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

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

Improving Results in Endoscopic DCR

The aim of presenting this article is to highlight the factors causing failure in endoscopic dacryocystorhinostomy (DCR). Understanding these factors will lead to an enhancement in the success rate of endoscopic DCR. Out of 600 cases done in a period of 10 years (from 1998 to 2008), 60 were revision cases. 60 patients referred over a period of 10 years, were selected. The aim was to study the factors causing failure in each case. The cases included were revised in a period of 10 years from 1998 to 2008. These were the cases that were unsuccessful for one or the other reason. The author presents a series of failed DCR cases referred over a period of 10 years. Patients had undergone primary surgery elsewhere and were referred due to the persistence of symptoms. Assessment of all the cases was done with the examination of Eyes and lids for any obvious deformity, watering or purulent discharge in the medial canthal area. ROPLAS test was done as a spot diagnosis for NLD block. This was followed by probing and syringing in the outdoor. All the cases were revised and the likely causes leading to failure of the first surgery were analyzed. It was found that the improper selection of cases accounted for 3.3% of total failed cases; Low rhinostomy accounted for 28.3% cases, inadequate sac opening for 38.3% cases, Pre existing canaliculitis for 1.6% of cases, contracture at the rhinostomy site in 10% cases. Laser burn canalicular scarring for 3.3% of total cases and laxity of the lids and atonic sac was responsible for failure in 3.3% cases. Most of the above factors are secondary to the false localization of the sac, inadequate removal of the sac wall, too much of mucosal removal leading to synaechia formation at the surgical site and inability to detect any additional block with NLD (Nasolacrimal duct) block

Cutaneous benign mixed tumor (chondroid syringoma) of the eyelid: clinical presentation and management.

PURPOSE: To describe the clinical presentation of cutaneous benign mixed tumor of the eyelid and its management options. METHODS: Periocular cases of cutaneous benign mixed tumor were gathered from members of an oculoplastics specialty Internet discussion group. A total of 9 patients are described in this retrospective, interventional case series. The clinical presentation, histopathology, and management of these lesions is reviewed. RESULTS: Patients were typically asymptomatic, presenting with a slowly enlarging, nontender nodule of 2 to 8 years' duration. The lesions ranged from 4 mm to 17 mm in greatest dimension. Four of the lesions were on the eyelid margin, three in the sub-brow area of the upper eyelid, and two in the central lids. All six cases not involving the brow were fixed to the tarsus; one brow lesion was believed to be adherent to the skin. None of the lesions was associated with significant changes of the overlying epidermis, although one lesion showed overlying pigmentation. All patients underwent excisional biopsy for diagnostic or cosmetic reasons. On histopathologic examination, the tumors were biphasic, with an epithelial component exhibiting apocrine or hair follicle differentiation and a myxoid, adipocytic, chondroid, and/or fibrous stroma. The pathologic diagnoses were all consistent with cutaneous benign mixed tumor (chondroid syringoma, pleomorphic adenoma). Follow-up ranged from 2 weeks to 12 months, although several patients failed to keep scheduled follow-up appointments. No clinical recurrences were identified. CONCLUSIONS: Cutaneous benign mixed tumor may occur in the eyelid, and, although uncommon, should be included in the differential diagnosis of firm, nodular eyelid tumors. The histopathologic features are similar to those seen in this tumor type arising in other areas of the body. Preoperative consideration of this diagnostic possibility may allow the surgeon to plan for complete excision, thereby reducing the possibility of recurrence or malignant transformation

The Influence of Secondary Interactions on the [N−I−N]+ Halogen Bond

[Bis(pyridine)iodine(I)]+ complexes offer controlled access to halonium ions under mild conditions. The reactivity of such stabilized halonium ions is primarily determined by their three-center, four-electron [N−I−N]+ halogen bond. We studied the importance of chelation, strain, steric hindrance and electrostatic interaction for the structure and reactivity of halogen bonded halonium ions by acquiring their 15N NMR coordination shifts and measuring their iodenium release rates, and interpreted the data with the support of DFT computations. A bidentate ligand stabilizes the [N−I−N]+ halogen bond, decreasing the halenium transfer rate. Strain weakens the bond and accordingly increases the release rate. Remote modifications in the backbone do not influence the stability as long as the effect is entirely steric. Incorporating an electron-rich moiety close by the [N−I−N]+ motif increases the iodenium release rate. The analysis of the iodine(I) transfer mechanism highlights the impact of secondary interactions, and may provide a handle on the induction of stereoselectivity in electrophilic halogenations