuscript, speaker fee from Boehringer Ingelheim and Moderna, support from Chiesi for attending British Thoracic Society (BTS), and serving non paid as European Respiratory Society (ERS) Group 01.02 Pulmonary Rehabilitation and Chronic Care secretary and American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly chair. PM reports receiving consulting fee from AstraZeneca and The Binding Site, speaker fee from AstraZeneca, Moderna, AbbVie, and support for attending meetings from AstraZeneca. JKQ reports receiving funding from Evidera for providing advice throughout the current study, research grants from Medical Research Council (MRC), Health Data Research UK (HDR UK), GSK, Boehringer Ingelheim, Asthma + Lung UK and AstraZeneca to her research institution, and consulting fee from GSK, Evidera, AstraZeneca, Insmed., (© 2023 The Authors.)