Categories
Sexual Assault

Accessing Emergency Contraception After Sexual Assault

Not surprisingly, I have heard from many of you in the last 24 hours about your worries and concerns–there is a lot of angst about how many of you either work in facilities where patients are denied access to emergency contraception because it’s a religiously affiliated hospital or you’re hearing stories from others. There’s a lot to unpack here, and I can’t tackle all of it in this post, but I want to start with worst case scenarios. It’s never the ideal to have patients paying for/getting their own EC after a medical-forensic exam (it actually infuriates me that it still happens), but knowing that’s a reality, I did a search online for current prices, and here’s what it looks like for patients who must pay out of pocket at the biggest national retailers:

(Online prices, so they may differ in store; all brands listed were available in stores at the time of this search.)

For those folks purchasing Plan B One-Step, the manufacturer has an online coupon that can be redeemed for $10 off. Still costly, but if that’s the only brand your pharmacy carries, it’s not nothing.

Now, I am aware many of our patients don’t have even 10 extra dollars. I am aware some of our patients don’t have access to pharmacies in their area. I am aware that some states allow pharmacists to refuse to sell EC. I am aware some will refuse regardless of what the law allows. There are a lot of barriers out there. But there are some things we as clinicians can do:

  1. Know what’s available in your area and provide patients with regularly updated, accurate information. That should be part of the discharge plan.
  2. Instead of raising all your money for shiny new equipment, consider putting some of those dollars into store gift cards for patients who need to access EC but cannot get it from your agency. Ensure patients have a way to get there right after or have someone who can go get it for them. [Related: when people ask if they can donate items to your program, yes, gift cards.]
  3. Make sure you and your team are working with the most accurate science and know the current public policy issues related to EC. Guttmacher is my trusted resource for all thing policy. In regards to science, know what the research says about timeframes, potential weight impacts, and other considerations for the various types of EC. I am not providing you with a full research review on this (yet), but I have found articles like this one to be helpful in understanding the current evidence base.
  4. Ensure that all patients who can become pregnant are being offered EC. In this, the year 2019, it is frustrating that we must remind folks that people of all genders can become pregnant. Just because someone does not look like your idea of a pregnant person does not mean they cannot become pregnant. Just because someone is taking testosterone does not mean they cannot get pregnant. We need to ensure that our trans-/nonbinary/gender non-conforming patients are screened for pregnancy exposure, too.

This space will contain a lot on EC (and abortion) access in the coming months because what’s happening here in the US has a very real impact on our patients and our practices. We need to be having a national dialog on what this means moving forward, but all of you should be having these same conversations at the local level because that’s where much of the work will be done. I welcome suggestions for future topics of concern and question. And much as I love all of the private messages I get, it wouldn’t kill you to use the Comments section so others could benefit from your feedback 😉 [I know–after 10 years, I should be used to the fact that the Comments section is the least used section of this website. But a girl can hope.]

ADD: Transphobic garbage has me linking to an article in point #4, as if I should even have to do that. It’s but one example in the medical literature. I’m annoyed I have to even justify the statement, but I guess some folks are going to engage in nonsense, so here we are.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Categories
Sexual Assault

Sexual Assault Patients and Access to Abortion

Well, the news isn’t great. Alabama has become the latest state to pass a near abortion ban, and it’s time we talk about what this means for our patients in the US, because it’s certainly not something we can ignore.

For now, at least, abortion is still legal in all 50 states, so let’s begin there. But as (predominantly male, non-physician or nurse) legislators chip away at abortion access, the question needs to be asked: how does this change the way we counsel patients about emergency contraception? Should we be ensuring we can offer copper IUDs for women who are concerned that their weight may make Ella or Plan B less effective? Do we need to have far more nuanced conversations with our patients who can become pregnant about EC and subsequent options if pregnancy occurs? Pregnancy tests are expensive, so will we offer follow up testing for pregnancy to ensure that the EC worked, just to make sure any EC failure is caught prior to the 6-week cut-offs (assuming they end up being the threshold)?

Abortion is incredibly personal, but access to abortion should not be. Regardless of the decisions we might make if faced with an unplanned pregnancy, every single patient who has the potential to become pregnant deserves a clinician who will provide full-throated advocacy for their right to not be if that’s what they want. And laws that would punish clinicians for terminating the pregnancies caused by rapists more harshly than the actual rapists is such absurdity it’s hard to even type that sentence. It’s time, as a profession, to have some very real conversations about what it looks like to provide patient-centered care in the face of laws that are anything but.

If you have the means to donate some cash to support organizations doing the work of keeping abortion safe and legal for everyone in the US, consider:

https://yellowhammerfund.org/

https://sistersong.nationbuilder.com/donate

https://abortionfunds.org/

https://prochoice.org/about-naf/support-naf

(or add some of your favorites in the Comments)

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Categories
DV/IPV Elder Abuse/Neglect Sexual Assault

Is Your Agency Ready to Serve Transgender and Non-Binary Clients?

I just discovered that FORGE has recently published a self-assessment, Is Your Agency Ready to Serve Transgender and Non-Binary Clients, and before you are all, of course, we are, we already do, may I suggest you take a good long look at the tool. Then at your program. And then start making the fixes you need to make. Bonus: if you’re in program development mode like we are right now, it’s like a glorious (albeit extensive) checklist. Not everything will be applicable, but enough of it is that you should download this ASAP.

Excellent work, team FORGE. This is a great (and much needed) resource.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Since Last We Spoke, 5-13-19

Greetings from cold and rainy DC. I was super privileged to spend a very satisfying day with the NY state IAFN chapter last Friday talking testimony. A lot of great conversation, many insightful questions, and just such good people. So much fun.

I’m back home this week because the work never stays put on the calendar, and now all my April and May work is August and September work, so it gives me plenty of time to wrap up some odds and ends, and maybe get something new going. I’m also prepping for the big graduation in a few weeks, and after that, a couple weeks in Japan. But for now, I’m staying put; here’s what caught my eye since last we spoke:

How women and minorities are claiming their right to rage

Generic HIV drugs will soon be within reach

I frequently play patriarchy chicken–most often in airports and on airplanes

NIWRC has a new special collection on Missing and Murdered Indigenous Women and Girls

Come on, Nike, do better

Let’s talk about how to end sexual violence

A poem to live by:

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
DV/IPV

No Visible Bruises

I am about a third of the way through the newly published book, No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us. It is extremely well-written, and although this is my area of expertise, I still find the book compelling. I am not alone in this (reviews here and here). You’ll find a lot of familiar names, hear so much that is familiar from your own patients, and yet…

Tuesday, Terri Gross interviewed the author, Rachel Louise Snyder, and Suzanne Dubas, the CEO of one of the programs featured in her book. It’s worth your time.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Sexual Assault

Teen Sex Trafficking: Recognizing the Signs and Creating a Safe Space for Disclosure

Evidentia Publishing (publishers of the IAFN Pediatric Strangulation Case Review and Assessment) and MobileODT are co-hosting a webinar May 14th at 2pm ET, Teen Sex Trafficking: Recognizing the Signs and Creating a Safe Space for Disclosure. I haven’t attended any of their offerings before so I cannot tell you much except that it is an industry-sponsored event, for what that’s worth. I would expect some product promotion, but hopefully, there’s also some quality content contained in the session:

The average age of a victim’s entrance into sex trafficking is between 12 – 14 years old. At this developmental stage, teens are especially vulnerable to traffickers and may not even realize that they are victims of trafficking.

So how can healthcare professionals recognize the signs of sex trafficking and create a safe space for disclosure?

Our live webinar (co-hosted by MobileODT and Evidentia Publishing) featuring leading child abuse expert, Jordan Greenbaum, MD, Medical Director of the Global Health and Well-being Initiative with the International Centre for Missing and Exploited Children, is not to be missed. Be a part of the learning experience – get answers from experts and feedback from peers on this critical issue!

Gain knowledge in:

  • Definitions and signs of sex trafficking in teens – what in adolescent development makes them vulnerable
  • Using a trauma informed approach with adolescents in healthcare settings
  • How forensic exams and medical documentation may be different for this population

Register for the webinar here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Thank You!

Because of the volume of offers to review the latest research compilation, I cannot respond individually to everyone. I have reached out to those who I have asked to review at this point. So allow me to say thank you to everyone who sent me their CVs. I will hold on to them for future compilations. Your willingness to review was epic much appreciated!

Categories
Sexual Assault

Demystifying Care of Patients with Mental Illness Following a Sexual Assault

SAFEta has a webinar coming up next month, Demystifying Care of Patients with Mental Illness Following a Sexual Assault. The session will be held June 10th at 2pm ET. As with all of their offerings, it will be archived in case you can’t attend live. From the website:

Recent research suggests that up to 40% of patients who present for care following a sexual assault have some history of mental illness. But there has been limited academic work that examines unique considerations that may arise when caring for this patient population. How do we best provide medical care and forensic services for patients with mental illness in the acute setting following a reported sexual assault? How do we determine when it is, and is not, appropriate to offer a sexual assault medical forensic exam (SAMFE)? In this webinar, an interdisciplinary panel of SANEs and psychiatrists will highlight some of the challenges faced and questions that may arise, including:

What does the research suggest about prevalence of various mental illness among victims of sexual assault? What is the relationship between experiencing trauma and developing symptoms of mental illness? What are the practice implications?

What are some circumstances in which a patient’s mental illness may limit their capacity to consent an SAMFE? How should we perform capacity assessments in these patients?

What signs and symptoms of mental illness may not preclude capacity, but otherwise interfere with the SAMFE? How can we conceptualize other factors of a patient’s presentation when assessing whether the SAMFE is appropriate?

What are some approaches that can be used when providing a SAMFE to a patient with mental illness, to facilitate delivery of compassionate and safe care?

Register for the webinar here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Since Last We Spoke, National Nurses Week 2019 Edition

A happy National Nurses Week this week! Here’s hoping you are feeling the love wherever you are working this week–I will have the good fortunate of spending part of it with my friends and colleagues in New York where I will be collaborating on a testimony workshop with members of the NY State IAFN chapter. Seriously looking forward to that trip.

Also, Ramadan Mubarak to all observing this holy month. Peace and blessings to you.

I worked most of the weekend, but I managed to get a fair bit of reading done. Here’s what caught my eye since last we spoke:

Frustrating news from the Pentagon

And the military story I want to hear

Coworkers keep mixing up people of color

Whew, this discrimination suit at Mount Sinai is no joke. Wishing peace and power to all those women.

Confronting institutionalized racism in nursing

The myth of testosterone

This story about women having to do men’s emotional labor was a ride

Wonder if this really will buy you more time

If you could win a Pulitzer for a headline…(also, seriously)

The best thing I saw this weekend:

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
DV/IPV Sexual Assault Testimony

Peer Reviewers Needed

Looking for a few folks who are interested in being peer reviewers for the next research compilation on strangulation. This compilation is much lengthier (it’s clocking in at about 25 pages, so it’s monograph-length), so you have been warned.

If you would like to be considered, and you have the time to do a thorough review in the next two weeks, please email me (jenifer.markowitz@gmail.com since you cannot attach a CV to the Contact email on the site) along with a copy of your CV. This is meant to assist clinicians with being better prepared to go to court, so I need folks who have some experience in—well, preparing to go to court. I’m less concerned about formal educational credentials, but you do need to be comfortable reading research. You do not have to be a nurse. I am equally interested in the opinions of physicians, attorneys, and other professionals who read this site who have served as expert witnesses in the past. In fact, I always have one non-nurse reviewer.

All reviewers will receive a copy of the final research compilation once it’s published, along with the other two research compilations in the store (if you don’t have them, or you want to give them to someone else, your choice).

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Sexual Assault

Updated Clinical Guide: Use of ALS to Identify Fluids on the Body

We can’t update Part II and not update Part I, so here’s the updated clinical guide, Use of ALS to Identify Fluids on the Body. There’s much less new here, but it’s nice to be complete. Let me know if I’m missing something, but I think all the peer-reviewed literature is there. Please don’t read one clinical guide without the other–much of what is contained in the ALS for Bruising guide is applicable, particularly as it concerns understanding the underlying science of how ALS works and its limitations.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault Testimony

Updated Clinical Guide: Use of ALS to Identify Bruising

In anticipation of the next research compilation, I have updated one of the most popular clinical guides on the site, Use of ALS to Identify Bruising. There have been a number of research articles published since the guide was last updated, so those have been added.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
DV/IPV Sexual Assault

Late Notice: Webinars from IAFN and NIWRC

Starting this week off with a couple of late notice webinars for you, rather than our usual Monday offering, since both are good ones that simply ended up on my radar after last week’s posts:

First up: IAFN’s continuing webinar series, Medical-Forensic Evaluation of Asylum Seekers holds its 4th session, The Evaluation of Women Asylum Seekers. It’s live on May 3rd from 1-2:30pm ET. It will also be archived if you can’t make it at that time or it’s full (max registrants is 200). It’s free for IAFN members, and includes 1.5 nursing CEUs. Previous sessions in the series include:

  • Legal Framework for Immigrant Victims & Introduction to the Istanbul Protocol (Completed November 15.  Available in the Online Learning Center)
  • The Clinical Interview & Considerations for Vulnerable Populations (Completed December 11.  Available in the Online Learning Center)
  •  Physical Exam & Utilizing the Istanbul Protocol (Completed April 17.)

Register for the webinar here.

The second webinar is from the National Indigenous Women’s Resource Center (NIWRC). They are holding a session on May 2nd at 3pm ET, Honoring Missing and Murdered Indigenous Women to Guide Our Advocacy for Change. They also archive their webinars if you cannot attend the event live. From the announcement:

During the period of 1979 through 1992, homicide was the third-leading cause of death of Indian females aged 15 to 34, and 75 percent were killed by family members or acquaintances. In 2005, the movement for safety of Native women resulted in the “Safety for Indian Women” being included under the Violence Against Women Act.  A study released by the U.S. Department of Justice has found that in some tribal communities, American Indian women face murder rates that are more than 10 times the national average. Over the last decade awareness of this national issue has increased but more must be done to stop disappearances and save lives.  Please join us on May 5th, 2019, as we honor missing and murdered Indigenous women and together increase our national awareness and demand change at the tribal, federal and state levels.

Register for the session here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Elder Abuse/Neglect

WEAAD 2019: Lifting Up Voices of Older Survivors

On June 5th at 2pm ET, the National Clearinghouse on Abuse in Later Life (NCALL), in collaboration with the National Center on Elder Abuse (NCEA), will be hosting a webinar to preview a draft of their new video series, Lifting Up the Voices of Older Survivors. The webinar will be in anticipation of World Elder Abuse Awareness Day, (June 15th) and it’s a particularly good one for your multidisciplinary teams. For those of you looking at expanded practice, this is a great opportunity to begin that conversation. I’m looking forward to seeing the video series, myself.

Register for the webinar here.

Read more about the video series here.

Check out the most recent research compilation from NCEA here (PDF).

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Sexual Assault

Identifying and Protecting Campus Survivors’ Privacy Rights: Schools, SANEs, and Student Survivors

Victim Rights Law Center has a webinar coming up on one of my favorite topics–patient privacy. That will be the focus of the session, Identifying and Protecting Survivors’ Privacy Rights: Schools, SANEs and Student Survivors, which will be held May 16th at 1pm ET. It’s a topic that’s pretty relevant to my work right now, and I know I’m not the only one. The always excellent Kim Day and Jesse Mindlin will be presenting, so try and attend if you can. I imagine it’ll be archived, but I don’t have fidelity on that yet. From the registration page:

During this webinar, Jessica Mindlin and Kim Day will discuss unique privacy issues campus sexual assault survivors face. Objectives include: outlining care-related privacy issues a survivor may confront post-assault; describing SANE privacy obligation when providing care to student survivors; and identifying and anticipating medical forensic exam-related privacy considerations for student survivors and the sexual assault examiner who provides their assault-related care.

You can register here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Since Last We Spoke, 4-22-19

For those of you celebrating, I hope your Pesach/Easter was filled with peace and love (and good food). We had a house full, and the aftermath took a full day from which to recover, but it’s still one of my favorite holidays of the year. Especially because this year the guests ranged from 10 months old to 90. I was heartbroken to wake up Sunday to the news in Sri Lanka; one of the couples around our Seder table had recently been there, which is really neither here, nor there, but just one of those small details that make me cherish the here and now in all its small and messy glory. With the cooking and the girlchild being in town and all of the cleanup after, there really wasn’t much time for surfing, but here are a couple things that caught my eye since last we spoke:

Getting home from MSU Friday was an ordeal that included multiple modes of transportation, a canceled flight, and a lucky spot on the standby list. On the 2-hour bus ride (!) that unexpectedly became part of my journey, I finished the new Beyonce documentary. Here’s your reading list once you’ve watched it (and you really should watch it).

Stop treating nonprofits like businesses

A look at Queens’ Human Trafficking Intervention court

Your weekly dose of rage-inducement

…And maybe the story you need this week

Forced sterilization is not just a historical artifact

As someone who believes in getting paid for their labor, this article really spoke to me. I do not work for exposure. That’s not to say I don’t donate my time to causes I deem to be important to me, but there is a calculus behind that decision, and it’s one I make. If you ask me to speak, you must pay me.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Sexual Assault

A Few Updates RE: STDs

A few new updates re: STDs (since April is STD Awareness Month, in addition to Sexual Assault Awareness and Child Abuse Prevention Months)

There’s new surveillance data out from the CDC on extragenital chlamydia and gonorrhea infections in men who have sex with men, and it’s certainly relevant to sexual assault practice, so if you haven’t read the report, you can find it here. The study’s limited in that it only includes samples from 5 cities (and it’s critical you know what the incidence and prevalence rates are in your own service area), but it’s a good reminder that we need to consider more than just potential genital infection.

Not so coincidentally, I noticed IAFN posted this report to their social media pages today–apparently once again we can blame it on the hive mind. I haven’t had the opportunity to read it yet, but I’m about to get on a plane, and nothing says leave me alone like a report with the words syphilis and gonorrhea in the title 🙂

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Sexual Assault

Sexual Assault Examiner Skills Sustainability

The Tribal Forensic Healthcare project has a webinar coming up in June that touches on a topic I have yet to see as the subject of a webinar: Sexual Assault Examiner Skills Sustainability. The session will be held June 21st at 1pm ET. All their webinars are archived; the session includes nursing and physician continuing education units (so it’s great for those of you looking at SANE recertification). From the announcement:

It can be difficult to maintain and practice the specific skills required to remain competent and confident in the role of sexual assault nurse examiner. This webinar will discuss the need for assessing competency, a variety of ways to address or measure competency, and review the process of moving from novice to expert in this specialty role.

Register here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Since Last We Spoke, 4-15-19

I’m heading back up to MSU this week, and then I come home to seder-hosting duties (we’ll be 10 at my table this year), so the week is a hectic one. I’m trying to finish off the draft of my next FHO research brief– my goal is to have it in the store by the end of next month, so I spent most of the weekend working on that while Sash was down at Ft. Bragg. But I managed some late night surfing–here’s what caught my eye since last we spoke:

Mothers vs fathers on the campaign trail

Applying for a new job and need a great example of a cover letter? This is an excellent one.

A tragic tale of being a woman in the world

Time for women in the world to set the agenda.

If you are a list person, this is a good read

America’s leaders need sex ed

By now you’ve probably heard about the woman whose work allowed black holes to be photographed, but have you also heard about how this has made her a target for trolls?

Tips for receiving critical feedback

Protecting yourself on airlines

Here’s the piece you need to start your week off right

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Articles of Note Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault Testimony

Articles of Note, April 2019 Edition

Time once again for Articles of Note, our monthly frolic through the peer-reviewed literature. I assure you, this month’s is *full* of science you’re going to want to read, some of which is freely available through the links posted below. Everything else takes you to PubMed abstracts, which should take you down some excellent rabbit holes of their own. Happy reading!

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.