Artigos de revistas sobre o tema "Surveillance detection – Great Britain – History"

SUMMARYThe monitoring and surveillance of animal diseases is becoming increasingly important to policy-makers in Great Britain particularly given recent incursions of avian influenza and the emergence of bovine spongiform encephalopathy. To meet this surveillance objective, data from British livestock is collected and analysed retrospectively on an ongoing basis. However, these data can also be analysed prospectively within an early detection system which raises alerts to significant increases in disease reporting soon after they occur in the field. The feasibility of such an approach has been examined previously for Salmonella. This paper applied the approach to a further subset of surveillance data to alert those monitoring disease to increases in potentially new and emerging diseases. Thus far, the analysis, conducted on a quarterly basis, has proved a useful additional tool in enhanced surveillance by raising alerts to significant increases in several syndromes in both sheep and cattle.

Intelligence and law enforcement agencies in western democracies are turning increasingly to electronic surveillance tools in their efforts to identify and combat new terrorist threats. But this does not mean that they are equally equipped to undertake these measures. As the author shows by comparing surveillance activities in three countries—Great Britain, the United States, and Germany—the Federal Republic's more restrictive legal norms and institutions provide its government with much less freedom of maneuver than its allies.

SUMMARYDisease surveillance can be made more effective by either improving disease detection, providing cost savings, or doing both. Currently, cattle herds in low-risk areas (LRAs) for bovine tuberculosis (bTB) in England are tested once every 4 years. In Scotland, the default herd testing frequency is also 4 years, but a risk-based system exempts some herds from testing altogether. To extend this approach to other areas, a bespoke understanding of at-risk herds and how risk-based surveillance can affect bTB detection is required. Here, we use a generalized linear mixed model to inform a Bayesian probabilistic model of freedom from infection and explore risk-based surveillance strategies in LRAs and Scotland. Our analyses show that in both areas the primary herd-level risk factors for bTB infection are the size of the herd and purchasing cattle from high-risk areas of Great Britain and/or Ireland. A risk-based approach can improve the current surveillance system by both increasing detection (9% and 7% fewer latent infections), and reducing testing burden (6% and 26% fewer animal tests) in LRAs and Scotland, respectively. Testing at-risk herds more frequently can also improve the level of detection by identifying more infected cases and reducing the hidden burden of the disease, and reduce surveillance effort by exempting low-risk herds from testing.

AbstractThe New Zealand Wars of the 1860s have traditionally been associated with the popularity of antagonistic racial discourses and the growing influence of scientific racism. Building upon recent research into the resonance of humanitarian racial discourses in this period, this article reconsiders the experience of Governor Thomas Gore Browne during the Taranaki War, 1860–61. The Taranaki War was a global news event that precipitated fierce debates within both New Zealand and Great Britain over the war's origins and the rights of indigenous Maori. This article reveals how both Browne and his wartime critics defined themselves as the true defenders of Maori rights. This general usage of humanitarian racial discourses was encouraged by perceptions of metropolitan surveillance, New Zealand's prominence within networks of imperial communication, and an onus to administrate Maori with justice.

ObjectiveTo evaluate the impact of British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE) 2019 polypectomy surveillance guidelines within a national faecal immunochemical test-based bowel cancer screening (BS) cohort on surveillance activity and detection of pathology by retrospective virtual application.DesignA retrospective review of BS colonoscopies performed in 2015–2016 with 5 years prospective follow-up in single institution. Index colonoscopies were selected. Incomplete colonoscopies were excluded. Histology of all resected polyps was reviewed. Surveillance intervals were calculated according to BSG/ACPGBI/PHE 2019 guidelines and compared with pre-existing ‘European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis’ (EUQA 2013). Total number of colonoscopies deferred by virtual implementation of BSG/ACPGBI/PHE 2019 guidelines were calculated. Pathology identified on procedures that would have been deferred was reviewed.ResultsTotal number of index BS colonoscopies performed in 2015–2016 inclusive was 890. 115 were excluded (22 no caecal intubation, 51 inadequate bowel preparation, 56 incomplete polyp clearance). N=509 colonoscopies were scheduled within a 5-year interval following index colonoscopy surveillance rounds based on EUQA guidelines. Overall, volume of surveillance was significantly reduced with retrospective application of BSG/ACPGBI/PHE 2019 guidelines (n=221, p<0.0001). No cancers were detected within the ‘potentially deferred’ procedures who attended for follow-up (n=330) with high-risk findings found in<10% (n=30) of colonoscopies within the BSG/ACPGBI/PHE cohort.ConclusionBSG/ACPGBI/PHE 2019 guidelines safely reduce the burden of colonoscopy demand with acceptable pathology findings on deferred colonoscopies.

Reverse zoonotic transmission events of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been described since the start of the pandemic, and the World Organisation for Animal Health (WOAH) designated the detection of SARS-CoV-2 in animals a reportable disease. Eighteen domestic and zoo animals in Great Britain and Jersey were tested by APHA for SARS-CoV-2 during 2020–2023. One domestic cat (Felis catus), three domestic dogs (Canis lupus familiaris), and three Amur tigers (Panthera tigris altaica) from a zoo were confirmed positive during 2020–2021 and reported to the WOAH. All seven positive animals were linked with known SARS-CoV-2 positive human contacts. Characterisation of the SARS-CoV-2 variants by genome sequencing indicated that the cat was infected with an early SARS-CoV-2 lineage. The three dogs and three tigers were infected with the SARS-CoV-2 Delta variant of concern (B.1.617.2). The role of non-human species in the onward transmission and emergence of new variants of SARS-CoV-2 remain poorly defined. Continued surveillance of SARS-CoV-2 in relevant domestic and captive animal species with high levels of human contact is important to monitor transmission at the human−animal interface and to assess their role as potential animal reservoirs.

Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual’s lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.

AbstractThis study is part of a larger project on theLandscapes of the Eastern Question, contextualizing the architecture of diplomacy in İstanbul as a symbolic and material refraction of changing power balances and representational strategies. In Beyoğlu, where most of the main diplomatic residences were located, the embassies were originally Ottoman woodenkonakstructures, but, in time, the increasing influence of Russia, Great Britain and France fostered their monumentalization and the adoption of European academic classicism. By contrast, the summer embassies on the European shore of the Bosphorus remained largely local in terms of technology, image, materials, and spatial layout until the end of the Ottoman Empire. The paper argues that, for many diplomats, a stately winter residence representing national identity, along with a summer house in the spirit of the local traditions, would be used as a communicative and performative resource in the drama of European-Ottoman relations. It also evaluates foreign settlement on the northern shore of the Bosphorus as conforming to a strategy of surveillance and control in keeping with the strategic relevance and contested status of the straits.

In recent years, the importance of improving physical protection in nuclear facilities has been observed, mainly due to the increasing progress of the Brazilian nuclear program. Physical protection requires great attention and strategies that must be designed, tested and improved in order to maintain the physical integrity of the facilities and population. These strategies should be tested in exercises to see if the physical protection plan - PPP is in accordance with the actual conditions of the facility, such as: visibility of the borders and terrain, number and equipment of the team in charge of defense (security guards), detection equipment and access times of central security point agents to the places where suspicious activities have been detected. In this sense, this article aimed to develop a tool that allow the visualization and planning of action strategies in a virtual environment, aiming to improve security. A virtual model of the Instituto de Engenharia Nuclear (IEN) was created, with close representations of reality and the virtual characters can transit and interact in real time. Various situations that affect the visibility and detection of opponents, such as natural and artificial lighting, climatic phenomena, shadows and others can be simulated with a high degree of realism. In addition, the tool has a surveillance system through virtual cameras, enabling monitoring of the environment. Thus, this system will allow to simulate approach strategies, allowing an evaluation of the procedures performed, as well as assist in physical protection training in radioactive and nuclear facilities.

ABSTRACTTuberculosis (TB) in South American camelids (SAC) is caused byMycobacterium bovisorMycobacterium microti. Two serological methods, rapid testing (RT) and the dual-path platform (DPP) assay, were evaluated using naturally infected SAC. The study population included 156 alpacas and 175 llamas in Great Britain, Switzerland, and the United States. TB due toM. bovis(n= 44) orM. microti(n= 8) in 35 alpacas and 17 llamas was diagnosed by gross pathology examination and culture. Control animals were from herds with no TB history. The RT and the DPP assay showed sensitivities of 71% and 74%, respectively, for alpacas, while the sensitivity for llamas was 77% for both assays. The specificity of the DPP assay (98%) was higher than that of RT (94%) for llamas; the specificities of the two assays were identical (98%) for alpacas. When the two antibody tests were combined, the parallel-testing interpretation (applied when either assay produced a positive result) enhanced the sensitivities of antibody detection to 89% for alpacas and 88% for llamas but at the cost of lower specificities (97% and 93%, respectively), whereas the serial-testing interpretation (applied when both assays produced a positive result) maximized the specificity to 100% for both SAC species, although the sensitivities were 57% for alpacas and 65% for llamas. Over 95% of the animals with evidence of TB failed to produce skin test reactions, thus confirming concerns about the validity of this method for testing SAC. The findings suggest that serological assays may offer a more accurate and practical alternative for antemortem detection of camelid TB.

Breast cancer is the most frequent cancer among women worldwide. Therapeutic strategies to prevent or treat metastatic disease are still inadequate although great progress has been made in treating early‐stage breast cancer. Cancer stem-like cells (CSCs) that are endowed with high plasticity and self-renewal properties have been shown to play a key role in breast cancer development, progression, and metastasis. A subpopulation of CSCs that combines tumor-initiating capacity and a dormant/quiescent/slow cycling status is present throughout the clinical history of breast cancer patients. Dormant/quiescent/slow cycling CSCs are a key component of tumor heterogeneity and they are responsible for chemoresistance, tumor migration, and metastatic dormancy, defined as the ability of CSCs to survive in target organs and generate metastasis up to two decades after diagnosis. Understanding the strategies that are used by CSCs to resist conventional and targeted therapies, to interact with their niche, to escape immune surveillance, and finally to awaken from dormancy is of key importance to prevent and treat metastatic cancer. This review summarizes the current understanding of mechanisms involved in CSCs chemoresistance, dissemination, and metastasis in breast cancer, with a particular focus on dormant cells. Finally, we discuss how advancements in the detection, molecular understanding, and targeting of dormant CSCs will likely open new therapeutic avenues for breast cancer treatment.

There is a growing interest to document and better understand patterns and processes involved in non-native bee introductions and subsequent colonisation of new areas worldwide. We studied the spread of the East Asian bee Megachile sculpturalis in Serbia and south-eastern Europe; the bee was earlier established in the USA (since 1994) and western Europe (since 2008). Its establishment in Serbia remained dubious throughout most of 2017–2019, following its first detection. We hereby report on its establishment and spreading, which were corroborated in 2019 under specific circumstances. Owing to an exceptionally poor blooming of Styphnolobium japonicum in 2019, we recorded a high activity density of M. sculpturalis concentrated on a scarce key food resource. We present a novel quantitative approach for an improved early detection of M. sculpturalis, based on the interplay between the bee local occurrence pattern and dynamics of key food-plant(s) availability. This approach seems particularly effective during the early-phase colonisation, at initially low population density of introduced bees. We address the importance of integration of the genuine plant usage patterns with context-specific bee assessment options in establishing effective monitoring. The improved understanding of M. sculpturalis local dynamics triggered the questions about possible origin(s) and modes of its dispersal east of the Alps. To explore the possible scenarios of M. sculpturalis introduction(s), we extended the study to a wider spatio-temporal context – the region of SE Europe (2015–2019). The two complementary study approaches (at local and regional scale) provided more comprehensive evidence of bee dispersal history and the detection patterns in varied recording contexts. Based on this two-scale approach, we suggest that a diffusive mode of M. sculpturalis introduction into Serbia now seems to be a more plausible scenario (than a long-distance jump). We argue that the integration of outcomes from the contrasting approaches (a systematic surveillance, based on plant resources and a broad-scale opportunistic recording) could be of great methodological relevance for the development of future monitoring protocols.

1582 Background: Despite the use of clinical eligibility criteria and mutation predictive models, a great proportion of families are negative for germline mutations in BRCA1/2 genes. Traditionally, risk assessment of inconclusive results included the recommendation of high-risk surveillance protocol, the update of incident cancer cases in the family and the consideration of additional testing to rule out the possibility of phenocopy. More recently, next generation sequencing multigene panels have become a standard practice in cancer genetics clinics worldwide. We addressed the value of multigene panel retesting of BRCA1/2 negative HBOC families in our institution. Methods: After genetic counseling session and informed consent, a total of 137 individuals (119 probands and 18 extra cancer-affected relatives) from distinct BRCA1/2 negative families were retested using a panel containing 11 breast and ovarian cancer susceptibility genes ( BRCA1/2, PALB2, ATM, CHEK2, PTEN, TP53, STK11, BRIP1, RAD51C, RAD51D). Results: According to the BOADICEA model, the remaining probability of mutation in BRCA1/2 or PALB2 genes in our cohort was 5.5% (0.1-61). The reasons for considering retesting were the addition of any incident cancer diagnosis in 33 cases (24%), a prior study with a low sensitivity screening technique (dHPLC) in 6 families (5%) and the expansion of the study to other putative breast and ovarian susceptibility genes in 98 families (71%). Overall, 3 pathogenic (2 BRCA2, 1 CHEK2) and 8 likely pathogenic variants (1 BRCA2, 4 CHEK2 and 3 ATM) were found. The prevalence was 8%. The detection rate among 19 families with a > 10% remaining probability of mutation in BRCA1/2 and PALB2 genes was 26%. The 3 clinically significant variants in BRCA2 were detected in 2 families and 1 updated cancer family history (BOADICEA remaining probability of 59, 61 and 12%, respectively). Cascade testing was subsequently done in 15 relatives resulting 8 in mutation carriers and 9 true negatives. Conclusions: Our results support the value of updating cancer incident cases and considering expanded panels in selected families.

INTRODUCTION. Over the past few months, the topic of multisystem inflammatory syndrome in children has been evolving at an extraordinary pace, as evidenced by the increasing number of publications on this subject. The disease does not begin to develop immediately, not at the moment the virus enters the body, but after some time, and that is 14-21 days later. This is evidenced by the presence of IgG antibodies and the absence of RNA virus in the biological loci. Representatives of the Pediatric Intensive Care Society of Great Britain felt it necessary to circulate the “PICS Statement”, which contained data on the increasing number of children with a new multisystem inflammatory disease associated with positive tests for SARS-CoV-2. However, it should be noted that this association was confirmed in only some patients by appropriate tests performed in laboratory settings. The course of the disease was similar to a toxic shock syndrome and atypical Kawasaki disease, for which the characteristic symptoms are heart disease, abdominal pain and gastrointestinal symptoms. The patients showed abnormalities in blood parameters, changes in the number of blood corpuscules, the level of C-reactive protein (CRP), ferritin, troponin, brain natriuretic propeptide (NT-proBNP) was high. AIM. Using a case study to show the importance of a timely detection, treatment and follow-up of children with a new coronavirus infection. MATERIAL AND METHODS. The mother of a 3-month-old child (the subject of the study) applied to the follow-up office of the Republican Children’s Clinical Hospital in Ufa with a history of COVID-19 infection. The following were used to diagnose the current condition: copying of data from medical records, clinical examination with assessment of physical and psychomotor development, consultations of single-skilled specialists to make a diagnosis, laboratory and instrumental examinations. RESULTS AND DISCUSSION. The article presents an observation of a 1-year-old patient with COVID-19 infection complicated by multisystem inflammatory syndrome, including the Kawasaki syndrome. In this patient, against the background of the third hospitalization for COVID-19, a positive dynamics of the course of the disease was achieved with discharge to the outpatient stage of treatment and follow-up. CONCLUSION. Lesions of organs and organ systems caused by COVID-19 require an integrated approach to diagnosis and management of patients. Further accumulation of data on diagnosis and clinical course of the new coronavirus infection in children remains an urgent scientific and practical task.

The sense of being stared at, or scopaesthesia, is very common, and its existence is supported by experimental evidence. However, it contravenes the standard scientific assumption, dating back to Kepler’s discovery of retinal images in 1604, that vision involves only the inward movement of light – intromission – but not the outward movement of images or attention – extramission. From this point of view, scopaesthesia is impossible. Yet, paradoxically, the conventional explanation of virtual images in mirrors is still based on Euclid’s (c. 300 BC) extramission theory, and most people implicitly believe in visual extramission, which could help provide a basis for scopaesthesia. If scopaesthesia depends only on the detection of another’s attention, it could conceivably be a scalar phenomenon, with a magnitude but not direction, analogous to telephone telepathy, in which people feel who is calling but do not know where they are. In this case, scopaesthesia would tell us little about the nature of vision. But if scopaesthesia is normally directional, enabling those stared at to detect the direction from which the look is coming, it would be more like a vector phenomenon, with both magnitude and direction and would provide evidence for visual extramission. Experimental tests of scopaesthesia have so far been devoted to establishing its existence and have not looked at its directionality. Here, we examine the natural history of the phenomenon based on a collection of 960 case histories collected over 25 years involving both humans and non-human animals. This collection includes more than 80 interviews with surveillance officers, detectives, martial arts teachers, celebrity photographers, wildlife photographers, and hunters who have extensive experience of watching people or non-human animals. In 466 (49%) of the cases, directional effects were explicit, in that the person or animal looked at responded by turning and looking directly back at the looker rather than searching at random for the source of attention. In 186 (19%) of the cases directional effects were implicit. In most of the other cases, directional effects were not mentioned, usually because they were general statements lacking detail. In online surveys, including a survey of a group of skeptics, the great majority of respondents said they had experienced directional scopaesthesia. We conclude that directionality is a normal feature of scopaesthesia in real-life situations and suggest that this finding supports the idea that minds are extended beyond brains and that this extension involves some kind of visual extramission. We quote from more than 40 case histories and, in the online Supplementary Material make the entire collection of 960 cases available to those who would like to look at the data for themselves.

The purpose of this study was to assess the presence of threats of a pandemic based on the analysis of the prevalence of monkeypox globally in modern conditions. Materials and methods. The article is devoted to the analysis of cases of monkeypox in the world in 2022 and the evaluation of its pandemic potential in modern conditions. Official data of the World Health Organization, Public Health Centre of Ukraine, European Centre for Disease Control and Prevention, Centres for Disease Control and Prevention, USA were analyzed. Results and discussion. Taking into account the increasing scale of the monkeypox outbreak in the world, on July 23, 2022, the General Director of the World Health Organization declared the monkeypox outbreak a public health emergency of international importance. During this period, more than 16 thousand cases of monkeypox were registered in 75 countries of the world. As of October 2, 2022, 68,900 laboratory-confirmed cases of monkeypox and 25 deaths have been reported to the World Health Organization from 106 countries worldwide. Ten countries reporting the highest cumulative number of cases in the world are: United States of America (37.3%), Brazil (11.4%), Spain (10.4%), France (5.8%), Great Britain (5.3%), Germany (5.3%), Peru (3.8%), Colombia (3%), Mexico (2.4%) and Canada (2%). The smallest number was recorded in: Turkey and Indonesia (0.001% each); Moldova, Greenland and Georgia (0.002% each); Monaco (0.004%); Ukraine, Japan and Cuba (0.005% each); China, Bulgaria, Lithuania, Latvia (0.007% each). In Ukraine, the first case of monkeypox was laboratory-confirmed in September 2022. As of October 27, 2022, 4 laboratory-confirmed cases of monkeypox by polymerase chain reaction testing were registered in Ukraine. Based on the analysis, the transmission of the monkeypox virus primarily occurs through person-to-person contact, often through sexual intercourse. Risk factors for monkeypox include being between the ages of 18 and 44, male gender, engaging in sexual contact with other men, participating in risky sexual behaviour, engaging in sexual contact without condom use, having a history of HIV infection or previous sexually transmitted infections (including syphilis). The following groups are considered at high risk: men who have sex with men, passengers in close proximity to an infected individual on airplanes, healthcare workers, close family members or friends, and anyone who has close contact with an infected person, regardless of gender or sexual orientation. There is a possibility of further spread of the monkeypox virus and the potential for the causative agent to evolve into a pathogen with greater epidemic potential than it currently possesses. People with monkeypox should avoid contact with animals during the entire period of isolation. In case of suspicion of disease in domestic animals, the veterinary service must be immediately notified. Conclusion. Currently, the pandemic potential of the virus is insignificant; monkeypox is less contagious compared to other infections that caused pandemics, it is transmitted only in conditions of close contact with a sick person, a contaminated object, or an infected animal. The cases are found in certain groups of behavioural risk. In order to better understand the variability of the epidemiology of monkeypox, the current and future trends in the development of the epidemic process of monkeypox, it is necessary to carry out constant surveillance.

Gaucher disease (GD), a rare autosomal recessive disorder, is characterized by the deficiency of the lysosomal enzyme β-glucocerebrosidase, leading to the accumulation of glucosylceramide in macrophages throughout the body. Accordingly, the primary disease features are hepatosplenomegaly, hypersplenism, anemia, thrombocytopenia, and bone involvement. There are three types of GD, with a combined estimated occurrence ranging from 0.45 to 25.0 per 100,000 live births. However, among individuals with Ashkenazi Jewish heritage, type 1 GD is considerably more prevalent, with an estimated occurrence of 1 in 850 live births. Considerable controversy exists regarding the co-occurrence and risk of other diseases in patients with GD compared to the general population, GD-related and GD-unrelated, respectively. While Parkinson disease and cholelithiasis are clear examples of GD-related co-morbidities, there is uncertainty regarding the association between GD and cancer, a topic that raises great concern for patients and their families. The aim of the current study was to evaluate the risk of cancer in patients pre- and post- diagnosis of GD compared to a group of matched controls in a population-based comprehensive clinical database. This study utilized electronic health records from the Maccabi Healthcare Service (MHS), Israel's second-largest health maintenance organization, to study cancer risk in 264 patients with GD compared to 3441 controls matched by sex, year of birth, and socioeconomic status (SES). Cancer diagnoses were extracted from the MHS cancer register, which captures all cancer types, updated until January 31, 2021. Additional data extracted included ICD-9 codes for family history of cancer, smoking, splenectomy, the use of Gaucher-specific medication, and MHS codes for colonoscopy, mammography, occult blood in stool, Papanicolaou (PAP) smear, prostate-specific antigen (PSA), and skin screen. We analyzed cancer occurrence before and after the index date for GD diagnosis (i.e., the first documentation of GD in the MHS database). For the controls, the index date used was the index date for the GD diagnosis of the matched patient. The study design received approval from the MHS Institutional Review Board. Patient consent was waived since aggregated, de-identified, and anonymized data were utilized Cancer was diagnosed in 18 individuals before the index date; 11 (4.2%) in GD compared to 7 (0.2%) in controls (p&lt; 0.001). The main types of cancers in patients with GD were non-melanoma skin and hematological cancers, with clustering of the diagnoses around the time of GD diagnosis. Cancer was diagnosed in 57 individuals (20 (7.9%) in GD and 37 (1.1%) in control) after the index data, with a median follow-up of almost 13 years (Table). Patients with GD had a significantly higher risk of developing cancer than controls (Figure). The age and sex-adjusted incidence of cancer (excluding non-melanoma skin cancer) was 4.1 (95% CI 1.9-6.4) per 1,000 patients-years in patients with GD compared to 0.65 (95% CI 0.4-0.9) per 1,000 patients-years in controls, with an incidence rate ratio of 6.4. The median (range) age at cancer diagnosis was 62 (36-79) and 46 (26.5-91) years in patients with GD and controls, respectively (p=0.02). Multiple primary tumors were reported in four patients with GD but none in controls. Patients with GD underwent more cancer screening tests, e.g., colonoscopy, prostate-specific antigen, and skin screening, compared to controls. No difference in the rate of family history of cancer or smoking between patients with GD and controls. In a multivariate analysis among patients with GD, including age, sex, SES, the use of Gaucher-specific medication, and splenectomy, age was the only risk factor for cancer. The primary significance of this matched case-control study is that it addresses the cohort/selection bias present in previous reports regarding the potentially heightened cancer risk among individuals with GD, where compression of rates was done with non-matched cohorts. We herein show that the increased occurrence of cancer in patients with GD can be attributed partly to a more rigorous surveillance approach and frequent screening. However, the higher rates of cancers without early detection measures, such as multiple myeloma, indicate that there is indeed an elevated risk of developing cancer in individuals with GD that is not related to an ascertainment bias.

Background Immunocompromised children are at increased risk for severe respiratory syncytial virus (RSV)-associated lower respiratory tract infections (LRTIs), which can lead to poor outcomes, including death. Nirsevimab, an extended half-life monoclonal antibody that targets the RSV prefusion F protein, is approved in Canada, the EU, Great Britain, and the US for the prevention of RSV lower respiratory tract disease in neonates and infants during their first RSV season. In Canada and the US, approval extends to the second season for children remaining at higher risk for severe RSV disease. Here, we present the full analysis of the MUSIC trial (NCT04484935), a 12-month, Phase 2, open-label, uncontrolled, single-dose study of nirsevimab, designed to evaluate the safety, pharmacokinetics (PK), and emergence of antidrug antibodies (ADA) in immunocompromised children ≤24 months of age. Methods Children aged ≤24 months with ≥1 immunocompromising condition received a single intramuscular injection of nirsevimab 50 mg (if weight &lt;5 kg) or 100 mg (if weight ≥5 kg) prior to their first RSV season or 200 mg if entering their second RSV season (Table 1). Safety, ADA, and PK were evaluated to Day 361 (final database lock April 18, 2023). Adverse events of special interest (AESIs) included immediate hypersensitivity (including anaphylaxis), immune complex disease, or thrombocytopenia. Results One hundred children (first RSV season n=46, second RSV season n=54) were enrolled from 8 countries (Table 1). Immunocompromising conditions included primary immunodeficiency (n=33), systemic high-dose corticosteroid therapy, (n=29), immunosuppressive chemotherapy, (n=20), history of organ or bone marrow transplantation (n=16), other immunosuppressive therapy (n=15), and human immunodeficiency virus infection (n=8; children may have had more than one condition). Six children experienced 8 treatment-related adverse events (AEs; pyrexia n=4, abdominal pain n=1, erythema n=1, rash n=2); all were Grade 1 severity , except 1 event of Grade 2 pyrexia, and occurred within 7 days of dosing. No treatment-related serious AEs or new onset chronic diseases were observed. Six AESIs were reported in 5 children; all were Grade 1 hypersensitivity events limited to cutaneous findings (food allergy n=2, contrast media allergy n=1, urticaria n=2, erythema n=1), with 1 considered treatment-related (erythema). Three deaths occurred (LRTI, septic shock, and suspected tumor hemorrhage); all were determined to be unrelated to treatment. Eleven children developed treatment-emergent ADAs (median titer 200.0; Day 31 n=1, Day 151 n=1, and Day 361 n=9); none experienced a treatment-related serious AE, AESI, or skin hypersensitivity reaction. Of the children who were ADA-positive on Day 361, 1 experienced a treatment-related AE (Grade 1 pyrexia within 60 minutes of dosing), and 1 experienced a Grade 1 rash on Day 104, determined to be unrelated to treatment. Children who were ADA-positive on Day 361 were more likely to have nirsevimab levels below the limit of detection versus ADA-negative children, suggesting an influence of ADA on PK between Days 151 and 361. Nirsevimab serum exposures at Day 151 were similar to levels demonstrated to be effective in preventing medically attended RSV LRTI in healthy children enrolled in the Phase 3 MELODY trial (Figure 1). Fourteen children demonstrated a rapid decline in serum concentrations through Day 151 compared with the rest of the children; a review of their medical histories revealed evidence for protein-losing conditions, including graft versus host disease, chronic liver disease, and nephrotic syndrome, in 9 of the 14 children. Although none met protocol-defined case criteria for medically attended RSV LRTI, 3 children had an RSV-positive LRTI (central or local test) requiring medical attendance (in an inpatient or outpatient setting; all after Day 151), of whom 1 was hospitalized. Conclusions In immunocompromised children aged ≤24 months, a single dose of nirsevimab was well tolerated and no safety concerns arose over 361 days. Levels of ADA were low, with minimal effects on PK and no apparent impact on safety outcomes. Nirsevimab serum exposure was consistent with previous studies in healthy children and supportive of efficacy in this population at risk of severe RSV disease. Some children with underlying protein-losing conditions had a rapid decline in nirsevimab serum concentrations.

These four cases illustrate different aspects of the impact of prenatal sonography on the practice of newborn medicine. The themes illustrated by these cases are summarized below. Diagnostic Sensitivity Prenatal sonographic diagnosis is not a precise science. The technical and cognitive limitations of this developing technology demand an appreciation of the distinction between identification and diagnosis. Although the sensitivity of the technology for detecting fetal abnormalities is quite good in many settings, the "total picture" is not always apparent in utero. This is not to deny the clinical benefit of identifying a fetus likely to require specialized postnatal care even if a precise diagnosis cannot be made, but to emphasize the difficulty of counseling a woman contemplating pregnancy termination when the underlying syndromic diagnosis for an affected fetus is not technically possible before birth. Furthermore, the sensitivity of fetal ultrasound examination appears to vary by site and type of obstetric service. The Helsinki study demonstrated a far greater ascertainment rate for fetal abnormalities in an academic practice dedicated to the provision of high-risk services when compared with a community setting,9 and the multisite RADIUS study demonstrated a low detection rate for fetal abnormalities.10 Case 1 demonstrates that while the sensitivity of sonography for a specific anatomic abnormality may be great, the comprehensive diagnosis can still be missed. In this case, the antenatal detection of a cardiac malformation triggered a postnatal echocardiogram within the first hour after birth and prompted prostaglandin infusion. Work-up and treatment of the cardiac disease would not have been the first priority had the likelihood of a lethal chromosomal abnormality been appreciated by the admitting team, who were significantly influenced by the antenatal diagnosis of structural heart disease. Case 2 demonstrates the confusion that can be generated when an anatomic sonographic finding becomes a diagnosis without full appreciation of important details. In this case, the subtle but important prognostic difference between a hypoplastic left ventricle and a single ventricle with left ventricular morphology made an enormous difference in the predicted outcome for the infant. In both cases 1 and 4, neonatal demise occurred but autopsy permission was denied. The absence of autopsy limits the opportunity to correlate prenatal and postnatal findings. The importance of autopsy consent should be emphasized to all involved in the perinatal care of fetuses and infants with anomalies. Postnatal Interpretation of Prenatal Findings The interpretation of what appear to be fetal abnormalities is often not an entirely straightforward process. The technical capabilities of fetal sonography have resulted in the discovery of a new natural history for a number of conditions that may be variants of normal fetal development, or are of minor clinical significance in childhood. Examples include hydronephrosis and choroid plexus cysts. Pediatricians cians are left to sort out which of these conditions require postnatal confirmation, which require follow-up surveillance, and which can be ignored. The antenatal detection of conditions that are normally detected later in infancy or childhood or remain undetected due to lack of clinical symptoms can also create serious therapeutic dilemmas. For example, adrenal masses consistent with neuroblastoma can now be detected prenatally. In one study, 11 patients with prenatally diagnosed neuroblastoma had surgical resection of the tumor. In 7 of these cases, histologic studies were consistent with neuroblastoma in situ.11 The natural history of neuroblastoma in situ includes spontaneous regression. Thus, one might question whether surgical resection is truly warranted. Yet, how many parents, knowing that their fetus has an adrenal tumor, are comfortable with conservative care when surgical removal is an option at birth? Case 3 demonstrates that prenatal diagnosis can be a double-edged sword, in that infants who are clinically well at birth can undergo extensive diagnostic testing in an attempt to elucidate prenatal findings that may no longer be relevant clinically. For example, one of the infants in Case 3 was labeled as "abnormal," and normal newborn management, including feeding, was delayed. The other twin underwent a cardiac work-up in the setting of a normal physical examination with no heart murmur. The adverse psychological effects of this "labeling" for parents and subsequent care of the child or children are unexplored. The implications of such labeling for insurance purposes have also not been addressed. Coordination of Multidisciplinary Services: Prenatal and Postnatal Care Optimal management of prenatal patients requires clinicians who are able to cross traditional subspecialty definitions to work as a multidisciplinary team.12-16 Unless specific mechanisms for the transfer of prenatal records are devised, perinatologists, neonatologists and pediatricians can be unaware of important information, as they were in Case 4. Even within the same institution, breaches of communication can occur both between and within specialties, particularly when prenatal records are not centralized and available to all clinicians taking care of both the mother and the infant. Although neonatologists are more likely to have opportunities for face to face communication with obstetricians and perinatologists, general pediatricians must often rely on thirdhand information transcribed into the perinatal summaries in newborn charts to ascertain prenatal findings that may have implications for postnatal management. Prenatal diagnosis does not conclude with delivery or pregnancy termination. All these cases demonstrate the importance of coordinating prenatal and postnatal care. The logistical difficulty of this endeavor should not be underestimated. In a regionalized system of prenatal care, whereby pregnant women with suspected fetal abnormalities are referred from community sites into tertiary centers for diagnosis and delivery, then sent back to their primary care sites for follow-up, the window of opportunity for postnatal counseling can be very short. Karyotype results obtained at delivery or at pregnancy termination are rarely available before the mother leaves the tertiary center. The postnatal management of all cases described was complicated by transfer of both mothers and infants. In Cases 1 and 4, the infants died and the mothers' care was transferred back to the referring health care sites before chromosome results were available. The twins in Case 3 were transferred to a Level II nursery before assumption of care by their pediatrician, and the infant in Case 2 was transferred from the tertiary pennatal center to an adjacent children's hospital before discharge to the care of his pediatrician. Given the expected patient movement between tertiary site and referral center, mechanisms need to be created for improved communication between health care providers. In some cases, patients may need to return to tertiary centers for appropriate postnatal counseling and work-up if these cannot be provided at the referring health care site. Clinical Outcomes Research: The New Natural History of Malformations and Genetic Diseases The clinical outcomes for children with specific prenatal diagnoses have not been gathered into a comprehensive shared resource suitable for use by obstetricians, pediatricians, genetic counselors, pediatric subspecialists, and pediatric surgeons. In large part, this has resulted because data on functional outcomes in children with many of these conditions have not been collected systematically. In some important areas, pediatric surgical and medical therapies have advanced so rapidly that prognostic information is quickly outdated. For example, the prognosis for surgical repair of patients with hypoplastic left heart syndrome has dramatically improved, yet this information may not be readily available to all obstetricians performing sonography and counseling parents. In other diseases our understanding of the relationship between genotype and phenotype (information that can be a major factor in decisions regarding pregnancy termination) changes so quickly that prenatal counseling demands a sophisticated and cautious appreciation of the dynamic state of this field. Further complexity is introduced by the fact that prenatal diagnosis may in fact alter expected outcomes by permitting pediatricians to initiate therapy before symptoms appear. Infants whose duct-dependent cardiac malformations have been detected prenatally can be treated before they present with cyanosis and acidosis. Infants with unsuspected disease might be expected to present later as outpatients with more severe symptoms. In a similar fashion, infants with significant hydronephrosis detected prenatally can be treated with prophylactic antibiotics and urinary decompression, if necessary, while their undetected counterparts will be diagnosed only when they present as outpatients with urinary tract infections and diminution of renal function.

Abstract Background Abattoir data are under-used for surveillance. Nationwide surveillance could benefit from using data on meat inspection findings, but several limitations need to be overcome. At the producer level, interpretation of meat inspection findings is a notable opportunity for surveillance with relevance to animal health and welfare. In this study, we propose that discovery and monitoring of relational patterns between condemnation conditions co-present in broiler batches at meat inspection can provide valuable information for surveillance of farmed animal health and welfare. Results Great Britain (GB)-based integrator meat inspection records for 14,045 broiler batches slaughtered in nine, four monthly intervals were assessed for the presence of surveillance indicators relevant to broiler health and welfare. K-means and correlation-based hierarchical clustering, and association rules analyses were performed to identify relational patterns in the data. Incidence of condemnation showed seasonal and temporal variation, which was detected by association rules analysis. Syndrome-related and non-specific relational patterns were detected in some months of meat inspection records. A potentially syndromic cluster was identified in May 2016 consisting of infection-related conditions: pericarditis, perihepatitis, peritonitis, and abnormal colour. Non-specific trends were identified in some months as an unusual combination of condemnation reasons in broiler batches. Conclusions We conclude that the detection of relational patterns in meat inspection records could provide producer-level surveillance indicators with relevance to broiler chicken health and welfare.

Abstract Introduction The guidelines for post-polypectomy and post-colorectal cancer resection have recently been changed after consensus by the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland and Public Health England. The aim of our study is to evaluate the rate of compliance with the recommended guidelines following polyp removal. Methods The data was collected retrospectively by reviewing the colonoscopy database in a single centre district general hospital for all patients who underwent polypectomy during April-September 2021. We excluded patients who had prior history of colorectal malignancy. The frequency of subsequent colonoscopic surveillance were evaluated against the BSG/ACPGBI guidelines based on the clinico-histological characteristics of the removed polyps. Results There were 104 colonoscopies with polypectomies performed during April-September 2021. The patient cohort had a mean age of 65 years (range, 35–85 years), with the most common diagnosis being tubular adenoma with low grade dysplasia (n=86, 82.7%). Adherence to BSG/ACPGBI colonoscopic post-polypectomy surveillance guidelines, based on the characteristics of the colonic polyps at colonoscopy and histology, was 86.5% (n=90). There were 5 (4.8%) patients who had their surveillance endoscopy requested earlier than recommended and 8 (7.7%) patients had a surveillance colonoscopy requested but did not require any surveillance. 1 patient had colonoscopy requested later than recommended. There was no significant difference in compliance between physicians (87.5%) and surgeons (86.1%). Conclusion There is a high compliance with post-polypectomy surveillance guidelines. However more efforts and staff training are required to improve compliance even further.

Scanning surveillance facilitates the monitoring of many endemic diseases of livestock in Great Britain, including sheep scab, an ectoparasitic disease of major welfare and economic burden. There is, however, a drive to improve the cost-effectiveness of animal health surveillance, for example by thoroughly exploiting existing data sources. By analysing the Veterinary Investigation Diagnosis Analysis (VIDA) database, this study aimed to enhance the use of existing scanning surveillance data for sheep scab to identify current trends, highlighting geographical “hotspots” for targeted disease control measures, and identifying a denominator to aid the interpretation of the diagnostic count data. Furthermore, this study collated and assessed the impact of past targeted disease control initiatives using a temporal aberration detection algorithm, the Farrington algorithm, to provide an evidence base towards developing cost-effective disease control strategies. A total of 2,401 positive skin scrapes were recorded from 2003 to 2018. A statistically significant decline in the number of positive skin scrapes diagnosed (p &lt; 0.001) occurred across the study period, and significant clustering was observed in Wales, with a maximum of 47 positive scrapes in Ceredigion in 2007. Scheduled ectoparasite tests was also identified as a potential denominator for the interpretation of positive scrapes by stakeholders. Across the study period, 11 national disease control initiatives occurred: four in Wales, three in England, and four in Scotland. The majority (n = 8) offered free diagnostic testing while the remainder involved knowledge transfer either combined with free testing or skills training and the introduction of the Sheep Scab (Scotland) Order 2010. The Farrington algorithm raised 20 alarms of which 11 occurred within a period of free testing in Wales and one following the introduction of the Sheep Scab (Scotland) Order 2010. In summary, our analysis of the VIDA database has greatly enhanced our knowledge of sheep scab in Great Britain, firstly by identifying areas for targeted action and secondly by offering a framework to measure the impact of future disease control initiatives. Importantly this framework could be applied to inform future strategies for the control of other endemic diseases.

Abstract The early detection of plant pests and diseases is vital to the success of any eradication or control programme, but the resources for surveillance are often limited. Plant health authorities can however make use of observations from individuals and stakeholder groups who are monitoring for signs of ill health. Volunteered data is most often discussed in relation to citizen science groups, however these groups are only part of a wider network of professional agents, land-users and owners who can all contribute to significantly increase surveillance efforts through “passive surveillance”. These ad-hoc reports represent chance observations by individuals who may not necessarily be looking for signs of pests and diseases when they are discovered. Passive surveillance contributes vital observations in support of national and international surveillance programs, detecting potentially unknown issues in the wider landscape, beyond points of entry and the plant trade. This review sets out to describe various forms of passive surveillance, identify analytical methods that can be applied to these “messy” unstructured data, and indicate how new programs can be established and maintained. Case studies discuss two tree health projects from Great Britain (TreeAlert and Observatree) to illustrate the challenges and successes of existing passive surveillance programmes. When analysing passive surveillance reports it is important to understand the observers’ probability to detect and report each plant health issue, which will vary depending on how distinctive the symptoms are and the experience of the observer. It is also vital to assess how representative the reports are and whether they occur more frequently in certain locations. Methods are increasingly available to predict species distributions from large datasets, but more work is needed to understand how these apply to rare events such as new introductions. One solution for general surveillance is to develop and maintain a network of tree health volunteers, but this requires a large investment in training, feedback and engagement to maintain motivation. There are already many working examples of passive surveillance programmes and the suite of options to interpret the resulting datasets is growing rapidly.

Information from crop disease surveillance programs and outbreak investigations provide real-world data about the drivers of epidemics. In many cases, however, only information on outbreaks is collected and data from surrounding healthy crops is omitted. Use of such data to develop models that can forecast risk/no-risk of disease is therefore problematic, as information relating to the no-risk status of healthy crops is missing. This study explored a novel application of anomaly detection techniques to derive models for forecasting risk of crop disease from data comprised of outbreaks only. This was done in two steps. In the training phase the algorithms were used to learn the envelope of weather conditions most associated with historic crop disease outbreaks. In the testing phase the algorithms were used for hindcasting of historic outbreak events. Five different anomaly-detection algorithms were compared according to their accuracy in forecasting outbreaks: robust covariance, one-class k-means, Gaussian mixture model, kernel density estimator, and one-class support vector machine. A case study of potato late blight survey data from across Great Britain was used for proof-of-concept. The results showed that Gaussian mixture model had the highest forecast accuracy at 97.0%, followed by one-class k-means at 96.9%. There was added value in combining the algorithms in an ensemble to provide a more accurate and robust forecasting tool that can be tailored to produce region-specific alerts. The techniques used here can easily be applied to outbreak data from other crop pathosystems to derive tools for agricultural decision support.

AbstractDisease surveillance in wildlife populations presents a logistical challenge, yet is critical in gaining a deeper understanding of the presence and impact of wildlife pathogens. Erinaceus coronavirus (EriCoV), a clade C Betacoronavirus, was first described in Western European hedgehogs (Erinaceus europaeus) in Germany. Here, our objective was to determine whether EriCoV is present, and if it is associated with disease, in Great Britain (GB). An EriCoV-specific BRYT-Green® real-time reverse transcription PCR assay was used to test 351 samples of faeces or distal large intestinal tract contents collected from casualty or dead hedgehogs from a wide area across GB. Viral RNA was detected in 10.8% (38) samples; however, the virus was not detected in any of the 61 samples tested from Scotland. The full genome sequence of the British EriCoV strain was determined using next generation sequencing; it shared 94% identity with a German EriCoV sequence. Multivariate statistical models using hedgehog case history data, faecal specimen descriptions and post-mortem examination findings found no significant associations indicative of disease associated with EriCoV in hedgehogs. These findings indicate that the Western European hedgehog is a reservoir host of EriCoV in the absence of apparent disease.

Abstract Background Patients with chronic pancreatitis experience malnutrition, osteoporosis, pancreatic exocrine insufficiency and have a 80% lifetime risk of diabetes (1). These are progressive consequences and require proactive surveillance for detection and optimisation of treatment. The NICE pancreatitis guidelines recommend long-term follow up for patients with chronic pancreatitis (1). European guidelines recommend regular assessment of bone density, biochemical assessment of micronutrient status and a comprehensive nutritional assessment (2). The aim of this survey was to assess compliance with the NICE guidelines by analysing current practice in patients with chronic pancreatitis after pancreaticoduodenectomy. Methods A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow-up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical, vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included. The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26). Results One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets. Eighty eight percent worked in tertiary centres. Lifelong follow up was only offered in tertiary centres (n = 12) and was only provided by surgeons or dietitians (p = 0.03). The duration of follow up did not vary by region (p = 0.463). Patients in the South of England were more likely to undergo a micronutrient screen (p = 0.027). Only 26% of all patients were offered a DEXA scan. Clinicians with more than 10-years’ experience were more likely to assess weight (p = 0.039), glucose and HbA1c (p = 0.035) and assess symptoms (p = 0.031). Conclusions This survey demonstrated a need to improve the provision of long-term follow up for patients with chronic pancreatitis. Lack of clarity on the format and who within the clinical team should take responsibility may explain the lack of structured follow-up in this patient group. The importance of long-term assessment needs to be included in training programmes for junior clinicians, to standardise management, improve nutritional screening and improve access to bone mineral density scanning and diabetes screening. Responsibility for follow up should be agreed between primary, secondary and tertiary care.

Introduction Many years ago, the moral fable of Pinocchio warned children about the evils of lying (Perella). This article explores how children are learning lie-related insights from genres of currently marketed polygraph-style “spy kits”, voice stress analysis apps, and electric shock-delivering games. These artifacts are emerging despite the fact that polygraphy and other lie detection approaches are restricted in use in certain business and community contexts, in part because of their dubious scientific support. However, lie detection devices are still applied in many real-life settings, often in critically important security, customs, and employment arenas (Bunn). A commonly accepted definition of the term “lie” is “a successful or unsuccessful deliberate attempt, without forewarning, to create in another a belief which the communicator considers to be untrue” (Vrij 15), which includes the use of lies in various gaming situations. Many children’s games involve some kind of deception, and mental privacy considerations are important in many social contexts (such as “keeping a poker face”). The dystopian scenario of children learning basic honesty notions through technologically-enabled lie detection games scripted by corporate developers presents frightening prospects. These lie detection toys and games impart important moral perspectives through technological and algorithmic means (including electrical shocks and online shaming) rather than through human modelling and teaching. They normalise and lessen the seriousness of lying by reducing it into a game. In this article I focus on United States and United Kingdom toys and games, but comparable lie detection approaches have permeated other nations and cultures. Alder characterises the US as having an “obsession” with lie detection devices (1), an enthusiasm increasingly shared with other nations. Playing with the Truth: Spy Kits, Voice Stress Apps, and Shocking Liar The often-frightening image of an individual strapped to sensors and hooked up to a polygraph is often found in movies, television shows, and social media (Littlefield). I construe the notion of “lie detection” as “the use of a physiological measurement apparatus with the explicit aim of identifying when someone is lying. This typically comes with specific protocols for questioning the subject, and the output is graphically represented” (Bergers 1). Some lie detection toys utilise autonomic or unintentionally-supplied input in their analyses (such as the vocal changes related to stress); with networked toys, the data can subsequently be utilised by third parties. These aspects raise questions concerning consent as well as the validity of the results. Developers are producing related artifacts that challenge the difference between truth and lies, such as robots that “lie” by giving children responses to questions based on the children’s analysed preferences rather than standard determinations of truth and falsity (Zhu). Early lie detection games for children include the 1961 Lie Detecto from Manning Manufacturing. The technologies involved are galvanometers that required a 9-volt battery to operate, and sensors strapped to the hands of the subjects. It was reportedly designed “for junior G-men”, with suggested test questions for subjects such as "Do you like school?" Its ratings included "Could Be" and "Big Whopper" (“TIME’s New Products”). Lie detection had also been projected as fertile ground for children’s own educational research ventures. For example, in 2016 the popular magazine Scientific American outlined how young people could conduct experiments as to whether cognitive load (such as working on complex puzzles) affects the subject’s galvanic input to lie detection devices (Science Buddies). However, the Science Buddies’ description of the proposed activity did not encourage children to question the validity of the device itself. In organisational and agency settings, polygraph-style strategies are generally labour-intensive, involving experts who set up and administer tests (Bunn). These resource-intensive aspects of polygraphs may make their use in games attractive to players who want theatrical scripts to act out particular roles. An example of a lie detection toy that models the polygraph is the currently marketed Discovery Kids’ Electronic Lie Detection Portable Spy Kit, in which children go through the procedures of attaching the polygraph’s sensors to a human subject (Granich). The roles of “spy” and “detective” are familiar ones in many children’s books and movies, so the artifacts involved fit readily into children’s narratives. However, the overall societal importance of what they are modelling may still be beyond children’s grasps. Users of the comparable spy kit Project MC2 are given the following characterisation of their lie detection device, designed for individuals aged 6 and older: When someone lies, his or her body often produces small reactions from being nervous or stressed. One of those reactions is a small release of sweat. That moisture increases the skin’s electrical conductivity, or galvanic skin response, and the lie detector reads it as a fib. That's why the lie detector’s clips go on the fingers, because there are lots of sweat glands in your hands. Product includes: Lie detector, disguised as a mint box with a hidden button to force a truth or lie. Equipped with indicator light and sounds. Neon-colored wires with finger clips. (“Project MC2”) Similar sorts of lie detection approaches (though more sophisticated) are currently being used in US military operations. For example, the US Army’s Preliminary Credibility Assessment Screening Systems (PCASS) are handheld polygraphs designed for use in battle. Voice stress analysis systems for lie detection have been used for decades in business as well as medical and crime contexts. As described by Price, the US toy maker Hasbro distributes The Lie Detector Game, which “uses voice analysis to determine whether someone is lying”. In the box you’ll get a lie detector device and 64 cards with questions to answer as part of the gameplay … . If you tell the truth, or the device at least thinks you did, then you score a point. Lying loses you a point” (1). An assortment of smartphone apps with voice-stress analysis capabilities designed for lie detection are also widely available along with suggestions for their use in games (McQuarrie), providing yet another way for children to explore truth and deception in technologically-framed contexts. Lie detection devices for entertainment generally construe at least one of the participants in the toy’s or game’s operations as a “subject”. The Shocking Liar game openly entices users to construct the human game players as “victims”: The SHOCKING LIAR [sic] is a table top device that you strap your victim's hand to, delivering a small electric shock when it thinks a lie is being told… The lie detector evaluates the data and stores the information after each question giving an accumulation of data on the person being questioned. This means the more questions that you ask, the more information the lie detector has to evaluate... Place your hand onto the hand plate of the SHOCKING LIAR. If you tell the truth, you can move away from it safely and if you tell a direct lie or have given an unacceptable amount of half-truths, you will receive an electric shock. Children who use Shocking Liar are indeed led to assume that they can catch themselves or friends in dishonesty, but research justification for the Shocking Liar’s results is not available. The societal messages imparted by the toys to children (such as “this toy can determine whether you are lying”) make their impacts especially consequential. These toys and games extract from the subjects’ data various aspects of which the subjects may not have conscious control or even awareness. For instance, the pitch of the subject’s voice can be mined and subsequently given voice stress analysis, as in the previously described Hasbro game. From this “shadow” or autonomic input is developed an interpretation (however problematic) of the subjects’ mental state. The results of the analysis may eventually be processed consciously by subjects, either as polygraph readings or electrical shocks (as in Shocking Liar). The autonomic input involved is often known as “leakage” or “tells” (Ekman). Game playing with robots presents new lie detection venues. Children often react differently in robot-mediated interactions to truth and deception issues than they do with human beings (Pearson). Since the opportunities for child-robot interaction are increasing with the advent of companion robots, new contexts for lie detection games are emerging. Robots that present verbal feedback to children based on the child’s preferences over time, or that strategically withhold information, are being developed and marketed. Research on children’s responses to robots may provide clues as to how to make cognitive engineering and mental privacy invasions more acceptable. This raises serious concerns about children’s perceptions of the standings of robots as moral guides as well as gaming companions. For younger children who are just acquiring the notion of lying, the toys and games could extend the kinds of socialisation provided by their parents and guardians. As lie detection initiatives are taking on wide roles in everyday human interaction (such as educational cheating and employee credibility assessment), the integration of the approaches into children’s activities may serve to normalise the processes involved. Older children who already have some sense of what lying constitutes may find in the lie detection toys and games some insights as to how to become more effective as liars. Some parents may use these lie-detection toys in misguided attempts to determine whether their children are lying to them about something. Many toys and games are explicit in their lie detection and surveillance themes, with specific narratives relating to the societal roles of detectives and spies. Children become complicit in the societal functions of lie detection, rather than simply being subjects or audiences to them. Children’s toys and games are all about experimentation, and these lie detection artifacts are no different (Oravec 2000). Children are enabled through interactions with the toys and games to experiment with lying behavior and possibly explore certain aspects of their own mental lives as well as those of others. Children can learn how to modulate some of the external physiological signals that are often associated with lying, much in the way that individuals can alter various physiological responses with assistance of biofeedback technologies. Such efforts may be empowering in some senses but also increase the potential for confusion about truthfulness and lying. Use of the toys and games may support the emergence of psychopathic tendencies in which children exhibit antisocial and egocentric behavior along with a failure to learn about the consequences of their actions, in this case lying (Hermann). This situation is comparable to that of organisations that advertise training for how to “beat” or “outsmart” polygraphs, efforts that have often confounded law enforcement and intelligence agencies (Rosky). Playing with the Truth: Children and Honesty The constructions of lie detection events that are fostered in these toys and games generally simplify and mechanise truth-lie differences, and often present them in an unquestioning manner. Children are not encouraged to wonder whether the devices are indeed functioning as stated in the instructions and advertising materials. Failure to inform children about the toys’ intents and to request their consent about lie detection could also challenge some of them to attempt to subvert the toys’ mechanisms. However, many lie detection toys and games provide the opportunity for historically grounded lessons for children about the detection and surveillance strategies of other eras, if introduced in a critical and context-sensitive manner. The assumption that effective lie detection is possible and mental privacy is thus limited is reinforced by the framings of many of these toys and games (Oravec “Emergence”). Lying is indeed a reflection of “Theory of Mind” which enables us to imagine the minds of others, and children are given an arena for exploration on this theme. However, children also learn that their mental worlds and streams of consciousness are readily accessible by others with the use of certain technologies. Scientific justification for the use of polygraphs through the past decades has yielded problematic results, although polygraphs and many other lie detection technologies have still retained social acceptability apparently related to their cultural appeal (Paul, Fischer, and Voigt). Many voice stress apps are also not reliable according to recent research (Tyrsina). The normalisation of current and projected systems for lie detection and mental privacy incursions presents unsettling prospects for children’s development, and the designers and disseminators of toys and games need to consider these dimensions. Using technologically enhanced games, toys, or robots to detect “lies” rather than engaging more directly with other humans in a game context may have unfortunate overall outcomes. For example, the ability to practice various schemes to evade detection while lying may be an attractive aspect of these toys and games to some individuals. The kinds of input often linked with lying behaviors (or “leakage”) can include physiological changes in voice qualities that are generally not directly controllable by the speaker without specific practice; the games and toys provide such practice venues. Individuals who are able to disconnect from their autonomic expressions and lie without physical or acoustic signs can exacerbate personality issues and social pathologies. Some may become psychopaths, who lie to get their way and tend not to feel remorseful, with the games and toys potentially exacerbating genetic tendencies; others may become pathological liars, who lie regardless of whether there is specific benefit to them in doing so (Vrij). Some of these toy-related spying and detective activities can unfortunately be at the expense of others’ wellbeing, whatever their impacts on the children directly involved as players. For example, some forms of lie detection technologies incorporate the remote collection of data without notification of participants, as in the voice-analysis systems just described. Children’s curiosity about others’ thoughts and mental lives may be at the root of such initiatives, though children can also utilise them for bullying and other forms of aggressive behavior. Some research shows that early lie telling by children is often linked with self-defense as they attempt to save face, but other research couples it with anti-social action and behavioral problems (Lavoie). However, adults have been shown to have some considerable influence on children in their lie-telling conduct (Dykstra, Willoughby, and Evans), so there is hope that parents, guardians, teachers, and concerned community members can have some positive influence. Reflections and Conclusions: The “New Pinocchio”? Toys and games can indeed project comforting and nurturing imageries for children. However, they can also challenge individuals to think differently about themselves and others, and even present dystopian scenarios. For toy and game developers to promote lie detection technologies can be problematic because of the associations of lying with antisocial activity and behavioral problems as well as moral concerns. The characters that children play in roles of spies and lie detector administrators supply them with powerful narratives and impact on their mental concepts. The significance of truth-telling in children’s lives is expanding as societal attention to credibility issues increases. For example, children are often called on to present evidence during divorce proceedings and abuse-related cases, so there is a significant body of research about children’s verbal truth and deception patterns (Talwar, Lavoie, and Crossman). The data collected by some networked lie detection toys (such as voice stress analysers) can subsequently be used by third-parties for marketing purposes or direct surveillance, raising critical questions about consent (Oravec “Emergence”). Future entertainment modes may soon be developed with lie detection approaches comparable to the ones I discuss in this article, since many games rely on some form of mental privacy assumptions. Games often have some aspect of personal cognitive control at their roots, with the assumption that individuals can shield their own deliberations from other players at least to some extent. Technological capabilities for lie detection can alter the kinds of strategies involved in games. For example, if players know the quality of other players’ poker hands through technological means, games would need to be restructured substantially, with speed of response or other aspects at a premium. The current and future toy and game developments just discussed underscore the continuing need for ethical and professional vigilance on the part of researchers and developers as they choose projects to work on and technologies to bring to market. Children and young people who play with lie detection and surveillance-related artifacts are being exposed to assumptions about how their own consciousness functions and how they can best navigate in the world through truth-telling or lying. Although children once acquired insights about lying though moral fables like Pinocchio, they are now learning from corporate-developed technological toys and games. References Alder, Ken. The Lie Detectors: The History of an American Obsession. Simon and Schuster, 2007. Bergers, Lara. “Only in America? A History of Lie Detection in the Netherlands in Comparative Perspective, ca. 1910–1980.” The Netherlands: Utrecht U, 2018. <https://studenttheses.uu.nl/handle/20.500.12932/30502>. Bunn, Geoffrey C. The Truth Machine: A Social History of the Lie Detector. Johns Hopkins UP, 2012. Dykstra, Victoria, Teena Willoughby, and Angela D. Evans. "Perceptions of Dishonesty: Understanding Parents’ Reports of and Influence on Children and Adolescents’ Lie-Telling." Journal of Youth and Adolescence 49 (2020): 49–59. <https://doi.org/10.1007/s10964-019-01153-5>. Ekman, Paul. Telling Lies. New York: Norton, 1985. Granich, Mike. “17 Spy Gadgets and Spy Gear for Kids to Gift This Year.” Technolocheese, 2020. 14 Feb. 2020 <https://www.technolocheese.com/spy-gear-for-kids/>. Hermann, Henry. Dominance and Aggression in Humans and Other Animals: The Great Game of Life. Elsevier, 2017. Lavoie, Jennifer, et al. "Lie-telling as a Mode of Antisocial Action: Children’s Lies and Behavior Problems." Journal of Moral Education 47.4 (2018): 432–450. <https://doi.org/10.1080/03057240.2017.1405343>. Littlefield, Melissa. The Lying Brain: Lie Detection in Science and Science Fiction. U of Michigan P, 2011. McQuarrie, Laura. “Hasbro's Lie Detector Game Uses Voice Analysis to Pick Up on Untruths.” Trendhunter, 2019. <https://www.trendhunter.com/trends/lie-detector-game>. Oravec, Jo Ann. "Interactive Toys and Children's Education: Strategies for Educators and Parents." Childhood Education 77.2 (2000): 81-85. ———. "The Emergence of 'Truth Machines'? Artificial Intelligence Approaches to Lie Detection." Ethics and Information Technology 24.6 (2022). <https://link.springer.com/article/10.1007/s10676-022-09621-6>. Paul, Bettina, Larissa Fischer, and Torsten Voigt. “Anachronistic Progress? User Notions of Lie Detection in the Juridical Field.” Engaging Science, Technology, and Society 6 (2020): 328–346. <https://doi.org/10.17351/ests2020.433>. Pearson, Yvette. "Child-Robot Interaction: What Concerns about Privacy and Well-Being Arise When Children Play with, Use, and Learn from Robots?" American Scientist 108.1 (2020): 16–22. 22 June 2023 <https://link.gale.com/apps/doc/A613271878/AONE?u=anon~66b204b9&sid=googleScholar&xid=067570c2>. Perella, Nicolas. "An Essay on Pinocchio." Italica 63.1 (1986): 1–47. <https://doi.org/10.2307/479125>. Price, Emily. “Hasbro Is Launching a Lie Detector Party Game and Ghost-Busting Robot.” Fortune, 2019. 15 Feb. 2019 <http://fortune.com/2019/02/15/lie-detector-party-game/>. “Project MC2.” Amazon, 2020. <https://www.amazon.com/Project-Mc2-539230-Lie-Detector/dp/B015A7CHSA>. Rosky, Jeffrey. "The (F)utility of Post-Conviction Polygraph Testing." Sexual Abuse 25.3 (2013): 259–281. <https://doi.org/10.1177/1079063212455668>. Science Buddies. “Pinocchio’s Arm: A Lie Detector Test.” Scientific American, 10 Mar. 2016. <https://www.scientificamerican.com/article/pinocchio-s-arm-a-lie-detector-test/>. “Shocking Liar.” Amazon, 2020. <https://www.amazon.com/Dayan-Cube-Lie-Detector-Game/dp/B000GUGTYU>. Talwar, Victoria, Jennifer Lavoie, and Angela Crossman. "Carving Pinocchio: Longitudinal Examination of Children’s Lying for Different Goals." Journal of Experimental Child Psychology 181 (2019): 34–55. <https://doi.org/10.1016/j.jecp.2018.12.003>. “TIME’s New Products.” TIME Magazine 78.1 (7 July 1961): 35. Tyrsina, Radu. “These 2 Lie Detecting Programs for PC Will Help You Determine the Truth from All the Lies.” Windowsreport, 5 Aug. 2017. <https://windowsreport.com/lie-detector-software-pc/>. Vrij, Aldert. Detecting Lies and Deceit: Pitfalls and Opportunities. John Wiley & Sons, 2008. Zhu, Dingju. "Feedback Big Data-Based Lie Robot." International Journal of Pattern Recognition and Artificial Intelligence 32.2 (2018). <https://doi.org/10.1142/S0218001418590024>.

The Digital TurnMuch of the 19th century disappeared from public view during the 20th century. Historians recovered what they could from archives and libraries, with the easy pickings-the famous and the fortunate-coming first. Latterly, social and political historians of different hues determinedly sought out the more hidden, forgotten, and marginalised. However, there were always limitations to resources-time, money, location, as well as purpose, opportunity, and permission. 'History' was principally a professionalised and privileged activity dominated by academics who had preferential access to, and significant control over, the resources, technologies and skills required, as well as the social, economic and cultural framework within which history was recovered, interpreted, approved and disseminated.Digitisation and the broader development of new communication technologies has, however, transformed historical research processes and practice dramatically, removing many constraints, opening up many opportunities, and allowing many others than the professional historian to trace and track what would have remained hidden, forgotten, or difficult to find, as well as verify (or otherwise), what has already been claimed and concluded. In the 21st century, the SEARCH button has become a dominant tool of research. This, along with other technological and media developments, has altered the practice of historians-professional or 'public'-who can now range deep and wide in the collection, portrayal and dissemination of historical information, in and out of the confines of the traditional institutional walls of retained information, academia, location, and national boundaries.This incorporation of digital technologies into academic historical practice generally, has raised, as Cohen and Rosenzweig, in their book Digital History, identified a decade ago, not just promises, but perils. For the historian, there has been the move, through digitisation, from the relative scarcity and inaccessibility of historical material to its (over) abundance, but also the emerging acceptance that, out of both necessity and preference, a hybridity of sources will be the foreseeable way forward. There has also been a significant shift, as De Groot notes in his book Consuming History, in the often conflicted relationship between popular/public history and academic history, and the professional and the 'amateur' historian. This has brought a potentially beneficial democratization of historical practice but also an associated set of concerns around the loss of control of both practice and product of the professional historian. Additionally, the development of digital tools for the collection and dissemination of 'history' has raised fears around the commercialised development of the subject's brand, products and commodities. This article considers the significance and implications of some of these changes through one protracted act of recovery and reclamation in which the digital made the difference: the life of a notorious 19th century professional agitator on both sides of the Atlantic, John De Morgan. A man thought lost, but now found."Who Is John De Morgan?" The search began in 1981, linked to the study of contemporary "race riots" in South East London. The initial purpose was to determine whether there was a history of rioting in the area. In the Local History Library, a calm and dusty backwater, an early find was a fading, but evocative and puzzling, photograph of "The Plumstead Common Riots" of 1876. It showed a group of men and women, posing for the photographer on a hillside-the technology required stillness, even in the middle of a riot-spades in hand, filling in a Mr. Jacob's sandpits, illegally dug from what was supposed to be common land. The leader of this, and other similar riots around England, was John De Morgan. A local journalist who covered the riots commented: "Of Mr. De Morgan little is known before or since the period in which he flashed meteorlike through our section of the atmosphere, but he was indisputably a remarkable man" (Vincent 588). Thus began a trek, much interrupted, sometimes unmapped and haphazard, to discover more about this 'remarkable man'. "Who is John De Morgan" was a question frequently asked by his many contemporary antagonists, and by subsequent historians, and one to which De Morgan deliberately gave few answers. The obvious place to start the search was the British Museum Reading Room, resplendent in its Victorian grandeur, the huge card catalogue still in the 1980s the dominating technology. Together with the Library's newspaper branch at Colindale, this was likely to be the repository of all that might then easily be known about De Morgan.From 1869, at the age of 21, it appeared that De Morgan had embarked on a life of radical politics that took him through the UK, made him notorious, lead to accusations of treasonable activities, sent him to jail twice, before he departed unexpectedly to the USA in 1880. During that period, he was involved with virtually every imaginable radical cause, at various times a temperance advocate, a spiritualist, a First Internationalist, a Republican, a Tichbornite, a Commoner, an anti-vaccinator, an advanced Liberal, a parliamentary candidate, a Home Ruler. As a radical, he, like many radicals of the period, "zigzagged nomadically through the mayhem of nineteenth century politics fighting various foes in the press, the clubs, the halls, the pulpit and on the street" (Kazin 202). He promoted himself as the "People's Advocate, Champion and Friend" (Allen). Never a joiner or follower, he established a variety of organizations, became a professional agitator and orator, and supported himself and his politics through lecturing and journalism. Able to attract huge crowds to "monster meetings", he achieved fame, or more correctly notoriety. And then, in 1880, broke and in despair, he disappeared from public view by emigrating to the USA.LostThe view of De Morgan as a "flashing meteor" was held by many in the 1870s. Historians of the 20th century took a similar position and, while considering him intriguing and culturally interesting, normally dispatched him to the footnotes. By the latter part of the 20th century, he was described as "one of the most notorious radicals of the 1870s yet remains a shadowy figure" and was generally dismissed as "a swashbuckling demagogue," a "democratic messiah," and" if not a bandit … at least an adventurer" (Allen 684). His politics were deemed to be reactionary, peripheral, and, worst of all, populist. He was certainly not of sufficient interest to pursue across the Atlantic. In this dismissal, he fell foul of the highly politicised professional culture of mid-to-late 20th-century academic historians. In particular, the lack of any significant direct linkage to the story of the rise of a working class, and specifically the British Labour party, left individuals like De Morgan in the margins and footnotes. However, in terms of historical practice, it was also the case that his mysterious entry into public life, his rapid rise to brief notability and notoriety, and his sudden disappearance, made the investigation of his career too technically difficult to be worthwhile.The footprints of the forgotten may occasionally turn up in the archived papers of the important, or in distant public archives and records, but the primary sources are the newspapers of the time. De Morgan was a regular, almost daily, visitor to the pages of the multitude of newspapers, local and national, that were published in Victorian Britain and Gilded Age USA. He also published his own, usually short-lived and sometimes eponymous, newspapers: De Morgan's Monthly and De Morgan's Weekly as well as the splendidly titled People's Advocate and National Vindicator of Right versus Wrong and the deceptively titled, highly radical, House and Home. He was highly mobile: he noted, without too much hyperbole, that in the 404 days between his English prison sentences in the mid-1870s, he had 465 meetings, travelled 32,000 miles, and addressed 500,000 people. Thus the newspapers of the time are littered with often detailed and vibrant accounts of his speeches, demonstrations, and riots.Nonetheless, the 20th-century technologies of access and retrieval continued to limit discovery. The white gloves, cradles, pencils and paper of the library or archive, sometimes supplemented by the century-old 'new' technology of the microfilm, all enveloped in a culture of hallowed (and pleasurable) silence, restricted the researcher looking to move into the lesser known and certainly the unknown. The fact that most of De Morgan's life was spent, it was thought, outside of England, and outside the purview of the British Library, only exacerbated the problem. At a time when a historian had to travel to the sources and then work directly on them, pencil in hand, it needed more than curiosity to keep searching. Even as many historians in the late part of the century shifted their centre of gravity from the known to the unknown and from the great to the ordinary, in any form of intellectual or resource cost-benefit analysis, De Morgan was a non-starter.UnknownOn the subject of his early life, De Morgan was tantalisingly and deliberately vague. In his speeches and newspapers, he often leaked his personal and emotional struggles as well as his political battles. However, when it came to his biographical story, he veered between the untruthful, the denial, and the obscure. To the twentieth century observer, his life began in 1869 at the age of 21 and ended at the age of 32. His various political campaign "biographies" gave some hints, but what little he did give away was often vague, coy and/or unlikely. His name was actually John Francis Morgan, but he never formally acknowledged it. He claimed, and was very proud, to be Irish and to have been educated in London and at Cambridge University (possible but untrue), and also to have been "for the first twenty years of his life directly or indirectly a railway servant," and to have been a "boy orator" from the age of ten (unlikely but true). He promised that "Some day-nay any day-that the public desire it, I am ready to tell the story of my strange life from earliest recollection to the present time" (St. Clair 4). He never did and the 20th century could unearth little evidence in relation to any of his claims.The blend of the vague, the unlikely and the unverifiable-combined with an inclination to self-glorification and hyperbole-surrounded De Morgan with an aura, for historians as well as contemporaries, of the self-seeking, untrustworthy charlatan with something to hide and little to say. Therefore, as the 20th century moved to closure, the search for John De Morgan did so as well. Though interesting, he gave most value in contextualising the lives of Victorian radicals more generally. He headed back to the footnotes.Now FoundMeanwhile, the technologies underpinning academic practice generally, and history specifically, had changed. The photocopier, personal computer, Internet, and mobile device, had arrived. They formed the basis for both resistance and revolution in academic practices. For a while, the analytical skills of the academic community were concentrated on the perils as much as the promises of a "digital history" (Cohen and Rosenzweig Digital).But as the Millennium turned, and the academic community itself spawned, inter alia, Google, the practical advantages of digitisation for history forced themselves on people. Google enabled the confident searching from a neutral place for things known and unknown; information moved to the user more easily in both time and space. The culture and technologies of gathering, retrieval, analysis, presentation and preservation altered dramatically and, as a result, the traditional powers of gatekeepers, institutions and professional historians was redistributed (De Groot). Access and abundance, arguably over-abundance, became the platform for the management of historical information. For the search for De Morgan, the door reopened. The increased global electronic access to extensive databases, catalogues, archives, and public records, as well as people who knew, or wanted to know, something, opened up opportunities that have been rapidly utilised and expanded over the last decade. Both professional and "amateur" historians moved into a space that made the previously difficult to know or unknowable now accessible.Inevitably, the development of digital newspaper archives was particularly crucial to seeking and finding John De Morgan. After some faulty starts in the early 2000s, characterised as a "wild west" and a "gold rush" (Fyfe 566), comprehensive digitised newspaper archives became available. While still not perfect, in terms of coverage and quality, it is a transforming technology. In the UK, the British Newspaper Archive (BNA)-in pursuit of the goal of the digitising of all UK newspapers-now has over 20 million pages. Each month presents some more of De Morgan. Similarly, in the US, Fulton History, a free newspaper archive run by retired computer engineer Tom Tryniski, now has nearly 40 million pages of New York newspapers. The almost daily footprints of De Morgan's radical life can now be seen, and the lives of the social networks within which he worked on both sides of the Atlantic, come easily into view even from a desk in New Zealand.The Internet also allows connections between researchers, both academic and 'public', bringing into reach resources not otherwise knowable: a Scottish genealogist with a mass of data on De Morgan's family; a Californian with the historian's pot of gold, a collection of over 200 letters received by De Morgan over a 50 year period; a Leeds Public Library blogger uncovering spectacular, but rarely seen, Victorian electoral cartoons which explain De Morgan's precipitate departure to the USA. These discoveries would not have happened without the infrastructure of the Internet, web site, blog, and e-mail. Just how different searching is can be seen in the following recent scenario, one of many now occurring. An addition in 2017 to the BNA shows a Master J.F. Morgan, aged 13, giving lectures on temperance in Ledbury in 1861, luckily a census year. A check of the census through Ancestry shows that Master Morgan was born in Lincolnshire in England, and a quick look at the 1851 census shows him living on an isolated blustery hill in Yorkshire in a railway encampment, along with 250 navvies, as his father, James, works on the construction of a tunnel. Suddenly, literally within the hour, the 20-year search for the childhood of John De Morgan, the supposedly Irish-born "gentleman who repudiated his class," has taken a significant turn.At the end of the 20th century, despite many efforts, John De Morgan was therefore a partial character bounded by what he said and didn't say, what others believed, and the intellectual and historiographical priorities, technologies, tools and processes of that century. In effect, he "lived" historically for a less than a quarter of his life. Without digitisation, much would have remained hidden; with it there has been, and will still be, much to find. De Morgan hid himself and the 20th century forgot him. But as the technologies have changed, and with it the structures of historical practice, the question that even De Morgan himself posed – "Who is John De Morgan?" – can now be addressed.SearchingDigitisation brings undoubted benefits, but its impact goes a long way beyond the improved search and detection capabilities, into a range of technological developments of communication and media that impact on practice, practitioners, institutions, and 'history' itself. A dominant issue for the academic community is the control of "history." De Groot, in his book Consuming History, considers how history now works in contemporary popular culture and, in particular, examines the development of the sometimes conflicted relationship between popular/public history and academic history, and the professional and the 'amateur' historian.The traditional legitimacy of professional historians has, many argue, been eroded by shifts in technology and access with the power of traditional cultural gatekeepers being undermined, bypassing the established control of institutions and professional historian. While most academics now embrace the primary tools of so-called "digital history," they remain, De Groot argues, worried that "history" is in danger of becoming part of a discourse of leisure, not a professionalized arena (18). An additional concern is the role of the global capitalist market, which is developing, or even taking over, 'history' as a brand, product and commodity with overt fiscal value. Here the huge impact of newspaper archives and genealogical software (sometimes owned in tandem) is of particular concern.There is also the new challenge of "navigating the chaos of abundance in online resources" (De Groot 68). By 2005, it had become clear that:the digital era seems likely to confront historians-who were more likely in the past to worry about the scarcity of surviving evidence from the past-with a new 'problem' of abundance. A much deeper and denser historical record, especially one in digital form seems like an incredible opportunity and a gift. But its overwhelming size means that we will have to spend a lot of time looking at this particular gift horse in mouth. (Cohen and Rosenzweig, Web).This easily accessible abundance imposes much higher standards of evidence on the historian. The acceptance within the traditional model that much could simply not be done or known with the resources available meant that there was a greater allowance for not knowing. But with a search button and public access, democratizing the process, the consumer as well as the producer can see, and find, for themselves.Taking on some of these challenges, Zaagsma, having reminded us that the history of digital humanities goes back at least 60 years, notes the need to get rid of the "myth that historical practice can be uncoupled from technological, and thus methodological developments, and that going digital is a choice, which, I cannot emphasis strongly enough, it is not" (14). There is no longer a digital history which is separate from history, and with digital technologies that are now ubiquitous and pervasive, historians have accepted or must quickly face a fundamental break with past practices. However, also noting that the great majority of archival material is not digitised and is unlikely to be so, Zaagsma concludes that hybridity will be the "new normal," combining "traditional/analogue and new/digital practices at least in information gathering" (17).ConclusionA decade on from Cohen and Rozenzweig's "Perils and Promises," the digital is a given. Both historical practice and historians have changed, though it is a work in progress. An early pioneer of the use of computers in the humanities, Robert Busa wrote in 1980 that "the principal aim is the enhancement of the quality, depth and extension of research and not merely the lessening of human effort and time" (89). Twenty years later, as Google was launched, Jordanov, taking on those who would dismiss public history as "mere" popularization, entertainment or propaganda, argued for the "need to develop coherent positions on the relationships between academic history, the media, institutions…and popular culture" (149). As the digital turn continues, and the SEARCH button is just one part of that, all historians-professional or "amateur"-will take advantage of opportunities that technologies have opened up. Looking across the whole range of transformations in recent decades, De Groot concludes: "Increasingly users of history are accessing the past through complex and innovative media and this is reconfiguring their sense of themselves, the world they live in and what history itself might be about" (310). ReferencesAllen, Rob. "'The People's Advocate, Champion and Friend': The Transatlantic Career of Citizen John De Morgan (1848-1926)." Historical Research 86.234 (2013): 684-711.Busa, Roberto. "The Annals of Humanities Computing: The Index Thomisticus." Computers and the Humanities 14.2 (1980): 83-90.Cohen, Daniel J., and Roy Rosenzweig. Digital History: A Guide to Gathering, Preserving, and Presenting the Past on the Web. Philadelphia, PA: U Pennsylvania P, 2005.———. "Web of Lies? Historical Knowledge on the Internet." First Monday 10.12 (2005).De Groot, Jerome. Consuming History: Historians and Heritage in Contemporary Popular Culture. 2nd ed. Abingdon: Routledge, 2016.De Morgan, John. Who Is John De Morgan? A Few Words of Explanation, with Portrait. By a Free and Independent Elector of Leicester. London, 1877.Fyfe, Paul. "An Archaeology of Victorian Newspapers." Victorian Periodicals Review 49.4 (2016): 546-77."Interchange: The Promise of Digital History." Journal of American History 95.2 (2008): 452-91.Johnston, Leslie. "Before You Were Born, We Were Digitizing Texts." The Signal 9 Dec. 2012, Library of Congress. <https://blogs.loc.gov/thesignal/292/12/before-you-were-born-we-were-digitizing-texts>.Jordanova, Ludmilla. History in Practice. 2nd ed. London: Arnold, 2000.Kazin, Michael. A Godly Hero: The Life of William Jennings Bryan. New York: Anchor Books, 2006.Saint-Clair, Sylvester. Sketch of the Life and Labours of J. De Morgan, Elocutionist, and Tribune of the People. Leeds: De Morgan & Co., 1880.Vincent, William T. The Records of the Woolwich District, Vol. II. Woolwich: J.P. Jackson, 1890.Zaagsma, Gerban. "On Digital History." BMGN-Low Countries Historical Review 128.4 (2013): 3-29.

Photo by 14825144 © Alita Xander | Dreamstime.com ABSTRACT The US government's approach to the War on Drugs has created laws to deter people from using illicit drugs through negative punishment. These laws have not controlled illicit drug use, nor has it stopped the opioid pandemic from growing. Instead, these laws have created a negative bias surrounding addiction and have negatively affected particularly vulnerable patient populations, including pregnant women with substance use disorder and newborns with neonatal abstinence syndrome. This article highlights some misconceptions and underscores the challenges they face as they navigate the justice and healthcare systems while also providing possible solutions to address their underlying addiction. INTRODUCTION Pregnant women with substance use disorder require treatment that is arguably for the benefit of both the mother and the fetus. Some suggest that addiction is a choice; therefore, those who misuse substances should not receive treatment. Proponents of this argument emphasize social and environmental factors that lead to addiction but fail to appreciate how chronic substance use alters the brain’s chemistry and changes how it responds to stress, reward, self-control, and pain. The medical community has long recognized that substance use disorder is not simply a character flaw or social deviance, but a complex condition that requires adequate medical attention. Unfortunately, the lasting consequences of the War on Drugs have created a stigma around addiction medicine, leading to significant treatment barriers. There is still a pervasive societal bias toward punitive rather than rehabilitative approaches to addiction. For example, many women with substance use disorder lose custody of their baby or face criminal penalties, including fines and jail time.[1] These punitive measures may cause patients to lose trust in their physicians, ultimately leading to high-risk pregnancies without prenatal care, untreated substance misuse, and potential lifelong disabilities for their newborns.[2] As a medical student, I have observed the importance of a rehabilitative approach to addiction medicine. Incentivizing pregnant women with substance use disorder to safely address their chronic health issues is essential for minimizing negative short-term and long-term outcomes for women and their newborns. This approach requires an open mind and supportive perspective, recognizing that substance use disorder is truly a medical condition that requires just as much attention as any other medical diagnosis.[3] BACKGROUND The War on Drugs was a government-led initiative launched in 1970 by President Richard M. Nixon with the aim of curtailing illegal drug use, distribution, and trade by imposing harsher prison sentences and punishments.[4] However, it is worth noting that one can trace the roots of this initiative back further. In 1914, Congress enacted the Harrison Narcotics Tax Act to target the recreational use of drugs such as morphine and opium.[5] Despite being in effect for over four decades, the War on Drugs failed to achieve its intended goals. In 2011, the Global Commission on Drug Policy released a report that concluded that the initiative had been futile, as “arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations.”[6] One study published in the International Journal of Drug Policy in the same year found that funding drug law enforcement paradoxically contributed to increasing gun violence and homicide rates.[7] The Commission recommended that drug policies focus on reducing harm caused by drug use rather than solely on reducing drug markets. Recognizing that many drug policies were of political opinion, it called for drug policies that were grounded in scientific evidence, health, security, and human rights.[8] Unfortunately, policy makers did not heed these recommendations. In 2014, Tennessee’s legislature passed a “Fetal Assault Law,” which made it possible to prosecute pregnant women for drug use during pregnancy. If found guilty, pregnant women could face up to 15 years in prison and lose custody of their child. Instead of deterring drug use, the law discouraged pregnant women with substance use disorder from seeking prenatal care. This law required medical professionals to report drug use to authorities, thereby compromising the confidentiality of the patient-physician relationship. Some avoided arrest by delivering their babies in other states or at home, while others opted for abortions or attempted to go through an unsafe withdrawal prior to receiving medical care, sacrificing the mother's and fetus's wellbeing. The law had a sunset provision and expired in 2016. During the two years this law was in effect, officials arrested 124 women.[9] The fear that this law instilled in pregnant women with substance use disorder can still be seen across the US today. Many pregnant women with substance use disorders stated that they feared testing positive for drugs. Due to mandatory reporting, they were not confident that physicians would protect them from the law.[10] And if a woman tried to stop using drugs before seeking care to avoid detection, she often ended up delaying or avoiding care.[11] The American College of Obstetricians and Gynecologists (ACOG) recognizes the fear those with substance use disorders face when seeking appropriate medical care and emphasizes that “obstetric–gynecologic care should not expose a woman to criminal or civil penalties, such as incarceration, involuntary commitment, loss of custody of her children, or loss of housing.”[12] Mandatory reporting strains the patient-physician relationship, driving a wedge between the doctor and patient. Thus, laws intended to deter people from using substances through various punishments and incarceration may be doing more harm than good. County hospitals that mainly serve lower socioeconomic patients encounter more patients without consistent health care access and those with substance use disorders.[13] These hospitals are facing the consequences of the worsening opioid pandemic. At one county hospital where I recently worked, there has been a dramatic increase in newborns with neonatal abstinence syndrome born to mothers with untreated substance use disorders during pregnancy. Infants exposed to drugs prenatally have an increased risk of complications, stillbirth, and life-altering developmental disabilities. At the hospital, I witnessed Child Protective Services removing two newborns with neonatal abstinence syndrome from their mother’s custody. Four similar cases had occurred in the preceding month. In the days leading up to their placement with a foster family, I saw both newborns go through an uncomfortable drug withdrawal. No baby should be welcomed into this world by suffering like that. Yet I felt for the new mothers and realized that heart-wrenching custody loss is not the best approach. During this period, I saw a teenager brought to the pediatric floor due to worsening psychiatric symptoms. He was born with neonatal abstinence syndrome that neither the residential program nor his foster family could manage. His past psychiatric disorders included attention deficit disorder, conduct disorder, major depressive disorder, anxiety disorder, disruptive mood dysregulation disorder, intellectual developmental disorder, and more. During his hospitalization, he was so violent towards healthcare providers that security had to intervene. And his attitude toward his foster parents was so volatile that we were never sure if having them visit was comforting or agitating. Throughout his hospital course, it was difficult for me to converse with him, and I left every interview with him feeling lost in terms of providing an adequate short- and long-term assessment of his psychological and medical requirements. What was clear, however, was that his intellectual and emotional levels did not match his age and that he was born into a society that was ill-equipped to accommodate his needs. Just a few feet away from his room, behind the nurses’ station, were the two newborns feeling the same withdrawal symptoms that this teenager likely experienced in the first few hours of his life. I wondered how similar their paths would be and if they would exhibit similar developmental delays in a few years or if their circumstance may follow the cases hyped about in the media of the 1980s and 1990s regarding “crack babies.” Many of these infants who experienced withdrawal symptoms eventually led normal lives.[14] Nonetheless, many studies have demonstrated that drug use during pregnancy can adversely impact fetal development. Excessive alcohol consumption can result in fetal alcohol syndrome, characterized by growth deficiency, facial structure abnormalities, and a wide range of neurological deficiencies.[15] Smoking can impede the development of the lungs and brain and lead to preterm deliveries or sudden infant death syndrome.[16] Stimulants like methamphetamine can also cause preterm delivery, delayed motor development, attention impairments, and a wide range of cognitive and behavioral issues.[17] Opioid use, such as oxycodone, morphine, fentanyl, and heroin, may result in neonatal opioid withdrawal syndrome, in which a newborn may exhibit tremors, irritability, sleeping problems, poor feeding, loose stools, and increased sweating within 72 hours of life.[18] In 2014, the American Association of Pediatrics (AAP) reported that one newborn was diagnosed with neonatal abstinence syndrome every 15 minutes, equating to approximately 32,000 newborns annually, a five-fold increase from 2004.[19] The AAP found that the cost of neonatal abstinence syndrome covered by Medicaid increased from $65.4 million to $462 million from 2004 to 2014.[20] In 2020, the CDC published a paper that showed an increase in hospital costs from $316 million in 2012 to $572.7 million in 2016.[21] Currently, the impact of the COVID-19 pandemic on the prevalence of newborns with neonatal abstinence syndrome is unknown. I predict that the increase in opioid and polysubstance use during the pandemic will increase the number of newborns with neonatal abstinence syndrome, thereby significantly increasing the public burden and cost.[22] In the 1990s, concerns arose about the potentially irreparable damage caused by intrauterine exposure to cocaine on the development of infants, which led to the popularization of the term “crack babies.”[23] Although no strong longitudinal studies supported this claim at the time, it was not without merit. The Maternal Lifestyle Study (NCT00059540) was a prospective longitudinal observational study that compared the outcomes of newborns exposed to cocaine in-utero to those without.[24] One of its studies revealed one month old newborns with cocaine exposure had “lower arousal, poorer quality of movements and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes.”[25] Another study showed that at one month old, heavy cocaine exposure affected neural transmission from the ear to the brain.[26] Long-term follow up from the study showed that at seven years old, children with high intrauterine cocaine exposure were more likely to have externalizing behavior problems such as aggressive behavior, temper tantrums, and destructive acts.[27] While I have witnessed this behavior in the teenage patient during my pediatrics rotation, not all newborns with intrauterine drug exposure are inevitably bound to have psychiatric and behavioral issues later in life. NPR recorded a podcast in 2010 highlighting a mother who used substances during pregnancy and, with early intervention, had positive outcomes. After being arrested 50 times within five years, she went through STEP: Self-Taught Empowerment and Pride, a public program that allowed her to complete her GED and provided guidance and encouragement for a more meaningful life during her time in jail. Her daughter, who was exposed to cocaine before birth, had a normal childhood and ended up going to college.[28] From a public health standpoint, more needs to be done to prevent the complications of substance misuse during pregnancy. Some states consider substance misuse (and even prescribed use) during pregnancy child abuse. Officials have prosecuted countless women across 45 states for exposing their unborn children to drugs.[29] With opioid and polysubstance use on the rise, the efficacy of laws that result in punitive measures seems questionable.[30] So far, laws are not associated with a decrease in the misuse of drugs during pregnancy. Millions of dollars are being poured into managing neonatal abstinence syndrome, including prosecuting women and taking their children away. Rather than policing and criminalizing substance use, pregnant women should get the appropriate care they need and deserve. I. Misconception One: Mothers with Substance Use Disorder Can Get an Abortion If an unplanned pregnancy occurs, one course of action could be to terminate the pregnancy. On the surface, this solution seems like a quick fix. However, the reality is that obtaining an abortion can be challenging due to two significant barriers: accessibility and mandated reporting. Abortion laws vary by state, and in Tennessee, for instance, abortions are banned after six weeks of gestation, typically when fetal heart rhythms are detected. An exception to this is in cases where the mother's life is at risk.[31] Unfortunately, many women with substance use disorders are from lower socioeconomic backgrounds and cannot access pregnancy tests, which could indicate they are pregnant before the six-week cutoff. If a Tennessee woman with substance use disorder decides to seek an abortion after six weeks, she may need to travel to a neighboring state. However, this is not always a feasible option, as the surrounding states (WV, MO, AR, MI, AL, and GA) also have restrictive laws that either prohibit abortions entirely or ban them after six weeks. Moreover, she may be hesitant to visit an obstetrician for an abortion, as some states require physicians by law to report their patients' substance use during pregnancy. For example, Virginia considers substance use during pregnancy child abuse and mandates that healthcare providers report it. This would ultimately limit her to North Carolina if she wants to remain in a nearby state, but she must go before 20 weeks gestation.[32] For someone who may or may not have access to reliable transportation, traveling to another state might be impossible. Without resources or means, these restrictive laws have made it incredibly difficult to obtain the medical care they need. II. Misconception Two: Mothers with SUD are Not Fit to Care for Children If a woman cannot take care of herself, one might wonder how she can take care of another human being. Mothers with substance use disorders often face many adversities, including lack of economic opportunity, trauma from abuse, history of poverty, and mental illness.[33] Fortunately, studies suggest keeping mother and baby together has many benefits. Breastfeeding, for example, helps the baby develop a strong immune system while reducing the mother’s risk of cancer and high blood pressure.[34] Additionally, newborns with neonatal abstinence syndrome who are breastfed by mothers receiving methadone or buprenorphine require less pharmacological treatment, have lower withdrawal scores, and experience shorter hospital stays.[35] Opioid concentration in breastmilk is minimal and does not pose a risk to newborns.[36] Moreover, oxytocin, the hormone responsible for mother-baby bonding, is increased in breastfeeding mothers, reducing withdrawal symptoms and stress-induced reactivity and cravings while also increasing protective maternal instincts.[37] Removing an infant from their mother’s care immediately after birth would result in the loss of all these positive benefits for both the mother and her newborn. The newborns I observed during my pediatrics rotation probably could have benefited from breastfeeding rather than bottle feeding and being passed around from one nurse to the next. They probably would have cried less and suffered fewer withdrawal symptoms had they been given the opportunity to breastfeed. And even if the mothers were lethargic and unresponsive while going through withdrawal, it would still have been possible to breastfeed with proper support. Unfortunately, many believe mothers with substance use disorder cannot adequately care for their children. This pervasive societal bias sets them up for failure from the beginning and greatly inhibits their willingness to change and mend their relationship with their providers. It is a healthcare provider’s duty to provide non-judgmental care that prioritizes the patient’s well-being. They must treat these mothers with the same empathy and respect as any other patient, even if they are experiencing withdrawal. III. Safe Harbor and Medication-Assisted Treatment Addiction is like any other disease and society should regard treatment without stigma. There is no simple fix to this problem, given that it involves the political, legal, and healthcare systems. Punitive policies push pregnant women away from receiving healthcare and prevent them from receiving beneficial interventions. States need to enact laws that protect these women from being reported to authorities. Montana, for example, passed a law in 2019 that provides women with substance use disorders safe harbor from prosecution if they seek treatment for their condition.[38] Medication-assisted treatment with methadone or buprenorphine is the first line treatment option and should be available to all pregnant women regardless of their ability to pay for medical care.[39] To promote continuity of care, health officials could include financial incentives to motivate new mothers to go to follow-up appointments. For example, vouchers for groceries or enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may offset financial burdens and allow a mother to focus on taking care of her child and her recovery. IV. Mandated Substance Abuse Programs Although the number of people sentenced to state prisons for drug related crimes has been declining, it is still alarming that there were 171,300 sentencings in 2019.[40] Only 11 percent of the 65 percent of our nation’s inmates with substance use disorder receive treatment, implying that the other 89 percent were left without much-needed support to overcome their addiction.[41] It is erroneous to assume that their substance use disorder would disappear after a period without substance use while behind bars. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. Even if they are abstinent for some time during incarceration, the underlying problem persists, and the cycle inevitably continues upon release from custody. In line with the recommendations by Global Commission on Drug Policy and the lessons learned from the failed War on Drugs, one proposed change in our criminal justice system would be to require enrollment and participation in assisted alcohol cessation programs before legal punishment. Policy makers must place emphasis on the safety of the patient and baby rather than the cessation of substance use. This would incentivize people to actively seek medical care, restore the patient-physician relationship, and ensure that they take rehabilitation programs seriously. If the patient or baby is unsafe, a caregiver could intervene while the patient re-enrolls in the program. Those currently serving sentences in prisons and jails can treat their substance use disorder through medication assisted treatment, cognitive behavioral therapy, and programs like Self Taught Empowerment and Pride (STEP). Medication assisted treatment under the supervision of medical professionals can help inmates achieve and maintain sobriety in a healthy and safe way. Furthermore, cognitive behavioral therapy can help to identify triggers and teach healthier coping mechanisms to prepare for stressors outside of jail. Finally, multimodal empowerment programs can connect people to jobs, education, and support upon release. People often leave prisons and jail without a sense of purpose, which can lead to relapse and reincarceration. Structured programs have been shown to decrease drug use and criminal behavior by helping reintegrate productive individuals into society.[42] V. Medical Education: Narcotic Treatment Programs and Suboxone Clinics Another proactive approach could be to have medical residency programs register with the Drug Enforcement Administration (DEA) as Narcotic Treatment Programs and incorporate suboxone clinics into their education and rotations. Rather than family medicine, OB/GYN, or emergency medicine healthcare workers having to refer their patients to an addiction specialist, they could treat patients with methadone for maintenance or detoxification where they would deliver their baby. Not only would this educate and prepare the future generation of physicians to handle the opioid crisis, but it would allow pregnant women to develop strong patient-physician relationships. CONCLUSION Society needs to change from the mindset of tackling a problem after it occurs to taking a proactive approach by addressing upstream factors, thereby preventing those problems from occurring in the first place. Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. Decriminalizing drug use and encouraging good health habits during pregnancy is essential, as is access to prenatal care, especially for lower socioeconomic patients. Many of the current laws and regulations that policy makers initially created due to naïve political opinion and unfounded bias to serve the War on Drugs need to be changed to provide these opportunities. To progress as a society, physicians and interprofessional teams must work together to truly understand the needs of patients with substance use disorders and provide support from prenatal to postnatal care. There should be advocation for legislative change, not by providing an opinion but by highlighting the facts and conclusions of scientific studies grounded in scientific evidence, health, security, and human rights. There can be no significant change if society continues to view those with substance use disorders as underserving of care. Only when the perspective shifts to compassion can these mothers and children receive adequate care that rehabilitates and supports their future and empowers them to raise their children. - [1] NIDA. 2023, February 15. Pregnant People with Substance Use Disorders Need Treatment, Not Criminalization. https://nida.nih.gov/about-nida/noras-blog/2023/02/pregnant-people-substance-use-disorders-need-treatment-not-criminalization [2] Substance Use Disorder Hurts Moms and Babies. National Partnership for Women and Families. June 2021 [3] All stories have been fictionalized and anonymized. [4] A History of the Drug War. Drug Policy Alliance. https://drugpolicy.org/issues/brief-history-drug-war [5] The Harrison Narcotic Act (1914) https://www.druglibrary.org/Schaffer/library/studies/cu/cu8.html [6] The War on Drugs. The Global Commission on Drug Policy. Published June 2011. https://www.globalcommissionondrugs.org/reports/the-war-on-drugs [7] Werb D, Rowell G, Guyatt G, Kerr T, Montaner J, Wood E. Effect of drug law enforcement on drug market violence: A systematic review. Int J Drug Policy. 2011;22(2):87-94. doi:10.1016/j.drugpo.2011.02.002 [8] Global Commission on Drug Policy, 2011 [9] Women NA for P. Tennessee’s Fetal Assault Law: Understanding its impact on marginalized women - New York. Pregnancy Justice. Published December 14, 2020. https://www.pregnancyjusticeus.org/tennessees-fetal-assault-law-understanding-its-impact-on-marginalized-women/ [10] Roberts SCM, Nuru-Jeter A. Women’s perspectives on screening for alcohol and drug use in prenatal care. Womens Health Issues Off Publ Jacobs Inst Womens Health. 2010;20(3):193-200. doi:10.1016/j.whi.2010.02.003 [11] Klaman SL, Isaacs K, Leopold A, et al. Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance. J Addict Med. 2017;11(3):178-190. doi:10.1097/ADM.0000000000000308 [12] Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician–Gynecologist. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2011/01/substance-abuse-reporting-and-pregnancy-the-role-of-the-obstetrician-gynecologist [13] R. Ghertner, G Lincoln The Opioid Crisis and Economic Opportunity: Geographic and Economic Trends. ASPE. Office of Assistant Secretary for Planning and Evaluation. DHHS Revised September 11, 2018 https://aspe.hhs.gov/reports/economic-opportunity-opioid-crisis-geographic-economic-trends [14] Midon, M. Z., Gerzon, L. R., & de Almeida, C. S. (2021). Crack and motor development of babies living in an assistance shelter. ABCS Health Sciences, 46, e021215-e021215. And for example, see Crack Babies: Twenty Years Later : NPR https://www.npr.org/templates/story/story.php?storyId=126478643 [15] Williams JF, Smith VC, the Committee on Substance Abuse. Fetal Alcohol Spectrum Disorders. Pediatrics. 2015;136(5):e20153113. doi:10.1542/peds.2015-3113 [16] CDC Tobacco Free. Smoking During Pregnancy. Centers for Disease Control and Prevention. Published April 11, 2022. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm [17] Abuse NI on D. What are the risks of methamphetamine misuse during pregnancy? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/methamphetamine/what-are-risks-methamphetamine-misuse-during-pregnancy [18] CDC. Basics About Opioid Use During Pregnancy | CDC. Centers for Disease Control and Prevention. Published July 21, 2021. https://www.cdc.gov/pregnancy/opioids/basics.html [19] Honein MA, Boyle C, Redfield RR. Public Health Surveillance of Prenatal Opioid Exposure in Mothers and Infants. Pediatrics. 2019;143(3):e20183801. doi:10.1542/peds.2018-3801 [20] Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants with Medicaid: 2004–2014. Pediatrics. 2018;141(4):e20173520. doi:10.1542/peds.2017-3520 [21] Strahan AE, Guy GP Jr, Bohm M, Frey M, Ko JY. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. JAMA Pediatr. 2020;174(2):200-202. doi:10.1001/jamapediatrics.2019.4791 [22] Ghose R, Forati AM, Mantsch JR. Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis. J Urban Health Bull N Y Acad Med. 2022;99(2):316-327. doi:10.1007/s11524-022-00610-0 [23] Mayes LC, Granger RH, Bornstein MH, Zuckerman B. The Problem of Prenatal Cocaine Exposure: A Rush to Judgment. JAMA. 1992;267(3):406-408. doi:10.1001/jama.1992.03480030084043 [24] NICHD Neonatal Research Network. The Maternal Lifestyle Study. clinicaltrials.gov; 2016. https://clinicaltrials.gov/ct2/show/study/NCT00059540 [25] Lester BM, Tronick EZ, LaGasse L, et al. The maternal lifestyle study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants. Pediatrics. 2002;110(6):1182-1192. doi:10.1542/peds.110.6.1182 [26] Lester BM, Lagasse L, Seifer R, et al. The Maternal Lifestyle Study (MLS): effects of prenatal cocaine and/or opiate exposure on auditory brain response at one month. J Pediatr. 2003;142(3):279-285. doi:10.1067/mpd.2003.112 [27] Bada HS, Bann CM, Bauer CR, et al. Preadolescent behavior problems after prenatal cocaine exposure: Relationship between teacher and caretaker ratings (Maternal Lifestyle Study). Neurotoxicol Teratol. 2011;33(1):78-87. doi:10.1016/j.ntt.2010.06.005 [28] N, P, R. Crack Babies: Twenty Years Later. NPR. Published May 3, 2010. https://www.npr.org/templates/story/story.php?storyId=126478643 [29] Miranda L, Dixon V, September CRP on, 30, 2015. How States Handle Drug Use During Pregnancy http://projects.propublica.org/graphics/maternity-drug-policies-by-state [30] NCDAS: Substance Abuse and Addiction Statistics [2023]. NCDAS. https://drugabusestatistics.org/ [31] (Tenn. Code Ann. § 39-15-216). [32] Institute G. Interactive Map: US Abortion Policies and Access After Roe. https://states.guttmacher.org/policies/ [33] Whitesell M, Bachand A, Peel J, Brown M. Familial, Social, and Individual Factors Contributing to Risk for Adolescent Substance Use. J Addict. 2013;2013:579310. doi:10.1155/2013/579310 [34] CDC. Five Great Benefits of Breastfeeding. Centers for Disease Control and Prevention. Published July 27, 2021. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html [35] Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr. 2013;102(11):1060-1066. doi:10.1111/apa.12378 [36] Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med Off J Acad Breastfeed Med. 2012;7:269-274. doi:10.1089/bfm.2011.0096 [37] Pedersen CA, Smedley KL, Leserman J, et al. Intranasal Oxytocin Blocks Alcohol Withdrawal in Human Subjects. Alcohol Clin Exp Res. 2013;37(3):484-489. doi:10.1111/j.1530-0277.2012.01958.x [38] Montana SB0289. https://leg.mt.gov/bills/2019/billhtml/SB0289.htm [39] Mullins N, Galvin SL, Ramage M, Gannon M, Lorenz K, Sager B, Coulson CC. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. J Addict Med. 2020 May/Jun;14(3):185-192. doi: 10.1097/ADM.0000000000000562. PMID: 31567599. [40] Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. NCDAS. https://drugabusestatistics.org/drug-related-crime-statistics/ [41] Association APH. Online only: Report finds most U.S. inmates suffer from substance abuse or addiction. Nations Health. 2010;40(3):E11-E11. [42] Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) | NIDA Archives. Published January 17, 2018. http://archives.nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition