A Compromise to Help the Community : Rural Sexual Assault Nurse Examiner Experiences

Victims of sexual assault require specialized medical care when they report to hospital emergency departments including physical examination, evidence collection, and emotional support. Sexual Assault Nurse Examiners (SANEs) are medical professionals trained to complete the examination and evidence collection in a prompt and sensitive manner. In fact, where SANE programs exist, emergency room waiting times are shorter, evidence collection improves, and revictimization from untrained staff is reduced. Unfortunately, SANEs are not widely available, particularly in rural areas. This lack of trained examiners employed at local hospitals creates a gap in access to proper care, often resulting in long waits as hospitals try to locate an examiner, treatment from untrained staff, or a referral to another hospital. The purpose of this study was to determine SANE\u27s perceptions of the barriers contributing to their low representation in one Midwestern rural community. In-depth semi-structured interviews were completed with six Sexual Assault Nurse Examiners. Findings of this study suggested that Sexual Assault Nurse Examiners working in rural areas experience many of the same difficulties that Sexual Assault Nurse Examiners in urban areas experience in addition to their own unique challenges. Difficulties that rural and urban SANEs have in common include frustrations with on-call systems, difficulties with scheduling, difficulties maintaining competency and proficiency in SANE skills, and experiences of vicarious trauma. SANEs working in rural areas face unique challenges related to patient privacy as well as their own challenges related to competency. This study suggested for example, that rural SANE programs face additional challenges keeping SANEs proficient in their skills because of the low rates of sexual assault survivors seeking SANE services in rural areas. Policy recommendations and avenues for future research are also discussed

Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)

The SARS-CoV-2 virus spreading across the world has led to surges of COVID-19 illness, hospitalizations, and death. The complex and multifaceted pathophysiology of life-threatening COVID-19 illness including viral mediated organ damage, cytokine storm, and thrombosis warrants early interventions to address all components of the devastating illness. In countries where therapeutic nihilism is prevalent, patients endure escalating symptoms and without early treatment can succumb to delayed in-hospital care and death. Prompt early initiation of sequenced multidrug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. A multipronged therapeutic approach includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine. Randomized trials of individual, novel oral therapies have not delivered tools for physicians to combat the pandemic in practice. No single therapeutic option thus far has been entirely effective and therefore a combination is required at this time. An urgent immediate pivot from single drug to SMDT regimens should be employed as a critical strategy to deal with the large numbers of acute COVID-19 patients with the aim of reducing the intensity and duration of symptoms and avoiding hospitalization and death

Conjunctival Reconstruction with Progenitor Cell-Derived Autologous Epidermal Sheets in Rhesus Monkey

Severe ocular surface diseases are some of the most challenging problems that the clinician faces today. Conventional management is generally unsatisfactory, and the long-term ocular consequences of these conditions are devastating. It is significantly important to find a substitute for conjunctival epithelial cells. This study was to explore the possibility of progenitor cell-derived epidermal sheets on denuded amniotic membrane to reconstruct ocular surface of conjunctiva damaged monkeys. We isolated epidermal progenitor cells of rhesus monkeys by type IV collagen adhesion, and then expanded progenitor cell-derived epidermal sheets on denuded amniotic membrane ex vivo. At 3 weeks after the conjunctiva injury, the damaged ocular surface of four monkeys was surgically reconstructed by transplanting the autologous cultivated epidermal progenitor cells. At 2 weeks after surgery, transplants were removed and examined with Hematoxylin-eosin staining, Periodic acid Schiff staining, immunofluorescent staining, scanning and transmission electron microscopy. Histological examination of transplanted sheets revealed that the cell sheets were healthy alive, adhered well to the denuded amniotic membrane, and had several layers of epithelial cells. Electron microscopy showed that the epithelial cells were very similar in appearance to those of normal conjunctival epithelium, even without goblet cell detected. Epithelial cells of transplants had numerous desmosomal junctions and were attached to the amniotic membrane with hemidesmosomes. Immunohistochemistry confirmed the presence of the conjunctival specific markers, mucin 4 and keratin 4, in the transplanted epidermal progenitor cells. In conclusion, our present study successfully reconstructed conjunctiva with autologous transplantation of progenitor cell-derived epidermal sheets on denuded AM in conjunctival damaged monkeys, which is the first step toward assessing the use of autologous transplantation of progenitor cells of nonocular surface origin. Epidermal progenitor cells could be provided as a new substitute for conjunctival epithelial cells to overcome the problems of autologous conjunctiva shortage