Vaginal lacerations from consensual intercourse in adolescents

Objective

(1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries.

Methods

We present a case series of 4 female adolescent patients seen at a children's hospital over a period of 6 months. Each patient developed significant vaginal bleeding after sexual intercourse, and 3 of the patients presented to the emergency department with vital signs consistent with compensated shock.

Results

Each patient was evaluated by pediatric surgery, and found to have a laceration of the vagina. Three of the patients described consensual intercourse prior to the onset of bleeding, and had lacerations of the vaginal fornices; these patients were determined to have injuries resulting from consensual sexual intercourse. The fourth patient reported sexual assault as the cause of her injuries, and was treated for longitudinal lacerations of the vaginal wall.

Conclusions

Lacerations of the upper vagina are not frequently reported in forced vaginal intercourse, but are occasionally reported as injuries sustained during consensual coitus. In the absence of reported sexual assault, a severe vaginal fornix laceration is consistent with the diagnosis of coital injury from consensual intercourse. Diagnosis and treatment of this injury can be delayed due to the sensitive nature of these injuries. Bleeding can be profuse, leading to hemorrhagic shock, and these injuries may require transfusion of blood products and surgical repair in some cases. Complications may include hemoperitoneum, pneumoperitoneum, or retroperitoneal hematoma, even in the absence of complete vaginal perforation.

Practice implications

Knowledge of the consensual sexual injuries that may occur in adolescent patients can guide diagnosis, treatment, and counseling for the patient and her family, preventing long-term medical complications and legal consequences.     

Implementing web 2.0 tools in the classroom: Four teachers’ accounts

In this paper, four teachers shared their experiences using the following free Web 2.0 tools with their students: Jing, Wix, Google Sites, and Blogger. The teachers found that students reacted positively to lessons in which these tools were used, and also noted improvements they could make when using them in the future.     

Using Multidimensional Item Response Theory to Evaluate Educational and Psychological Tests

Many educational and psychological tests are inherently multidimensional, meaning these tests measure two or more dimensions or constructs. The purpose of this module is to illustrate how test practitioners and researchers can apply multidimensional item response theory (MIRT) to understand better what their tests are measuring, how accurately the different composites of ability are being assessed, and how this information can be cycled back into the test development process. Procedures for conducting MIRT analyses–from obtaining evidence that the test is multidimensional, to modeling the test as multidimensional, to illustrating the properties of multidimensional items graphically-are described from both a theoretical and a substantive basis. This module also illustrates these procedures using data from a ninth-grade mathematics achievement test. It concludes with a discussion of future directions in MIRT research.     

e-Learning Object Portals: a new resource that offers new opportunities for librarians

e-Learning Object Portals are emerging as a new form of electronic information. Four portals most effective in providing health care information are identified: The Medical Library Association's Center of Research and Education (CORE), the Health Education Assets Library (HEAL), the American Academy of Medical College's MedEDPortal, and the Multimedia Education Resource for Learning and Online Teaching (MERLOT). Various user groups such as librarians, educators, and students are discussed, as well as their reasons for using e-learning object portals. New roles for librarians in promoting and developing these portals are also reviewed.     

Long-Term Mentors’ Perceptions of Building Mentoring Relationships with At-Risk Youth

Youth mentoring, defined within this study, as the pairing of a youth at risk with a caring adult, is an intervention that is often used for youth at risk for academic and social failure. We sought to understand mentors’ perspectives of the fundamental elements that foster positive mentor–mentee relationships that build resiliency and increase social and academic success. Twelve participants with extensive experience in mentoring youth at high risk participated in structured interviews during two focus groups. Major themes revealed in data analysis included needs for supportive acceptance and consistency to help the mentees build social literacy and future visioning.     

TRANSFER RATES AMONG STUDENTS FROM RURAL,SUBURBAN, AND URBAN COMMUNITY COLLEGES: WHAT WE KNOW,DON'T KNOW,AND NEED TO KNOW

During the past decade much thought has been given to the merits and weaknesses of different ways of calculating transfer rates. This debate, although legitimate and necessary, has not led to research on transfer rates among colleges in different geographic locations. Furthermore, the lack of consensus and sometimes neglect in defining geographic location has reduced the reliability of the data that do exist. This article examines what is known about transfer rates by geographic location and what remains to be studied. Findings on differences by ethnic group and location also are presented. Although there are indications that students from rural areas differ from their urban and suburban counterparts, there has been little work that explores the impact of those differences on transfer rates. The need for further research on transfer rates and college location is also addressed.     

Scaffolded support systems: examining a multi‐tiered support plan protocol for struggling teacher candidates

Teacher candidates train in an educational world that has changed dramatically. The tensions and challenges that preservice teachers experience are a reality for teacher education programs and must be planned for. The authors from a teacher preparation program describe the steps they have taken to support more authentic and integrated work with teacher candidates who struggle in their performance during their licensure program. After implementing a program‐wide support plan protocol and professional action plan tool, we examined the issues that signaled the need for intervention, the types of supports provided, and the resulting program decision. We captured staff perspectives regarding the effectiveness of the support plan protocol and conclude with recommendations to support teacher candidates in acquiring the conceptual and technical knowledge, skills, and disposition needed to teach in today’s classrooms.     

How instructional design experts use knowledge and experience to solve ill‐structured problems

This study examined how instructional design (ID) experts used their prior knowledge and previous experiences to solve an ill‐structured instructional design problem. Seven experienced designers used a think‐aloud procedure to articulate their problem‐solving processes while reading a case narrative. Results, presented in the form of four assertions, showed that experts (1) narrowed the problem space by identifying key design challenges, (2) used an amalgam of knowledge and experience to interpret the problem situation, (3) incorporated a mental model of the ID process in their problem analyses, and (4) came to similar conclusions about how to respond to the situation, despite differences in their initial conceptualizations. Implications for educating novice instructional designers are discussed.