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Studying post-mortem changes based on signs of decomposition (e.g., using scoring models) is one of the methods used in scientific studies to relate observable changes to the postmortem interval (PMI). The majority of the studies on cadaver decomposition are based on large cadavers. There is limited literature on the decomposition pattern and rate of small cadavers, even though it is at least as important to be able to estimate the PMI for infants and subadults. Therefore, it is crucial to acquire knowledge of the decomposition process of child-sized remains. To fill this knowledge gap, a season-based subaerial outdoor decomposition study was conducted with small pig cadavers at the Forensic Anthropological Outdoor Research Facility located in Den Ham, The Netherlands, over a period of 4 years. Den Ham is located in the eastern part of the Netherlands, close to the German border, and has a temperate maritime climate, with a Cfb classification according to the Köppen–Geiger system. Salient findings were acquired during the decomposition study, specifically regarding a deviating decomposition rate during winter and the subsequent spring, reproducibility, the effect of body weight, post-mortem movement, the effect of heavy rainfall on insect activity, delayed bloating, the interaction of different insect species, and invertebrate activity. This article includes a systemic review of the results obtained during this four-year decomposition study and discusses the impact of the findings on the estimation of the PMI.

Introduction In 2012 and 2013 a movie and a book about a ‘dignified end of life’ were published in the Netherlands. These items described suicide using an ‘exit bag’ to establish asphyxiation using helium (the helium method). ‘Right-to-die-organisations’ inform the elderly about this method. The purpose of this study is to investigate whether the use of suicidal asphyxiation by means of the helium method substituted other, related, methods following its publication in the Netherlands. Material and methods We analysed suicides in the Netherlands over the period from 1 July 2012 to 30 June 2019. We compared the number of deaths caused by the helium method with other, related, cases. Secondly, we related these deaths to the total number of inhabitants and suicides recorded by Statistics Netherlands. Results The study showed a stable trend in the use of the helium method in the period 2012–2019 and this was the same for the other, related methods. Individuals using the helium method were significantly younger than those using other, related, methods. At the scene of death, information about suicide and suicide notes were found more often at ‘helium method’ cases than with the ‘other, related, methods’ cases. Family was significantly more often present during a helium method suicide than during suicide by other, related, methods. Discussion The number of suicides by the helium method and other, related, cases is stable in the Netherlands over the past years. Therefore, we conclude that there is no substitution effect within this category of suicides. Whilst ‘right-to-die-organisations’ strive to inform the old and sick of the helium method, it is noteworthy that the individuals using the helium method are significantly younger than the individuals who choose other, related, methods.

Purpose: Between 0.1—3% of injured children who present at a hospital emergency department ultimately die as a result of their injuries. These events are typically reported as unnatural causes of death and may result from either accidental or non-accidental trauma (NAT). Examples of the latter include trauma that is inflicted directly or resulting from neglect. Although consultation with a forensic physician is mandatory for all deceased children, the prevalence of fatal inflicted trauma or neglect among children is currently unclear. Methods: This is a retrospective study that included children (0–18 years) who presented and died at one of the 11 Level I trauma centers in the Netherlands between January 1, 2014, and January 1, 2019. Outcomes were classified based on the conclusions of the Child Abuse and Neglect team or those of forensic pathologists and/or the court in cases referred for legally mandated autopsies. Cases in which conclusions were unavailable and there was no clear accidental cause of death were reviewed by an expert panel. Results: The study included 175 cases of childhood death. Seventeen (9.7%) of these children died due to inflicted trauma (9.7%), 18 (10.3%) due to neglect, and 140 (80%) due to accidents. Preschool children (< 5 years old) were significantly more likely to present with injuries due to inflicted trauma and neglect compared to older children (44% versus 6%, p < 0.001, odds ratio [OR] 5.80, 95% confidence interval [CI] 2.66–12.65). Drowning accounted for 14 of the 18 (78%) pediatric deaths due to neglect, representing 8% of the total cases. Postmortem radiological studies and autopsies were performed on 37 (21%) of all cases of childhood death. Conclusion: One of every five pediatric deaths in our nationwide Level I trauma center study was attributed to NAT; 44% of these deaths were the result of trauma experienced by preschool-aged children. A remarkable number of fatal drownings were due to neglect. Postmortem radiologi

Introduction Elephantiasis is endemic around the equator. In Western countries the phenomenon is extremely rare. Case description A Dutch 41-year-old severely obese male was found dead in his home. During the external examination, an extensive skin infection was seen on both lower legs. The man was treated for erysipelas two years prior and did not visit the general practitioner again. Clinical autopsy showed there was a serious stasis dermatitis of both lower legs with a superimposed erysipelas which led to a sepsis and multiple organ failure. The erysipelas presented itself as elephantiasis. Discussion Elephantiasis is most often caused by filariasis. In our case, the deceased had not been abroad and had predisposing factors for elephantiasis nostras verrucosa (ENV), such as obesity and an objectified erysipelas infection two years prior. The chronic skin infection caused sepsis and multiple organ failure. The position in which the deceased was found may have contributed to the death. Conclusion Elephantiasis is a highly uncommon phenomenon in Western countries. A chronic erysipelas can cause non-filarial elephantiasis and if left untreated, can cause death.

Dit onderzoek rond het thema lijkschouw en gerechtelijke secties is verricht in opdracht van het ministerie van Veiligheid en Justitie. De aanleiding voor het onderzoek was de discussie dat in Nederland de kwaliteit van de lijkschouw onvoldoende zou zijn en ‘een groot aantal misdrijven zou worden gemist’. Tevens bestond de vraag hoe het systeem van postmortaal onderzoek in andere landen werkt. In dit rapport is Nederland vergeleken met België, Duitsland en Engeland. Voor deze landen is gekozen, omdat zij wat betreft cultuur, bevolkingsopbouw en misdrijfpercentage dicht bij Nederland zitten. Tevens zijn de gegevens over gerechtelijke secties in Nederland in de jaren 2005, 2010 en 2015 nader onderzocht. Hierbij is aandacht besteed aan het aantal secties, de reden voor het aanvragen van een sectie en de uitkomst van de sectie. Systeemvergelijkend onderzoek. Alle onderzochte landen vallen onder art. 2 van het Europees Verdrag voor de Rechten van de Mens, waarin het recht op leven is vastgelegd. Uit dit artikel vloeit voort dat de staat een verplichting heeft om een plausibele verklaring te geven voor een overlijden. Tevens hebben alle onderzochte landen de European Autopsy Rules ondertekend. Echter, de afzonderlijke landen geven een andere invulling aan deze regels. Nederland is hierin het meest afwijkend door deze regels wel aan te nemen maar het voorbehoud te maken om zelf te mogen beslissen op welke grond postmortaal onderzoek c.q. een gerechtelijke sectie plaatsvindt. Het voorbehoud dat Nederland heeft gemaakt op de Autopsy Rules leidt ertoe dat slechts in een beperkt aantal gevallen en voor beperkte indicaties postmortaal onderzoek wordt uitgevoerd. In elk van de onderzochte landen bestaat een min of meer wettelijk verankerd systeem van postmortaal onderzoek. De verschillen tussen en binnen de onderzochte landen zijn aanzienlijk. De waargenomen verschillen worden niet ingegeven door verschillen in misdrijfcijfers. Met name is het verschil in