Human iPSC-derived renal organoids engineered to report oxidative stress can predict drug-induced toxicity.

Advances in regenerative medicine have led to the construction of many types of organoids, which reproduce important aspects of endogenous organs but may be limited or disorganized in nature. While their usefulness for restoring function remains unclear, they have undoubted usefulness in research, diagnostics, and toxicology. In toxicology, there is an urgent need for better models for human kidneys. We used human iPS-cell (hiPSC)-derived renal organoids to identify HMOX1 as a useful marker of toxic stress via the oxidative stress pathway, and then constructed an HMOX1 reporter in hiPSCs. We used two forms of hiPSC-derived HMOX1-reporter renal organoids to probe their ability to detect nephrotoxicants in a panel of blind-coded compounds. Our results highlight the potential usefulness, and some limitations, of HMOX1-reporter renal organoids as screening tools. The results may guide development of similar stress-reporting organoid assays for other stem-cell-derived organs and tissues.

Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments-2015.

To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.

Semantic interoperability in Czech healthcare environment supported by HL7 version 3.

OBJECTIVES: The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the "Information Society" program. METHODS: At the beginning of the project a set of requirements the SIP should meet was formulated. Several communication standards (openEHR, HL7 v3, DICOM) were analyzed and HL7 v3 was selected to exchange health records in our solution. Two systems were included in our pilot environment: WinMedicalc 2000 and ADAMEKj EHR. RESULTS: HL7-based local information models were created to describe the information content of both systems. The concepts from our original information models were mapped to coding systems supported by HL7 (LOINC, SNOMED CT and ICD-10) and the data exchange via HL7 v3 messages was implemented and tested by querying patient administration data. As a gateway between local EHR systems and the HL7 message-based infrastructure, a configurable HL7 Broker was developed. CONCLUSIONS: A nationwide implementation of a full-scale SIP based on HL7 v3 would include adopting and translating appropriate international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our pilot study showed that our approach is feasible but it would demand a huge effort to fully integrate the Czech healthcare system into the European e-health context.

The value of spiritual health.

Spiritual health is that aspect of our well-being which organizes the values, the relationships, and the meaning and purpose of our lives. Patients and healthcare professionals alive have experienced a growing recognition of the importance of spiritual health as a foundation for physical health and well-being. As a reformed healthcare system places greater emphasis on etiology and prevention as opposed to relief of symptoms, creative and holistic partnerships between the medical profession and spiritual care givers can and will emerge. In studying the etiology of illnesses, healthcare providers must examine the underlying social problems of the day: violence, divorce, unemployment, and a host of other factors that lead to disintegrating relationships. In the past many physicians and nurses refrained from discussing spiritual matters with patients. But given the importance of the relationship between physical and spiritual well-being, providers must make spiritual assessments at the time of any triage. The medical record needs to include references to the patient's spiritual history. And healthcare institutions must seek partnerships with community organizations and leaders to monitor the effects of societal issues that lead to physical and spiritual distress.

The renaissance of pastoral care.

Administrators are finding pastoral care has a future, and a vital one. Without question, the chaplaincy of the future will not be the same as the chaplaincy of the past. Its theology will remain a constant, and its roots will hold fast, but the services will change, along with the healthcare environment in which it operates. If it wants to be an integral part of the clinical team, pastoral care must address three critical areas: spirituality, outreach, and accountability. Healing is spiritual. The meaning and purpose patients find in life, as well as their involvement with the spiritual, are key healing indicators in their treatment. As the spirituality movement articulates its value within the practice of medicine, pastoral care departments are likely to be its principal catalysts. Pastoral care departments are reassessing their ability-and the need-to see every patient, and instead are identifying those patients who will most benefit from pastoral intervention. At the same time, pastoral care services are extending beyond the hospital and will be based in many other settings in the future. If pastoral care hopes to be indispensable in the healthcare setting, it must demonstrate that it makes a contribution and a difference. This requires developing and applying clinical standards to its ministry, as well as creating an empirical data base to substantiate the efficacy of pastoral care interventions.

When the bough breaks. Pastoral care for families of dying infants.

Although physicians and other medical personnel can present the parents of dying babies with all the medical and prognostic indicators, few are properly trained to help couples cope with their feelings and the psychic trmoil that follows such a revelation. Often, the hospital chaplain is called to minister to and support the grieving family. Chaplains are called because (1) they represent the spiritual and may be able to help parents find purpose and meaning in their tragedy, (2) they are trained to listen, to help parents talk through their experience, and (3) they foster healing relationships among friends and families and with God. With many ill newborns, death is imminent and time is critical. Bonding, both actual and symbolic, is important. The Church's sacraments can foster this bonding, especially when they are celebrated as a family occasion, as opposed to a last-minute bedside rite. Bereaved parents especially cling to the outward symbols of the sacraments. In working with the grieving parents, chaplains should keep in mind that parents need to know all the available facts, that, individually, each family member goes through a grieving process, each with its own dynamics and time schedule. The death of a child will change parents' lives. Support groups for bereaved parents are helpful, and follow-up is important.

Pastoral care must address spiritual needs of the elderly.

For the immediate future, the attention and resources of healthcare will be focused on the increasing number of elderly individuals. But the American population is ill-prepared to handle the psychosocial aspects of this enormous population shift. Too often this country's mind-set toward the elderly is exemplified by its stereotypes. The ramifications of these biases are ethical, political, social, religious, and economic. Pastoral care should identify and create avenues to address the spiritual needs of the elderly, which can be categorized under three major areas: 1. The need to find a meaning and purpose to life 2. The need to feel a sense of belonging and love 3. The need to find reconciliation with God and the human community One tool to address these needs is the "life review", whose fundamental operational principle is that memory confers identity. The pastoral care professional identifies, interprets, and probes the remembrances and reminiscences of the elderly to help them find understanding and hope in the waning days of life.