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Discusses some of the major causes of accidents in childhood: road trauma, drowning, burns, and poisoning. Also, briefly indicates methods to reduce such accidents. (CM)

When human remains are inadvertently located, case-related circumstantial information is used to generate an identification hypothesis, and the preservation of the remains typically informs which identification methods may then be used to validate that hypothesis. What happens, however, when there is no contextual information to generate an identification hypothesis? This paper presents the case of a near-complete human skeleton discovered at Sandy Point in Victoria, Australia. The circumstances of the case did not facilitate an identification hypothesis, and with no hypothesis to triage the identification process, all possible identification methods were employed. Preservation of the individual meant neither a visual nor a fingerprint identification was possible, and the lack of an identification hypothesis meant there was no antemortem reference data to compare with the postmortem DNA or dental information. Consequently, in addition to historical research, novel methods, such as radiocarbon dating and genetic intelligence, were utilized to complement information provided by the forensic anthropology and odontology analyses, which ultimately resulted in the identification. This example highlights the complexity of cases of unidentified skeletal remains and emphasizes the fact that identification is a process that necessarily requires a multidisciplinary and collaborative approach., Key Points: Human skeletal remains were recovered from Sandy Point, Victoria.The absence of circumstantial information and the poor preservation (i.e. skeletonized) of the remains precluded the formation of an identification hypothesis, rendering the identification process complex.Only through the integration of anthropology, odontology, molecular biology, radiocarbon dating, historical research, and genealogy were the remains able to be identified as Mr. Christopher Luke Moore, who drowned in 1928.Human identification is a process that necessarily requires a multidisciplinary and collaborative approach., (© Commonwealth of Australia. Published by OUP on behalf of the Academy of Forensic Science.)

Aim: To catalogue and compare the pattern of metastatic disease in germline BRCA1/2 pathogenic mutation carriers and non-carriers with breast, ovarian and prostate cancer from a rapid autopsy programme., Methods and Results: The number of metastases in the major body systems and the proportion of participants with metastases were documented in 50 participants (19 germline mutation carriers). Analysis was conducted on the participants' pattern of disease for the different cancers and mutation subgroups. The four commonly affected organ systems were the digestive (liver only) (82%), respiratory (76%), gastrointestinal (65%) and reticuloendothelial (42%). There were significant differences in the pattern of metastatic breast cancer in BRCA1/2 germline carriers compared with non-carriers. Breast cancer carriers had significantly fewer organ systems involved (median n = 3, range = 1-3) compared with non-carriers (median n = 9, range = 1-7) (P = 0.03). BRCA1/2 carriers with ovarian carcinomas had significantly more organ systems with metastatic carcinoma (median n = 10, range = 3-8) than non-carriers (median n = 5, range = 3-5) (P < 0.001). There were no significant differences in the number of involved systems in BRCA2 carriers compared with non-carriers with prostate cancer (P = 1.0). There was an absence of locoregional disease (6.5%) compared with distant disease (93.5%) among the three cancer subtypes (P < 0.001). The majority of metastatic deposits (97%) collected during the autopsy were identified by recent diagnostic imaging., Conclusion: Even though a major limitation of this study is that our numbers are small, especially in the breast cancer carrier group, the metastatic patterns of breast and ovarian cancers may be impacted by BRCA1/2 carrier status, suggesting that tumours derived from patients with these mutations use different mechanisms of dissemination. The findings may focus clinical diagnostic imaging for monitoring metastases where whole-body imaging resources are scant., (© 2023 The Authors. Histopathology published by John Wiley & Sons Ltd.)

Although melanoma is initiated by acquisition of point mutations and limited focal copy number alterations in melanocytes-of-origin, the nature of genetic changes that characterise lethal metastatic disease is poorly understood. Here, we analyze the evolution of human melanoma progressing from early to late disease in 13 patients by sampling their tumours at multiple sites and times. Whole exome and genome sequencing data from 88 tumour samples reveals only limited gain of point mutations generally, with net mutational loss in some metastases. In contrast, melanoma evolution is dominated by whole genome doubling and large-scale aneuploidy, in which widespread loss of heterozygosity sculpts the burden of point mutations, neoantigens and structural variants even in treatment-naïve and primary cutaneous melanomas in some patients. These results imply that dysregulation of genomic integrity is a key driver of selective clonal advantage during melanoma progression.

This is a critical review to discuss the best practice approaches to mortuary operations in preparation for and the response to natural, mass fatality, disaster events, as identified by a review of published articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) Statement guided the identification of potential articles to use in this critical review. Subsequent searches were also conducted to identify articles relating to heat wave, and flood mortality. All identified peer-reviewed studies published in English which discussed the preparation and response of mortuaries to mass fatality natural disasters occurring in developed countries were included. Using the PRISMA-P method of identifying articles, 18 articles were selected for inclusion in this review. Although there are numerous articles which describe the mortuary response to mass fatality incidents, few articles analyzed the response, or discussed the roles which supported and enabled the organization to undertake the task of identifying disaster victims. It is thus difficult to determine objectively if the actions and activities outlined in the articles represent best-practice.

The management of the recent Ebola virus disease (EVD) epidemic continues to pose currently insuperable challenges to health care providers in the resource-deprived countries of West Africa. In an age where air travel facilitates rapid movement of people between countries and continents, there is an urgent requirement for health systems around the globe to develop management strategies and protocols in the event that EVD cases are suspected or confirmed. Departments of forensic pathology play an important, and underestimated, role in public health service delivery, particularly at times of novel infectious disease emergence. This role can include disease identification, characterization, and notification, as well as close engagement with agencies responsible for disease surveillance and treatment provision. A mass outbreak of EVD in the Western world is considered highly unlikely; however, there is clear responsibility on departments of forensic pathology to develop protocols for rapid assessment of sporadic or suspected cases while ensuring the health and safety of mortuary and pathology personnel. The Ontario Forensic Pathology Service and the Victorian Institute of Forensic Medicine have collaborated on the development of a protocol for management of EVD cases presenting at a scene or in the mortuary. It is hoped that this trans-national, inter-departmental exercise will serve as a model for future co-operative endeavors. The protocol has been distributed to forensic pathology departments around Australia and may be modified to accommodate local resource capabilities.

Patients with high-grade serous ovarian cancer (HGSC) have experienced little improvement in overall survival, and standard treatment has not advanced beyond platinum-based combination chemotherapy, during the past 30 years. To understand the drivers of clinical phenotypes better, here we use whole-genome sequencing of tumour and germline DNA samples from 92 patients with primary refractory, resistant, sensitive and matched acquired resistant disease. We show that gene breakage commonly inactivates the tumour suppressors RB1, NF1, RAD51B and PTEN in HGSC, and contributes to acquired chemotherapy resistance. CCNE1 amplification was common in primary resistant and refractory disease. We observed several molecular events associated with acquired resistance, including multiple independent reversions of germline BRCA1 or BRCA2 mutations in individual patients, loss of BRCA1 promoter methylation, an alteration in molecular subtype, and recurrent promoter fusion associated with overexpression of the drug efflux pump MDR1.

In a coronial setting a deceased person must be formally identified. It is difficult to identify a deceased person when their physical features are disrupted and identification by visual means cannot occur. In the absence of visual identification, the confirmation of identity of a deceased person relies on the scientific comparison of information obtained post mortem with ante mortem information. The ante mortem information may include dental and medical records, fingerprints, and DNA profiling. For cases involving incinerated remains, this traditionally requires the collection of blood, muscle or bone samples from the deceased (depending on the severity of the burns) for DNA analysis and subsequent comparison to a reference sample for kinship determination. Following on from work conducted during the DVI response to a plane crash in Papua New Guinea in 2011, a study has been performed examining the viability of utilising material obtained from bladder swabs in deaths associated with fires. Twenty-eight cases were analysed during 2012 with deaths occurring in motor vehicle and aviation accidents, as well as house fires, homicides and from self-immolation. Bladder and conventional (blood, muscle or bone) samples were subjected to DNA analysis and compared. Our findings demonstrate that the bladder samples all gave DNA of sufficient quality for DNA profiling. This easily obtained sample (when available) can be now recommended in the scientific identification process of fire affected deceased persons., (Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.)

On the day of the 2009 Victorian bushfires the Victorian Institute of Forensic Medicine activated its emergency plan. Within 48 h a temporary body storage facility was constructed adjacent to the existing mortuary. This temporary facility had the capacity to store up to 300 deceased persons. Pathologists, anthropologists, odontologists, police and mortuary assistants responded from all around Australia, New Zealand and Indonesia. The existing forensic mortuary and staff were divided into two areas: DVI (disaster victim identification) and "routine operations". A high priority for the mortuary was to ensure the casework of the "routine" deceased persons (those cases which were not related to the bushfires) was handled concurrently and in a timely manner. On admission each set of victim remains was given both a Coroner's case number in addition to the DVI number allocated at the scene. The case was CT scanned, examined by a pathologist, an anthropologist, and odontologist and in some instances a fingerprint expert. Where possible a DNA sample was taken. All processes, samples, labels and paperwork underwent a quality assurance check prior to the case completion. Regular audits were conducted. All of post mortem examinations were completed within 20 days of admission. Occupational health and safety issues of the staff were a high priority; this included correct manual handling, infection control and psychological debriefings. During the operation it was found that some remains were contaminated with asbestos. Procedures were set in place to manage these cases individually and each was isolated to reduce the risk of exposure by staff to asbestos. This overall mortuary operation identified a number of significant challenges, in particular the management of multiple parts of human remains for one individual. A new procedure was developed to ensure that all human remains, where possible, were reconciled with identified deceased persons prior to the release to the funeral director. It also highlighted the need to have well documented plans in place including plans for temporary mortuary facilities., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

The February 7th 2009 bushfires in Victoria, Australia, resulted in the deaths of 173 individuals, of whom 164 were included in the subsequent DVI operation. The final stage of the International DVI protocol is a debrief, referred to as Phase 5. The Phase 5 operational debrief process conducted in the wake of this disaster was designed for the purpose of developing new strategies in light of this experience. The agencies involved included the Coroners Court of Victoria, the Victorian Institute of Forensic Medicine, the Department of Justice, and Victoria Police. During the course of this debriefing process strategies and protocols were developed which aim to improve the capacity of all agencies to respond and resolve future incidents. This paper outlines the Phase 5 debrief carried out in the 6 months following the final coronial identification board, and details the findings and recommendations made by the agencies involved., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

It has been proposed that Sudden Infant Death Syndrome (SIDS) might occur as a consequence of a developmental deficit associated with the cardiorespiratory and arousal control centers located within the brainstem. In this study 1.1' dioctadecyl-3,3,3',3-tetramethylindocarbocyanine perchlorate (DiI) was used to investigate the trajectories of the glossopharyngeal and vagus nerves which carry essential afferent and efferent fiber tracts associated with cardiac and respiratory control and of the hypoglossal nerve which innervates the tongue, in SIDS (n = 14) and control (n = 7) infants. The postnatal development of the trajectories of these nerves was examined in non-SIDS brains and comparisons were then made with age-matched SIDS brains. The mean profile area of hypoglossal and dorsal motor neurons were also assessed. In controls, no major alterations were observed in the trajectories of axon bundles with increasing age (7 wk to 2 yr) in each of the nerves investigated although axon bundles appeared to increase in thickness with age. In SIDS cases (2 wk to 44 wk), the trajectories of the cranial nerves were not different from those seen in age-matched control cases. The mean profile area of hypoglossal and dorsal motor neurons was not significantly different between control and SIDS infants. We conclude that the DiI tracing technique can be used successfully to trace the pathways of cranial nerves in human infant fixed-tissue. Furthermore, if functional differences exist between SIDS and non-SIDS brains in the control of respiration, circulation, or arousal they do not appear to be related to markedly reduced or aberrant projections of the glossopharyngeal, vagus, or hypoglossal nerves.

The cholinergic neurotransmitter system is vital for several brainstem functions including cardiorespiratory control and central chemosensitivity. This study has examined aspects of the cholinergic neurotransmitter system in the brainstem of sudden infant death syndrome (SIDS) and control infants. The cellular localisation and the optical density of the immunoreactivity of the cholinergic enzyme choline acetyltransferase (CHAT-IR) and the muscarinic acetylcholine receptor m2 (m2-IR) in the medulla was described in 14 SIDS and 9 control cases. There was a reduction in the number of CHAT-IR neurons in the hypoglossal nucleus (control: 71.2+/-8.3% vs SIDS: 46.1+/-5.3%) and the dorsal motor nucleus of the vagus (DMV) (control: 77.2+/-5.0% vs SIDS: 52.5+/-7.4%) and reduced optical density of CHAT-IR in the hypoglossal nucleus (control: 0.20+/-0.01 vs SIDS; 0.14+/-0.02) in SIDS infants. In contrast there were no changes in the optical density of m2-IR in the hypoglossal nucleus, the DMV, or the arcuate nucleus. Hypoplasia of the arcuate nucleus was observed in one SIDS infant. These results suggest that there is a specific defect in some cholinergic motor neurons in the medulla of SIDS infants. This could lead to abnormal control of cardiovascular and respiratory function and airway patency and may be one of the contributing factors in the etiology of SIDS.

Of 100 fatal accident cases involving motor vehicles, 60 showed damage to the cervical spine, involving bony or disc damage in 31 and focal haemorrhages in another 29. In 8 cases, pre-autopsy radiology failed to detect lesions which were found by radiology and pathological examination of the post-autopsy specimen. Most of the lesions missed were at the C6-7 region. In some cases, the initial pathological examination 'missed' laterally placed fractures and small chip fractures. Narrow cervical canals in the elderly indicated advanced spondylosis.

The case is reported of a 10-yr-old girl who developed intractable hematuria from hemorrhagic cystitis following chemotherapy for a malignant lymphoma. Following the intravesical instillation of formalin, which controlled the hematuria, she developed oliguria attributable to ureteric stenosis and fibrotic contraction of the renal pelves. Bilateral nephrostomies were constructed, but recurrent pyelonephritis and further renal pelvic obstruction developed. A series of renal biopsies and ultimately bilateral nephrectomy revealed severe, chronic interstitial nephritis, massive renal interstitial accumulation of deposits probably containing Tamm-Horsfall protein and, in the left nephrectomy specimen, a florid interstitial chronic granulomatous inflammatory reaction. Although ureterohydronephrosis has been described by others as a complication of the intravesical instillation of formalin, fibrotic contraction of the upper urinary tract and the florid interstitial nephritis with granulomata as described herein have not previously been reported. It is proposed that vesicoureteric reflux of formalin, perhaps accompanied by intrarenal reflux, caused or contributed to these pathological changes.