Explore the vast range of titles available.

Mention of organoids—organlike structure growing in a Petri dish—might conjure up images of science fiction. However, the generation of organoids is very real, as is the increased understanding of organ form and function that comes from studying them. Lancaster and Knoblich review organoids as structures that include more than one cell type of an organ that exhibit structural and functional features of the natural counterpart. Knowledge of normal organ developmental pathways guides the formation of these structures. Organoids show great promise for modeling human development and disease and for biomedical research and regenerative medicine. Science , this issue 10.1126/science.1247125 Classical experiments performed half a century ago demonstrated the immense self-organizing capacity of vertebrate cells. Even after complete dissociation, cells can reaggregate and reconstruct the original architecture of an organ. More recently, this outstanding feature was used to rebuild organ parts or even complete organs from tissue or embryonic stem cells. Such stem cell–derived three-dimensional cultures are called organoids. Because organoids can be grown from human stem cells and from patient-derived induced pluripotent stem cells, they have the potential to model human development and disease. Furthermore, they have potential for drug testing and even future organ replacement strategies. Here, we summarize this rapidly evolving field and outline the potential of organoid technology for future biomedical research.

Growing functional human tissues and organs would provide much needed material for regeneration and repair. New technologies are taking us in that direction. In addition to their use in regenerative medicine, stem cells that grow and morph into organ-like structures known as organoids can be used in drug development and toxicology testing. The potential developments and possibilities are numerous and affect not only biomedicine but also areas of ongoing ethical debate, such as animal experimentation, research on human embryos and fetuses, ethics review, and patient consent. Bredenoord et al. review how organoids affect existing ethical debates and how they raise novel ethical dilemmas and professional responsibilities. Science , this issue p. 10.1126/science.aaf9414 The ability to generate human tissues in vitro from stem cells has raised enormous expectations among the biomedical research community, patients, and the general public. These organoids enable studies of normal development and disease and allow the testing of compounds directly on human tissue. Organoids hold the promise to influence the entire innovation cycle in biomedical research. They affect fields that have been subjects of intense ethical debate, ranging from animal experiments and the use of embryonic or fetal human tissues to precision medicine, organoid transplantation, and gene therapy. However, organoid research also raises additional ethical questions that require reexamination and potential recalibration of ethical and legal policies. In this Review, we describe the current state of research and discuss the ethical implications of organoid technology.

This article reveals how law and legal interests transform medicine. Drawing on qualitative interviews with medical professionals, this study shows how providers mobilize law and engage in investigatory work as they deliver care. Using the case of drug testing pregnant patients, I examine three mechanisms by which medico-legal hybridity occurs in clinical settings. The first mechanism, clinicalization, describes how forensic tools and methods are cast in clinical terminology, effectively cloaking their forensic intent. In the second, medical professionals informally rank the riskiness of illicit substances using both medical and criminal-legal assessments. The third mechanism describes how gender, race, and class inform forensic decision-making and criminal suspicion in maternal health. The findings show that by straddling both medical and legal domains, medicine conforms to the standards and norms of neither institution while also suspending meaningful rights for patients seeking care.

ObjectivesPoisoning children is a recognised form of physical abuse and the subject of several serious case reviews.1 Little data exists on the incidence of poisoning of children as a form of physical abuse or drug ingestion due to neglect. The objective of this study was to investigate utilisation of urine toxicology testing. We aimed to evaluate:reasons for testingproportion of positive samplesuse of Chain of Evidence (COE).MethodsLaboratory data was obtained for children aged 0 –10 years with urine toxicology samples from January 2016 to January 2021 and medical records were reviewed. Reasons for testing, whether COE procedure was followed correctly and results of tests were recorded. When reviewing results of tests, sub analysis aimed to demonstrate whether the result was expected or an unexpected result.Finally, the proportion of samples sent for COE was evaluated following publication of local guidelines.Results79 patients aged 0–10 years had urine samples sent at least once for toxicology testing over the 5 year period. 28 positive samples.Expected positive: 19Unexpected positive: 91 child was positive for more than one drug meaning in total 8 patients had unexpected positive results in a 5-year period. These children had concerning clinical presentations.COE samples20 of 79 tests sent COE – 25%8 of 79 were attempted COE but the process was not completed – 10% Guideline publication September 2019:Pre-guideline – 48 samples were sent, 10 of these being COE – 21%.Post guideline – 30 samples were sent, 12 of these being COE – 40%.Abstract 6514 Figure 1Abstract 6514 Figure 2ConclusionUpon initial assessment clinicians may not possess all the clinical/social information. Therefore, at this stage it may be best to send all samples COE. However, this is costly and resource intensive. Point of care testing for drugs is used in some units which may help allowing for full COE procedures in select cases.Deciphering the relevance of ‘trace’ results is difficult due to lack of normative data, forensic hair strand testing should be considered.2 Our results highlighted 8 children where unexpected drugs were present in urine this may have represented deliberate poisoning environmental exposure or accidental ingestion. although physical abuse and FII must be a consideration also neglect concerns were regularly raised where children may have accidentally ingested medications/drugs.The publication of a COE Guideline did have meaningful impact, this needs further improvement as testing rates remain low and 10% of attempted COE samples failed. Clarity on which cases would benefit from COE is needed and further training is planned.3 Referenceshttps://library.nspcc.org.uk HeritageScriptsHampshireBabyZOverview.pdf 2020.Archer JR, Wood DM, Dargan PI. How to use toxicology screening tests. Archives of Disease in Childhood-Education and Practice, 2012;97(5):194–199.Dyer EM, Salehian S. How to interpret urine toxicology tests. Archives of Disease in Childhood-Education and Practice, 2020;105(2):84–88.

In 2021, 106,699 deaths occurred, resulting in an age-adjusted rate of 32.4 per 100,000 standard population according to the Centers for Disease Control and Prevention.4 From 2020 through 2021, the rate for men increased from 39.5 to 45.1 and the rate for women increased from 17.1 to 19.6.4 However, according to the Department of Health and Human Services Substance Abuse and Mental Health Services Administration,5 the number of clients in addiction programs who were younger than age 18 years declined from 82,532 in 2011 to 39,271 in 2020. Furthermore, a recent cohort study of 4,039,216 Medicaid-enrolled youth between ages 13 and 22 years found that after opioid overdose, less than one-third of them received timely addiction treatment, and only 1 in 54 received the recommended evidence-based pharmacotherapy.6 This lack of availability of addiction medicine resources to the adolescent population (probably the most vulnerable population in terms of drug use) is particularly troublesome.7 To make any dent in the rising numbers of drug overdose deaths, organized medicine must address this issue in a comprehensive manner. Substance Abuse and Mental Health Services Administration.

Identifying adolescent substance use can be complicated, as symptoms can be nonspecific and testing can be difficult to obtain and interpret appropriately. Familiarity with consent and confidentiality issues surrounding urine drug testing is important when discussing testing with adolescents and families. Understanding the pros and cons of testing can help pediatricians decide when and how to obtain urine drug screening as well as inform result interpretation. Being aware of home drug testing concerns and having a basic knowledge of fentanyl test strips can assist pediatricians in guiding families and their adolescents. [Pediatr Ann. 2023;52(5):e166–e169.]

More than a decade ago, it was foreseen that ‘…(products) branded with the logos of transnational companies…could indeed become monster sellers…when presented to mothers who are led to believe that the products have saved the lives of their children’.1 When dietary nutrient deficiencies or food shortages are not grave, when natural and social conditions are peaceful, and when local governments can do their work, every effort should be made to improve food availability and access, rather than disrupt this sustainable process by supplementing costly industrial nutrients. [...]in India, local food combinations can be designed using linear programming tools (https://datatools.sjri.res.in/ICDS/), for feasible and economical daily complementary feeding of young children, including through content modification of ongoing governmental take-home rations or hot cooked meals programmes. [...]for robust policy decisions, efficacy trials of any nutrient supplementation product should have a positive control comparison with such local food combinations.

This study examines child welfare case managers' perceptions of parental substance use disorders (SUDs) on child safety and describes their experiences conducting newborn crisis assessments. Qualitative focus groups with case managers (n = 23) discussed perceptions of parental SUD. Transcripts were analyzed using inductive thematic analysis. Participants discussed substance type, newborn crisis assessments, parental engagement, child removal and barriers to addressing child safety. Findings support increased training for child protective services (CPS) staff and providing comprehensive behavioral health care.

Opioid use, both prescribed and illicit, has grown exponentially in the United States since the late 1990s, and with it, opioid use during pregnancy and neonatal abstinence syndrome (NAS) have also increased. NAS is a withdrawal syndrome occurring in newborns that results from maternal opioid use during pregnancy and has variable onset, severity, and duration. Given the increasing incidence of NAS, this article seeks to review its definition, presentation, evaluation, and management to ensure adequate care of these infants and families. [Pediatr Ann. 2022;51(6):e234–e242.]

The mission of child welfare is to ensure children's safety, permanency, and well-being. It is also charged with preserving and strengthening families and with avoiding the removal of children who can be kept at home safely. This paper addresses some of the challenges in meeting these concurrent goals in work with children prenatally exposed to alcohol and their families. Current child welfare practices are unlikely to identify prenatal alcohol exposure or children with fetal alcohol spectrum disorders (FASD). Yet if this exposure is identified when families come into contact with child welfare, a jurisdiction's laws and safety and risk assessment processes may lead to unnecessary removal of children from their homes, particularly for Black and American Indian/Alaska Native families. Drawing from research and discourse in the field, strategies are described that could help the child welfare system care for children who may be impacted by FASD while preserving their families. A crucial strategy is partnering with key child and family service providers to identify and respond to FASD.