Category Archives: Forensic pathology

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

Reference Manual on Scientific Evidence: Third Edition (2011)

National Academies Press  ISBN: 978-0-309-21421-6

The Reference Manual on Scientific Evidence, Third Edition, assists judges in managing cases involving complex scientific and technical evidence by describing the basic tenets of key scientific fields from which legal evidence is typically derived and by providing examples of cases in which that evidence has been used.

First published in 1994 by the Federal Judicial Center, the Reference Manual on Scientific Evidence has been relied upon in the legal and academic communities and is often cited by various courts and others. Judges faced with disputes over the admissibility of scientific and technical evidence refer to the manual to help them better understand and evaluate the relevance, reliability and usefulness of the evidence being proffered. The manual is not intended to tell judges what is good science and what is not. Instead, it serves to help judges identify issues on which experts are likely to differ and to guide the inquiry of the court in seeking an informed resolution of the conflict.

The core of the manual consists of a series of chapters (reference guides) on various scientific topics, each authored by an expert in that field. The topics have been chosen by an oversight committee because of their complexity and frequency in litigation. Each chapter is intended to provide a general overview of the topic in lay terms, identifying issues that will be useful to judges and others in the legal profession. They are written for a non-technical audience and are not intended as exhaustive presentations of the topic. Rather, the chapters seek to provide judges with the basic information in an area of science, to allow them to have an informed conversation with the experts and attorneys.

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Informatics and Autopsy Pathology

Surgical Pathology Clinics Available online 26 March 2015;  doi:10.1016/j.path.2015.02.010

Many health care providers believe that the autopsy is no longer relevant in high-technology medicine era. This has fueled a decline in the hospital autopsy rate. Although it seems that advanced diagnostic tests answer all clinical questions, studies repeatedly demonstrate that an autopsy uncovers as many undiagnosed conditions today as in the past. The forensic autopsy rate has also declined, although not as precipitously. Pathologists are still performing a nineteenth century autopsy procedure that remains essentially unchanged. Informatics offers several potential answers that will evolve the low-tech autopsy into the high-tech autopsy.

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Cause of death [Feature]

Science 27 March 2015:  Vol. 347 no. 6229 pp. 1410-1413
DOI: 10.1126/science.347.6229.1410

As startling as it sounds, health experts don’t really know what kills many people worldwide. They’re especially likely to be in the dark when the cause was some kind of infection and the victim was a child. And without this information, health officials don’t know where to focus limited dollars, or how well current disease-reduction programs work. Researchers are therefore hoping that minimally invasive autopsies (MIAs)—which take fluids and bits of tissue from a half-dozen organs and examine them in the lab—can substitute for full autopsies and provide critical mortality data. The general idea of MIAs actually dates back several decades, but they have become a hot idea as international health agencies seek crucial data on causes of death. That’s why teams in several countries, including Mozambique, have spent the past few years testing both the scientific validity and cultural acceptability of MIAs—with an eye toward expanding them across the globe.

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Deaths linked to synthetic cannabinoids

Forensic Science, Medicine, and Pathology March 2015

Over the last 5 years there has been an influx of novel designer drugs (mostly illegal) which are intended to mimic the effects of cannabis (synthetic cannabinoids). Many of these compounds are created by research groups attempting to find an analog of cannabis that can be used therapeutically to treat pain and other conditions.
PB-22 (1-pentyl-8-quinolinyl ester-1H-indole-3-carboxylic acid) is a relatively new synthetic cannabinoid which has cannabis like activity and possibly other as yet unknown effects. There is no published data on the pharmacodynamics, pharmacokinetics or toxicology of PB-22. However, a recent publication has reported 4 deaths associated with use of 5F-PB-22 which is a derivative of PB-22 [1]. Although synthetic cannabinoids have been reported in association with sudden death, the precise pathophysiological mechanisms by which death occurs remain obscure.

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Histologic validation of locus coeruleus MRI contrast in post-mortem tissue

NeuroImage Available online 17 March 2015; doi:10.1016/j.neuroimage.2015.03.020

The locus coeruleus (LC) noradrenergic system regulates arousal and modulates attention through its extensive projections across the brain. LC dysfunction has been implicated in a broad range of neurodevelopmental, neurodegenerative and psychiatric disorders, as well as in the cognitive changes observed during normal aging. Magnetic resonance imaging (MRI) has been used to characterize the human LC (elevated contrast relative to surrounding structures), but there is limited understanding of the factors underlying putative LC contrast that are critical to successful biomarker development and confidence in localizing nucleus LC. We used ultra-high-field 7 T magnetic resonance imaging (MRI) to acquire T1-weighted microscopy resolution images (78 μm in-plane resolution) of the LC from post-mortem tissue samples. Histological analyses were performed to characterize the distribution of tyrosine hydroxylase (TH) and neuromelanin in the scanned tissue, which allowed for direct comparison with MR microscopy images. Our results indicate that LC-MRI contrast corresponds to the location of neuromelanin cells in LC; these also correspond to norepinephrine neurons. Thus, neuromelanin appears to serve as a natural contrast agent for nucleus LC that can be used to localize nucleus LC and may have the potential to characterize neurodegenerative disease.

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Sudden unexpected death in infancy: aetiology, pathophysiology, epidemiology and prevention in 2015 [Review]

Arch Dis Child  Online 19 February 2015 doi:10.1136/archdischild-2014-306424

Despite the fall in numbers of unexpected infant deaths that followed the ‘Back to Sleep’ campaigns in the early 1990s in the UK and many other countries, such deaths remain one of the largest single groups of deaths in the postneonatal period in many Western countries. Changes in the ways in which unexpected infant deaths are categorised by pathologists and coroners, and increasing reluctance to use the term ‘sudden infant death syndrome’, make assessment of nationally and internationally collected data on incidence potentially inaccurate and confusing. In this paper, we review current understanding of the epidemiology and aetiology of unexpected deaths in infancy, and current hypotheses on the pathophysiology of the processes that may lead to death. We also review interventions that have been adopted, with variable degrees of effectiveness in efforts to reduce the numbers of deaths, and new approaches that offer the possibility of prevention in the future.

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The role of forensic death investigators interacting with the survivors of death by homicide and suicide

J. Forensic Nurs. 2015; 11: 28-32;  doi: 10.1097/JFN.0000000000000058

When sudden unexpected death occurs, an investigation ensues in an attempt to discover the cause and manner of death. Autopsies are performed when reasons for death are not obvious. They are used to provide information, confirm the cause of death, and/or reveal conditions not recognized before death (Hendricks, 2011). One important reason for performing an autopsy is to help families to understand what happened to their loved one so that they can begin the process of grieving. The way that the initial notification and investigation is handled can have a bearing on how a family’s grief progresses. Forensic nurses are in a unique position to bring a holistic approach to death investigation with a focus of care that includes not only the decedent but the surviving loved ones as well (Koehler, 2008). Forensic nurse death investigators can assist families through initial stages of grief in the investigation of death.

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