Banshee is an American crime drama television series created by Jonathan Tropper and David Schickler for Cinemax. The series takes place in the fictional small town of Banshee, Pennsylvania. After serving 15 years in prison for stealing diamonds from Ukrainian gangster Rabbit (Ben Cross), the unnamed protagonist (Antony Starr) travels to Banshee to find his heist accomplice and former lover, Anastasia (Ivana Miličević). When he finds her, the protagonist learns that she is now a married mother of two living under the assumed identity of Carrie Hopewell. Later, when the incoming Sheriff is killed, the protagonist takes on his identity as Lucas Hood, becoming the town's new Sheriff, using his own brand of unorthodox methods. Banshee sees Hood struggle with adapting to his new identity while dealing with the machinations of local crime lord Kai Proctor (Ulrich Thomsen), and remaining hidden from Rabbit.[1][2] The series premiered on January 11, 2013.
The victim of sexual abuse requires to be examined by a competent clinician with a comprehensive knowledge of his/her forensic and therapeutic role. Essential components of a sexual forensic examination (Table 1) must be described in a standardized medico-legal report, with objective terms, providing expert opinion in legal proceedings, but in a language readable by police and lay people.11 Ingemann-Hansen O, Charles AV. Forensic medical examination of adolescent and adult victims of sexual violence. Best Pract Res Clin Obstet Gynaecol 2013;27(01):91-102. Doi: 10.1016/j.bpobgyn.2012.08.014
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It is important consider the clinical context in which the clinical environment in which physical and genital examinations were performed, and the expertise of the clinician. It is clear that clinicians or nurses with different training levels will bring different competencies to the clinical forensic examination, and this will influence their findings. The venue can be a referral unit, center or any variant of this model care (e.g., emergency unit). Both examiner and place heterogeneities may explain the different outcomes that a sexual forensic examination can have.22 Kennedy KM. Heterogeneity of existing research relating to sexual violence, sexual assault and rape precludes meta-analysis of injury data. J Forensic Leg Med 2013;20(05):447-459. Doi: 10.1016/j.jflm.2013.02.002
The vaginal epithelium is characteristically thin in childhood, but after puberty, it begins to thicken in response to estrogen stimulation with progressive cellular proliferation and growth that results in the formation of intermediate and superficial layers of cells,88 Colvin CW, Abdullatif H. Anatomy of female puberty: The clinical relevance of developmental changes in the reproductive system. Clin Anat 2013;26(01):115-129. Doi: 10.1002/ca.22164 which could make the vagina more resistant to friction. Although it could be deduced that children may get genital injuries easily, most sexually abused children will not have signs of genital or anal injury, especially when examined non-acutely.99 Adams JA, Farst KJ, Kellogg ND. Interpretation ofmedical findings in suspected child sexual abuse: an update for 2018. J Pediatr Adolesc Gynecol 2018;31(03):225-231. Doi: 10.1016/j.jpag.2017.12.011 Moreover, the primary predictor of diagnostic findings was not the age, timing of the examination, or the history told by the adult, but the history reported by the child.1010 Gallion HR, Milam LJ, Littrell LL. Genital findings in cases of child sexual abuse: genital vs vaginal penetration. J Pediatr Adolesc Gynecol 2016;29(06):604-611. Doi: 10.1016/j.jpag.2016.05.001
The prevalence of genital injuries reported after sexual assault ranges between 5 and 87%, according to a meta-analysis conducted by Kennedy.22 Kennedy KM. Heterogeneity of existing research relating to sexual violence, sexual assault and rape precludes meta-analysis of injury data. J Forensic Leg Med 2013;20(05):447-459. Doi: 10.1016/j.jflm.2013.02.002 The same study found a mean prevalence of 34.8%. However, the authors claimed that they were unable to draw firm conclusions about the precise prevalence of genital injuries due to the heterogeneity of research methodologies. In a more recent and bigger work,1616 Zilkens RR, Smith DA, PhillipsMA, Mukhtar SA, Semmens JB, Kelly MC. Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault. Forensic Sci Int 2017;275:195-202. Doi: 10.1016/j.forsciint.2017.03.013 genital injuries were detected in 22.0% of women examined at a sexual assault referral center (SARC). Nevertheless, while genital injuries were found in 24.5% of women who alleged complete vaginal penetration, only 13.2% of women with suspected sexual assault but no clear type of penetration had similar findings.
To improve the accuracy of interpretation of physical findings, some years ago a pattern of genital injuries in female victims was defined, whose acronym is TEARS1717 Slaughter L, Brown CRV, Crowley S, Peck R. Patterns of genital injury in female sexual assault victims. Am J Obstet Gynecol 1997;176(03):609-616. Doi: 10.1016/s0002-9378(97)70556-8 -9378(97)70... : Tears (lacerations), Ecchymosis (bruises), Abrasions, Redness and Swelling. Another classification considers abrasions, bruises and wounds, which can be lacerations or incisions.1818 Dalton M, Ed. Forensic gynaecology: advanced skills series. Cambridge: Cambridge University Press; 2015 Many studies, however, have excluded erythema, redness and swelling when calculated injury rates as they are more subjective. These studies tend to have lower injury rates than those using the TEARS system, making comparison difficult.33 White C. Genital injuries in adults. Best Pract Res Clin Obstet Gynaecol 2013;27(01):113-130. Doi: 10.1016/j.bpobgyn.2012.08.011
Another issue to consider is the timing of sexual assault and healing. The knowledge of injury healing may assist to decide the urgency with which an examination is performed. In some cases, the age of an injury might assist in determining who had access to the victim during the specified timeframe. Police or the court may ask the clinician to consider how old a genital injury is, and this may help to determine whether it was a result of previous consensual intercourse or a later alleged assault. On the other hand, many studies did not stipulate injury rates as genitalia tend to heal quickly.33 White C. Genital injuries in adults. Best Pract Res Clin Obstet Gynaecol 2013;27(01):113-130. Doi: 10.1016/j.bpobgyn.2012.08.011
From a therapeutic and forensic perspective, a differential diagnosis is crucial. In both settings, the professional could be asked whether the genital findings resulted from an alleged assault or have another explanation. Therefore, awareness of medical conditions that affect the genitals can significantly reduce stress in patients and their surroundings, and lead to an accurate diagnosis. There are several conditions that might be confused with injuries such as allergy, eczema, psoriasis, infections (e.g., candida), and normal anatomical variations, amongst others. Consequently, obtaining a full history, when indicated, is a critical element to establish the context in which these findings should be interpreted.33 White C. Genital injuries in adults. Best Pract Res Clin Obstet Gynaecol 2013;27(01):113-130. Doi: 10.1016/j.bpobgyn.2012.08.011 ,2323 American Academy of Pediatrics. Supplemental Information Appendix. Conditions that may be mistaken for child sexual abuse. Pediatrics 2013;132(02):s1-s8
Based upon the theory that genital injuries might be more likely to occur or be more severe in those cases without consent, the presence, pattern and/or severity of genital injury might be helpful in answering the question about consent. However, this hypothesis is outdated. Although the aforementioned studies done by Astrup et al3434 Astrup BS, Ravn P, Thomsen JL, Lauritsen J. Patterned genital injury in cases of rape-a case-control study. J Forensic Leg Med 2013;20(05):525-529. Doi: 10.1016/j.jflm.2013.03.003 and by Lincoln et al3535 Lincoln C, Perera R, Jacobs I, Ward A. Macroscopically detected female genital injury after consensual and non-consensual vaginal penetration: a prospective comparison study. J Forensic Leg Med 2013;20(07):884-901. Doi: 10.1016/j.jflm.2013.06.025 reported that cases had significantly more abrasions and bruises, and a higher frequency of multiple lesions, the small sample size of the former and the delayed cases examination of the latter affect this presumption. Anderson et al3737 Anderson SL, Parker BJ, Bourguignon CM. Predictors of genital injury after nonconsensual intercourse. Adv Emerg Nurs J 2009;31(03):236-247. Doi: 10.1097/TME.0b013e3181afd306 shows that there were differences in the types of injuries and the total numbers of injuries between the nonconsensual and the consensual groups. Except for redness, there were more sites of injury in the nonconsensual group than in the consensual group, where lacerations, ecchymosis, and abrasions were greater in the nonconsensual than in the consensual group. One remaining chance to keep this hypothesis as partially valid is the use of standardized scales such as the Genital Injury Severity Scale developed by Kelly et al1515 Kelly DL, Larkin HJ, Cosby CD, Paolinetti LA. Derivation of the Genital Injury Severity Scale (GISS): a concise instrument for description and measurement of external female genital injury after sexual intercourse. J Forensic Leg Med 2013;20(06):724-731. Doi: 10.1016/j.jflm.2013.04.012 to define and measure external genital injury after sexual intercourse. However, they need to be validated prospectively in an unbiased/unselected population.
Astrup et al3434 Astrup BS, Ravn P, Thomsen JL, Lauritsen J. Patterned genital injury in cases of rape-a case-control study. J Forensic Leg Med 2013;20(05):525-529. Doi: 10.1016/j.jflm.2013.03.003 described that victims had a higher frequency of lesions in locations other than the 6 o'clock position. However, controls had a significantly higher frequency of lesions in the 6 o'clock position than cases when the naked eye and toluidine blue dye were used. Also, the cases had a significantly higher frequency of lesions on the labia than controls when colposcope and toluidine blue dye were used. None of the investigated women had lesions in the vagina or cervix. 2ff7e9595c
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