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IntroductionTelemedicine has had a slow integration into surgical subspecialties like urology. Little data exists on its effect on urologic patient-provider rapport nor long term clinical outcomes. The purpose of this study was to assess the feasibility and parent-reported experience with telemedicine visits in a tertiary pediatric urology practice during the COVID-19 pandemic.MethodsParents/guardians of pediatric urology patients who were seen via telemedicine between March 12th - October 30th, 2020, at Children’s Hospital Colorado main campus or a satellite campus were contacted within 1 week of their child’s visit and invited to take a telephone survey. A total of 4 yes/no questions and an open-ended question was asked to explore domains of the drawbacks and benefits to telemedicine. Categorical responses and associations between parent demographics and telehealth satisfaction were analyzed with descriptive statistics. Open-ended questions were analyzed using a team-based content analysis approach.ResultsResponse rate was 76.7% (376/490). Median patient age was 4 years. 60.9% (229/376) patients were male, and 39.1% (147/376) patients female. 96.5% of parents felt that all their questions were answered by the end of their appointment. 97.8% of parents felt comfortable using telemedicine for future appointments. Patient sex, age, provider type, insurance type, clinic site, distance from clinic site, and visit diagnosis had no significant impact on survey response. Based on open-ended responses, five general themes emerged: issues with accessing technology, time saving logistics, challenging clinical interactions, a positive overall experience, and parents having about a 50/50 split in preference for telemedicine or in person visits. Multiple parents expressed discomfort with a genital exam via telemedicine.ConclusionsOverall, parents found telemedicine to be an acceptable alternative to in-person visits and demonstrated a willingness to continue to use it in the future. Patient diagnosis and insurance type had no effect on parent response. Parents noted that pediatric urology offers unique challenges due to its personal and sensitive treatment, including the need to evaluate the genitalia. As the role of telemedicine continues to expand, consideration of these challenges is needed to ensure that pediatric urology patients and their parents are comfortable with this approach.
Colorado has consistently had one of the highest rates of suicide in the United States, and El Paso County has the highest number of suicide and firearm-related suicide deaths within the state. Community-based solutions like those of the Suicide Prevention Collaborative of El Paso County may be more effective in preventing suicide as they are specific to local issues, sensitive to local culture, and informed by local data, community members, and stakeholders.
Background
Suicide is the tenth leading cause of death in the United States, with over half of cases involving firearms. Despite research indicating negative effects of exposure to suicide, there is little research on who typically finds the body of the suicide decedent. Understanding who finds the body of the suicide decedent may be important to understand trauma and mental health effects.
Findings
Of the 332 people who died by suicide in El Paso County, Colorado, 182 (55%) used firearms. Those who died by firearm suicide were more likely to be male (83.5% vs. 67.3%) have military affiliation (39.0% vs. 19.3%) and were less likely to have a known mental health diagnosis (47.3% vs. 64.7%) compared to those who died from other means. Most suicide decedents were found by a family member or friend (60.2%). The remaining decedents were found by a stranger/acquaintance (21.0%) or a first responder (22.4%) One-fifth of suicides involved forced witnessing (19%) and the majority were already deceased when the body was discovered (73.2%).
Conclusions
While most suicide decedents are discovered by a family member or a friend, it is unknown what the bereavement and trauma-related outcomes are among people who discover a suicide decedent who has died by violent means, especially by firearms. Further studies exploring who discovers suicide decedents and targeted postvention strategies for supporting impacted family, friends, first responders, and strangers are needed.
We were able to predict normal/abnormal renal function in US images with an AUROC 0f 0.776. Including both sagittal and transverse views in the model improved our performance (Table 1). To improve the interpretability of our predictions, we generated heat maps to view areas of interest in US images that our classifier deemed most indicative for predicting function abnormalities.CONCLUSIONS: Prediction of normal or abnormal function based on US images alone appears to be feasible without featureengineering or clinical/patient variables. This technology may allow for closer monitoring of infants and reduce exposure to invasive testing patients receive to assess function.
Idiopathic Pulmonary Fibrosis (IPF) is a progressive and fatal lung disease with limited therapeutic options. Epithelial reprogramming and honeycomb cysts are key pathological features of IPF, however, the IPF distal bronchiole cell subtypes and their potential contribution to IPF development and progression still remain poorly characterized. Here, we utilized single-cell RNA sequencing on enriched EpCAM+ cells of the distal IPF and Donor lung. Using the 10x Genomics platform, we generated a dataset of 47,881 cells and found distinct cell clusters, including rare cell types, such as suprabasal cells recently reported in the healthy lung. We identified G-protein coupled receptor (GPR) 87 as a novel surface marker of distal Keratin (KRT)5+ basal cells. GPR87 expression was localized to distal bronchioles and honeycomb cysts in IPF in situ by RNA Scope and immunolabeling. Modulation of GPR87 in primary human bronchial epithelial cells cultures resulted in impaired airway differentiation and ciliogenesis. Thus, GPR87 is a novel marker and potentially druggable target of KRT5+ basal progenitor cells likely contributing to bronchiole remodeling and honeycomb cyst development in IPF.
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