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Objectives: Bupropion toxicity can lead to adverse cardiovascular events (ACVE), but delayed onset of toxicity makes risk stratification difficult. This study aimed to validate previously defined predictors of ACVE and identify novel predictors among patients presenting to the emergency department (ED) after bupropion overdose. Methods: This secondary analysis of prospective data from the Toxicology Investigators Consortium Core Registry analyzed adult acute or acute‐on‐chronic bupropion exposures from 2015 to 2018. The primary outcome was ACVE (any of the following: myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest). Potential predictors of ACVE included previously derived predictors in the overall drug overdose population (prior cardiac disease, initial serum bicarbonate < 20 mEq/L, and initial QTc ≥ 500 ms), exposure circumstances, and initial serum lactate value. Candidate predictors were evaluated using univariate analysis and multivariable regression modeling. Receiver operator characteristic curves were used to derive optimal cutoff points for novel predictors, and prognostic test characteristics were calculated. Results: Of 355 patients analyzed, ACVE occurred in 34 (9.6%) patients. Initial serum bicarbonate < 20 mEq/L (adjusted odds ratio [aOR] 4.42, 95% confidence interval [CI] 1.94–10.0) and initial QTc ≥ 500 ms (aOR 2.52, 95% CI 1.01–6.09) independently predicted ACVE. Exposure circumstances did not predict ACVE. Initial serum lactate > 5.2 mmol/L independently predicted ACVE (aOR 12.2, 95% CI 2.50–75.2) and was 90.7% specific with 80.3% negative predictive value. Conclusions: Metabolic acidosis and QTc prolongation were validated as predictors of ACVE in ED patients with bupropion overdose. Serum lactate elevation was strongly predictive of ACVE in this study and warrants further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Tricyclic antidepressants often cause drug-induced QRS complex prolongation in overdose but are now less commonly prescribed. We sought to determine, among a contemporary cohort of patients, the pharmaceuticals independently associated with QRS complex prolongation in acute overdose. Methods: We performed secondary analysis of data from the Toxicology Investigators Consortium (ToxIC) Core Registry. We included adult patients presenting from January 2016 through March 2023 with acute or acute-on-chronic pharmaceutical exposures. The primary outcome was QRS complex prolongation >0.12 s. Secondary outcomes included cardiac arrest, death, ventricular dysrhythmia, intensive care unit admission, initiation of vasopressors, and treatment with sodium bicarbonate. We used a multivariable logistic regression model with QRS complex prolongation as the outcome and individual pharmaceuticals of interest as independent variables. We assessed yearly trends of the contribution of relevant pharmaceuticals to QRS complex prolongation since 2016. Results: Of 11,945 patients in the total cohort (median age 37 years, 6,652 [55.7%] female), 366 (3.1%) developed QRS complex prolongation. Of 9,417 patients included in the model, 290 (3.1%) developed QRS complex prolongation. Amitriptyline, nortriptyline, doxepin, imipramine, noxiptiline, bupropion, flecainide, carvedilol, propranolol, diphenhydramine, and lamotrigine poisonings were independent predictors of QRS complex prolongation. Flecainide poisoning conferred the greatest odds of QRS complex prolongation (OR 574.1; 95% CI: 88.3–12,747). The contribution of tricyclic antidepressants to QRS complex prolongation decreased from 38.8% to 17.6% of all patients with QRS complex prolongation from 2016 to 2022. In 2022, the proportion of QRS complex prolongation from diphenhydramine (20.6%) surpassed that of tricyclic antidepressants. Discussion: This study provides insights into contemporary pharmaceutical poisoning associated with QRS complex prolongation. Tricyclic antidepressants remain clinically relevant exposures but are no longer the most common cause of drug-induced QRS complex prolongation. Conclusions: Bupropion, diphenhydramine, and antidysrhythmics are increasingly common causes of QRS complex prolongation, each associated with numerous severe outcomes in poisoning. Greater safety measures to protect patients from cardiovascular toxicity from these pharmaceuticals are warranted. [ABSTRACT FROM AUTHOR]

Social studies and history teachers should be free to expose students to controversial ideas and to teach critical thinking skills. But are they free? Do they have the constitutional right--call it academic freedom--to teach what they want and to discuss controversial issues in the classroom? The short answer is "no." In this article, the author warns that teachers should not presume that their legal rights are protected by the First Amendment rather than by legally enforceable teacher contracts. He suggests some actions teachers can take to insure that their classroom remains a marketplace of ideas. (Contains 35 notes.)

Collects the "suggestions" of judges from the leading student press cases, creating a list of dos and don'ts that may aid school authorities when drafting rules governing student expression. (RL)

Consumers navigating the United States' modern electronic exchange economy are uniquely vulnerable to injury from data breaches. Hackers run data breach operations on an industrial scale, with a worldwide underground economy supporting the processing and exploitation of stolen information. Economic damages from data breaches exceed millions of dollars annually in direct and indirect costs for consumers and businesses alike. While existing common law, statutory law, and regulatory law offer consumers affected by a data breach some degree of protection, that protection is largely inadequate in the face of the threat posed by consumer data breaches. This Comment argues that consumers can be better protected from the harm caused by data breaches by importing principles from European data privacy law into American law. [ABSTRACT FROM AUTHOR]

Considers the implications of a court decision on administrative censorship of advertising in school newspapers. (RL)