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This article discusses some measures to stop cyber-bullying without violating free speech rights of students in the U.S. It reflects on the decision of the Supreme Court in the free speech case Tinker v. Des Moines Independent Community School District. It also explores the interpretations of the Tinker standard of a substantial disruption by several Federal Circuit Courts of Appeals which suggest that it could also be applied to cyber-bullying. In addition, the article notes the vulnerability of schools to students' First Amendment claims if they attempt to discipline against cyber-bullying.

Objectives: Sexual- and gender-diverse youth face unique stressors that negatively impact their health. The objective of this study was to use National Fatality Review-Case Reporting System data to epidemiologically describe fatalities among identified sexual- and gender-diverse youth to inform future prevention efforts., Methods: We used 2015 to 2020 data from the National Fatality Review-Case Reporting System to identify deaths among sexual- and gender-diverse youth and compare their characteristics to a matched sample of youth from these same data who were not known to be sexual- and gender-diverse. Demographic, injury, death, history, and life stressor characteristics were analyzed using descriptive statistics., Results: During the study period, 176 fatalities were identified among sexual- and gender-diverse youth. Decedents' mean age was 15.3 years. A greater proportion of deaths was attributed to suicide among sexual- and gender-diverse youth (81%) compared with nonsexual- and gender-diverse youth (54%). Receiving prior (69%) and/or current (49%) mental health services was more common among sexual- and gender-diverse youth, compared with nonsexual- and gender-diverse youth (50% and 31%, respectively). Sexual- and gender-diverse youth were significantly more likely to experience problems in school or be victims of bullying, compared with nonsexual- and gender-diverse youth (63% versus 47% and 28% versus 15%, respectively)., Conclusions: Suicide was the most common manner of death for sexual- and gender-diverse youth, despite many decedents receiving current or prior mental health services. These findings indicate the need to improve and diversify interventions to prevent these deaths., Competing Interests: CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: There has been little research on child maltreatment-related fatalities among children with disabilities. Despite being a minority of children in the United States, children with disabilities experience higher rates of victimization., Objective: To characterize fatalities due to child maltreatment among children with disabilities in the United States., Methods: Data from the National Violent Death Reporting System from 2010 to 2019 were analyzed to describe child maltreatment-related deaths among children with disabilities aged birth to 17 years., Results: There were 106 fatalities meeting the study criteria. The average age of the victims was 5.9 years old and 74.6 % were male. The most frequent suspected perpetrators of maltreatment-related fatalities were biological mothers (35.2 %), and most perpetrators were White (55.7 %). Analyses showed a statistically significant relationship between fatalities caused by neglect and diagnoses of attention deficit hyperactivity disorder, autism spectrum disorder, cerebral palsy, and/or traumatic brain injury. Overall, physical abuse and/or neglect resulting in a fatality among children with disabilities were significantly correlated with the relationship of the perpetrator to the victim., Conclusions: Children with disabilities who died as a result of abuse were more likely to have autism spectrum disorder, a developmental disability, or other physical impairment, with physical abuse being the most prevalent type of abuse that resulted in death. To decrease the likelihood of abuse of disabled children, healthcare practitioners and caseworkers should work together to create strategies to help caregivers cope with the financial, mental, and physical stress that comes with raising children with disabilities., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Erwinia amylovora causes a major disease of pome fruit trees worldwide, and is regulated as a quarantine organism in many countries. While some diversity of isolates has been observed, molecular epidemiology of this bacterium is hindered by a lack of simple molecular typing techniques with sufficiently high resolution. We report a molecular typing system of E. amylovora based on variable number of tandem repeats (VNTR) analysis. Repeats in the E. amylovora genome were identified with comparative genomic tools, and VNTR markers were developed and validated. A Multiple-Locus VNTR Analysis (MLVA) was applied to E. amylovora isolates from bacterial collections representing global and regional distribution of the pathogen. Based on six repeats, MLVA allowed the distinction of 227 haplotypes among a collection of 833 isolates of worldwide origin. Three geographically separated groups were recognized among global isolates using Bayesian clustering methods. Analysis of regional outbreaks confirmed presence of diverse haplotypes but also high representation of certain haplotypes during outbreaks. MLVA analysis is a practical method for epidemiological studies of E. amylovora, identifying previously unresolved population structure within outbreaks. Knowledge of such structure can increase our understanding on how plant diseases emerge and spread over a given geographical region., (© 2013 Society for Applied Microbiology and John Wiley & Sons Ltd.)

We analyzed clinical factors and graft survival associated with complement-dependent microcytotoxicity (CDC) crossmatch (XM) positive (+) kidney transplants in 1995 to 2009 United Network of Sharing (UNOS) registry data. CDCXM negative (-) transplants were selected from centers and years in which at least one CDCXM+ transplant was performed at a given center in a given year. CDCXM+ and CDCXM- results were compared with bivariate and multivariate survival analysis. Our observations are as follows: (1) The risk of graft loss with CDCXM+ vs. CDCXM- results was markedly lower than the risk observed historically, e.g., living donor (LD)-CDCXM+ absolute all-cause graft survival reductions were 0.7% at 24 hours (P=0.007), 2.9% at one year (P <0.0001), 3.7% at five years (P<0.0001); deceased donor (DD)-CDCXM+ absolute graft survival reductions were 0.7% at 24 hours (P=0.02), 3.5% at one year (P <0.0001), 2.7% at five years (P=0.0009). On covariate adjustment, the only significant association of CDCXM+ vs. CDCXM- results was with one-year graft loss risk: LD aHR 1.44 (95% CI 1.05-1.96), DD aHR 1.33 (CI 1.10-1.61). (2) CDCXM+ transplantation was more commonly performed among groups disadvantaged with respect to transplant access, including sensitized, previously transplanted women and black recipients. (3) In CDCXM+ recipients, there was a high percentage of flow cytometry (FC) XM- and autoXM+ results. After removing these groups, outcomes with CDCXM+ results were relatively good. (4) CDCXM+/FCXM+ vs. CDCXM-/FCXM- graft loss risk was observed only in LD recipients transplanted at centers performing fewer than 10 such transplants during the study period: 11.0% reduction (P<0.0001) and aHR of 2.86 (CI 1.18-6.94) at one year; 14.7% reduction (P<0.0001) and aHR of 1.77 (CI 0.88-3.58) at five years. Although using CDCXM+ as a contraindication to transplantation has been associated with virtual elimination of hyperacute rejection, the negative effect of a CDCXM+ in contemporary practice is relatively small, questioning the value of the CDCXM as a standalone test.

The clustered regularly interspaced short palindromic repeat (CRISPR)/Cas system confers acquired heritable immunity against mobile nucleic acid elements in prokaryotes, limiting phage infection and horizontal gene transfer of plasmids. In CRISPR arrays, characteristic repeats are interspersed with similarly sized nonrepetitive spacers derived from transmissible genetic elements and acquired when the cell is challenged with foreign DNA. New spacers are added sequentially and the number and type of CRISPR units can differ among strains, providing a record of phage/plasmid exposure within a species and giving a valuable typing tool. The aim of this work was to investigate CRISPR diversity in the highly homogeneous species Erwinia amylovora, the causal agent of fire blight. A total of 18 CRISPR genotypes were defined within a collection of 37 cosmopolitan strains. Strains from Spiraeoideae plants clustered in three major groups: groups II and III were composed exclusively of bacteria originating from the United States, whereas group I generally contained strains of more recent dissemination obtained in Europe, New Zealand, and the Middle East. Strains from Rosoideae and Indian hawthorn (Rhaphiolepis indica) clustered separately and displayed a higher intrinsic diversity than that of isolates from Spiraeoideae plants. Reciprocal exclusion was generally observed between plasmid content and cognate spacer sequences, supporting the role of the CRISPR/Cas system in protecting against foreign DNA elements. However, in several group III strains, retention of plasmid pEU30 is inconsistent with a functional CRISPR/Cas system.

Patients with the seat belt sign (SBS) from motor vehicle crashes (MVCs) are prone to specific regional injury patterns. Investigators at a Level 1 trauma center analyzed the incidence, clinical implications, and spectrum of regional injuries in patients injured in MVC over 2 years. SBS was seen in 11.3 per cent of patients injured in MVCs and 20.5 per cent of patients with known restraint use. Restrained patients were less severely injured with lower injury severity scores (7.62 vs 11.33) and mortality (1.1 vs 5.7%). Patients with SBS had lower mortality rates than patients without SBS (1.4 vs 3.7%). Thoraco-abdominal injuries were present in 47 per cent (34 of 72) of patients with SBS. Compared with patients without SBS, patients had a higher incidence of hollow viscous injuries (HVI) and solid organ trauma (8 and 17% vs 1 and 3%, P < 0.05); splenic trauma was 24-fold higher (9.7 vs 0.4%), liver injuries 3.1-fold higher (6 vs 3%), and rib fractures 2.4-fold higher (P < 0.05). Children had 2.8-fold higher rates of HVI (18 vs 9%, P < 0.05). SBS is associated with underlying regional injuries in nearly half of patients with a higher prevalence of HVI and solid organ trauma.

Defining how preprinted physician orders are developed within a hospital has the potential to positively affect patients' care, services, safety, and outcomes. When they are well designed, preprinted physician orders improve interdisciplinary integration in care and promote accurate communication. Designing good preprinted orders is both an art and a science that can benefit all hospitalized patients and all disciplines within healthcare.