Category Archives: Forensic pathology

Journal articles relating to forensic pathology including coronial autopsies and Disaster victim identification.

Quads, farmers 50+ years of age, and safety in Australia

Safety 2016, (2), 12; doi:10.3390/safety2020012

Quads are the leading cause of fatal non-intentional injuries on Australian farms. Due to normal age-related physiological and cognitive changes, farmers 50-years of age and above are at increased risk when using quads. This study identifies a non-statistically significant increasing trend for fatal quad incidents involving this cohort in Australia. It is contended that these vehicles are not “fit-for-purpose” for many typical agricultural tasks more broadly and that the ageing process further exacerbates these risks. Encouraging and promoting the use of more “fit-for-purpose” vehicles in the agricultural sector should be the primary focus of intervention approaches. Supplementing this, other approaches that reduce risks, specifically relating to rollovers, crush/asphyxiation and head injuries must be enacted.

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Forensic pathologist consensus in the interpretation of photographs of patterned injuries of the skin

J. Forensic Sci. 2016; 61(4): 972-978;  DOI: 10.1111/1556-4029.13092

Forensic pathologists are commonly asked to evaluate injuries on the basis of photographs. Members of the National Association of Medical Examiners were asked to participate in an online survey in which they were presented with 68 patterned injuries of the skin and asked to make a diagnosis ranging from very general (e.g., “blunt” vs. “sharp”) to specific (e.g., “baton blow”). This was not the case. Consensus for general diagnosis averaged 0.77 and 0.72 for specific diagnosis. While there was a strong correlation between consensus and confidence in aggregate, individual correlations were poor. Consensus diagnosis was inversely correlated with age, and positively correlated with jurisdictional size, medical degree, and whether or not the respondent was actively performing autopsies as a job function. A subsequent survey is exploring possible reasons for lack of consensus in low-consensus questions. The high correlation between confidence and consensus at the aggregate level and low correlation at the individual level may have implications for quality assurance protocols.

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Cyanide suicide after deep web shopping: a case report

American Journal of Forensic Medicine & Pathology July 2016; DOI: 10.1097/PAF.0000000000000241

Cyanide is a product that is known for its use in industrial or laboratory processes, as well as for intentional intoxication. The toxicity of cyanide is well described in humans with rapid inhibition of cellular aerobic metabolism after ingestion or inhalation, leading to severe clinical effects that are frequently lethal. We report the case of a young white man found dead in a hotel room after self-poisoning with cyanide ordered in the deep Web. This case shows a probable complex suicide kit use including cyanide, as a lethal tool, and dextromethorphan, as a sedative and anxiolytic substance. This case is an original example of the emerging deep Web shopping in illegal drug procurement.

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Elevation of post mortem vitreous humour sodium and chloride levels can be used as a reliable test in cases of suspected salt water drowning when the immersion times are less than one hour

Forensic Science International Volume 266, September 2016, Pages 338–342;    doi:10.1016/j.forsciint.2016.06.001

Background

Previous studies in salt water drowning deaths (SWD) demonstrated an observable elevation of post mortem vitreous sodium and chloride (PMVSC) levels. It remains unclear what the underlying mechanism responsible for this change is: whether this is due to rapid electrolyte changes from salt water inhalation/ingestion during drowning or from electrolyte diffusion and/or osmosis across the outer coats of the eyeballs during immersion. A recent animal study using sacrificed bovine eyeballs immersed in salt water demonstrated no significant elevations in PMVSC when immersed for less than one hour. Assuming similar physical properties between human and bovine, we extrapolate that an elevation in PMVSC in SWD with immersion times of less than one hour (SWD-1) would not be from immersion, but from drowning.

Aim

Investigate whether there is an elevation in PMVSC in SWD-1.

Methods

Retrospective study comparing PMVSC in SWD-1 with controls from 2012 to 2015 inclusive.

Results

PMVSC in SWD-1 was significantly elevated compared with controls. A PMVSC of 259 mmol/L has a sensitivity, specificity and likelihood ratio of 0.9, 0.9 and 7.6, respectively.

Conclusion

The elevation in PMVSC in SWD-1 is due to drowning. A PMVSC of 259 mmol/L and above is a reliable ancillary test in diagnosing drowning in bodies immersed in salt water for less than one hour.

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Genomic research with the newly dead: a crossroads for ethics and policy.

J Law Med Ethics. 2014 Summer;42(2):220-31. doi: 10.1111/jlme.12137.

Recent advances in next generation sequencing along with high hopes for genomic medicine have inspired interest in genomic research with the newly dead. However, applicable law does not adequately determine ethical or policy responses to such research. In this paper we propose that such research stands at a crossroads between other more established biomedical clinical and research practices. In addressing the ethical and policy issues raised by a particular research project within our institution comparatively with these other practices, we illustrate the moral significance of paying careful heed to where one looks for guidance in responding to ethical questions raised by a novel endeavor.

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Implementation of Child Death Review in the Netherlands: results of a pilot study

BMC Health Services Research 201616:235  DOI: 10.1186/s12913-016-1500-9

Background

Child mortality in the Netherlands declined gradually in the past decades. In total 1130 children and youth aged 0 to 19 years died in 2014 (i.e. 29.4 per 100,000 live births). A better understanding of the background and the circumstances surrounding the death of children as well as the manner and cause of death may lead to preventive measures. Child Death Review (CDR) is a method to systematically analyze child deaths by a multidisciplinary team to identify avoidable factors that may have contributed to the death and to give directions for prevention. CDR could be an addition to further reduce avoidable child deaths in the Netherlands. The purpose of this study is to explore the strengths, weaknesses, opportunities and threats (SWOT) of the pilot-implementation of CDR in a Dutch region. The results are translated in recommendations for future implementation of the CDR method in the Netherlands.

Methods

Children who lived in the pilot region and died aged 29 days after birth until 2 years were, after parental consent, included for reviewing by a regional CDR team. Eighteen logs and seven transcribed records of CDR meetings concerning 6 deceased children were analyzed using Atlas ti. The SWOT framework was used to identify important themes.

Results

The most important strengths identified were the expertise of and cooperation within the CDR team and the available materials. An important weakness was the poor cooperation of some professional groups. The fact that parents and professionals endorse the objective of CDR was an important opportunity. The lack of statutory basis was a threat.

Conclusions

Many obstacles need to be taken away before large-scale implementation of CDR in the Netherlands becomes possible. The most important precondition for implementation is the acceptance among professionals and the statutory basis of the CDR method.

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Ethical and Legal Challenges Associated with Public Molecular Autopsies

Journal of Law, Medicine & Ethics.  Vol. 44 Issue 2, 2016 pp 309-318

There is a national movement supporting the retention and use of bio-specimens from deceased individuals for the purpose of genetic testing.1 Studies have identified mutations that scientists believe can cause sudden unexpected death, and funding for a national registry for sudden death in the young (SDY) has been granted to several states to promote investigation into the causes of and risk factors for SDY.2 Medico-legal death investigators, particularly Medical Examiners (ME),3 are being called upon to develop systematic protocols to collect and retain bio-specimens for future use, and some ME offices are
going further by performing postmortem genetic testing themselves.

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