Mass Fatality Research Articles

A Review of Mitochondrial SNP Determination using Allele-Specific PCR in Forensic Identification

Allele-specific polymerase chain reaction (AS-PCR) is a rapid and cost-effective single nucleotide polymorphism (SNP) genotyping method compared to multiplex or real-time PCR. The SNPs occurring in mitochondrial DNA (mtSNPs) is the most abundant polymorphism in humans and can be used in human identification involving mass fatality incidents. Nevertheless, the application of AS-PCR has yet to be widely applicable in forensic investigations because this method requires further development due to its limitations. This review aims to relate the applications of AS-PCR, the combination of AS-PCR with other PCR techniques and improvements imposed on this technique in past studies. A narrative literature review was carried out over 70 studies related to the mtDNA, SNP, AS-PCR, and forensic DNA. The findings suggested that AS-PCR with new adaptations in technology such as incorporating additional mismatch, choosing allele-specific primer with either common forward or reverse, gel free real-time AS-PCR analysis, and usage of fluorescence probes can improve the specificity of SNP genotyping in forensic applications. This review concludes that AS-PCR and its combination with other improvised techniques can be applied in human identification to successfully analyze degraded or low quantity samples. Nevertheless, development of more SNP loci is required to implement AS-PCR in human identification to match the current gold standard STR typing method.

Dental hygiene students' matching accuracy when comparing antemortem dental radiographs and oral photographs to simulated postmortem WinID3® odontograms.

Matching dental antemortem (AM) and postmortem (PM) data for human identification is especially challenging when the workforce is limited. Dental hygienists have served mass fatality incidents (MFIs) due to dental-related expertise. However, forensics within dental hygiene education and research on transferable skills is limited. This qualitative balance design study assessed senior dental hygiene students' match accuracy of simulated cases varying in dental identifiers based on AM full mouth series (FMS) radiographs and oral photographs to PM WinID3® odontograms to demonstrate possible disaster victim identification (DVI) transferable skills gained during formal education. A convenience sample of senior dental hygiene students (n=31) was presented information on WinID3® interpretation, then presented with 5 mismatched cases and asked to visually interpret each to make 10 total matches; five based on AM FMS with simulated PM WinID3® odontograms and five based on AM photographs with PM WinID3® odontograms. Match accuracy scores ranged from 41.9% to 58.1% for cases with 1-10 identifiers, and 77.4% to 93.5% for cases with 11-40 identifiers. Accuracy when matching AM radiographs to PM odontograms versus AM photographs to PM odontograms was compared and revealed no statistical differences in match accuracy depending on image type (p=0.388 to 1.000). Results of this pilot study suggests transferable match accuracy skills resulted from the participants' dental hygiene formal education. These baseline skills with additional specialized training support the rationale for dental hygienists serving on DVI teams. More research is needed in education and practice when preparing dental hygienists for forensic-based service.

Overcoming the chaotic numerology of osteometry. A proposal for a univocal numeric coding system for osteometric measurements of the human skeleton

Osteometric measurements have a critical role particularly in forensic anthropology. They allow the objective quantification of morphological characteristics when developing the biological profile of unknown skeletons, rather than relying purely on qualitativedescriptions that are often subjective. Various coding systems for anthropometric measurements have been developed across the years and countries. Currently, there is not a shared classification for the most commonly applied measurements in osteometry. For ascientific community becoming ever more global and international, the lack of a common language can create impasses and lead to miscommunications between scientists. The problem could become more relevant in mass fatalities and international scenarios. In order to develop a new communal codification model, some imperfections in traditional classifications have been identified and overcome. The new proposed coding is based on a three-number taxonomy. The three cyphers, separated by a dot (#.#.#), indicate the anatomical area of which the measurement is referred (e.g. cranium, upper limb), the single bone (e.g. humerus) or the topographicregion (e.g. neurocranium) measured, and the specific measurement. The third number, an arithmetic progression that identifies every measurement, has been designed to allow the scientific community to introduce new measurements without scrambling the entire series

Validity of dental findings for identification by postmortem computed tomography

Postmortem computed tomography (PMCT) images help identify individuals and extract information from corpses. PMCT may substitute for a standard examination when bodies are severely damaged or when resources are limited in a mass fatality incident. In such situations, the dental information revealed by PMCT has the potential to narrow down candidates for identification further. However, the validity of the dental findings obtained from PMCT images remains unclear. In this study, we investigated the validity of dental findings on PMCT images compared to regular dental examinations as the reference standard. We routinely collected PMCT images of 148 unidentified corpses and compared the dental findings of each tooth obtained from PMCT with those of a regular dental examination. The validity of dental findings of PMCT was measured by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We also evaluated the accuracy of dental findings per corpse using 32 teeth as the denominator. The dental findings with high sensitivity and high specificity were a present tooth (0.96 and 0.97), a missing tooth (0.97 and 0.97), pontic (0.92 and 1.00), a dental implant (1.00 and 1.00), and a root filling (0.94 and 0.99). The mean accuracy of the dental findings per corpse in PMCT was 95.6% (standard deviation: 6.9, minimum ≤ median ≤ maximum: 65.6 ≤ 100 ≤ 100). The number of corpses with 100% accuracy in the dental findings was 81 (54.7%). The information obtained in this study highlights the potential use of PMCT during human identification in several settings with limited resources, such as the number of specialists present and the condition of the corpses.

Victim identification from the September 11, 2001 attack on the World Trade Center: Past trends and future projections

Victim identification following mass fatality events is critically important. Extensive traumatic injuries and body fragmentation add complexity to this process. World Trade Center (WTC) identification efforts have been ongoing for over 20 years and this study tracks identification trends from the 2753 known WTC victims and the 21,905 recovered remains. For identified victims, data include the number of remains identified, date(s) of the identification(s), and identification modalities. Results show a heavy reliance on DNA due to body fragmentation. Other modalities played an important role initially, but DNA eventually became the singular identification modality. For large-scale disasters involving significant body fragmentation, aggressive DNA testing strategies are critical for victim identification. Over time, the number of linked remains (portions of previously identified individuals) will greatly outnumber the new identifications (first-time identifications). A novel approach using statistical modeling from ecology studies was applied to estimate future WTC identification rates using Identification Accumulation Curve extrapolation with the Good-Toulmin estimator. Projections indicate there will be 76 first-time identifications (95% CI: 49–117) through the successful DNA testing of 3404 unidentified, fragmentary remains. The remainder of the identifications would be additional portions of previously identified victims. These results may be instructional for management of other large-scale, protracted victim identification efforts.

Discussion Panel Decedent Handling: Understanding the Challenges and Exploring Opportunities for Ergonomics research

The COVID-19 pandemic has taken many lives in the last two years. Handling high volumes of decedents within and beyond a hospital’s environment has put healthcare- and deathcare-workers at an increased health risk throughout this pandemic. However, systematic research about manual handling of the dead either at the hospital, morgue, funeral home, or in situations of mass fatalities is still in infancy. This session aims to educate ergonomics and safety professionals on the importance of understanding the risk factors associated with handling the decedents, design issues of body bags, effects of PPE, routine versus mass fatality handling of the decedents, and participatory ergonomics. This session will also examine the feasibility of translating the past and current research on the handling of live patients to the handling of patients postmortem. Finally, psychosocial risks due to handling the deceased within the pandemic environment that might influence these workers’ risk of musculoskeletal injuries will be deliberated.

Stature estimation of Malaysians using post-mortem computed tomography images of the spine

Background Stature estimation is important in medical investigations to identify victims and is most accurate using anatomical methods utilizing the entire skeleton. However, in cases of mass fatalities, it has been calculated using regression analysis formulas of different body parts. Radiology especially post-mortem computed tomography (PMCT) is increasingly being used in victim identification as it is non- invasive and allows for multi planar reconstruction. Methods This study aims to generate stature estimation formulae using regression analysis of the vertebral column incorporating population that form the Malaysian ancestry i.e. Malay, Chinese and Indian using PMCT. This was a retrospective study involving 115 subjects who had a PMCT. Subjects consisted of Malaysian males and females (92 males and 23 females) aged 18–70 years. Cervical length (CL), thoracic length (TL), lumbar length and the whole spine length (WSL) incorporating cervical, thoracic and lumbar length were compared against cadaveric length. Results Whole spine length had the highest correlation coefficient of 0.570 and showed highest correlation with cadaveric length among female subjects compared to males. Whole spine length amongst the Malay was the highest followed by the Chinese and Indian ethnic groups (r = 0.671, 0.629, 0.402). Conclusion Our study concluded that the use of WSL from PMCT images can be used for body height estimation amongst Malaysians. This study has also successfully generated population-specific database for Malaysian experts to perform stature estimation using measurements of the vertebral column.

Innovations in Fatality Management During the COVID-19 Pandemic.

Innovations in Fatality Management During the COVID-19 Pandemic.

Estimating Tibia Length: An Anatomical Landmarks Evaluation of Bones and X-ray Radiographs

The ability to estimate the length of the bone is a major step towards estimating the stature of an individual in forensic investigation of mass fatalities where body parts are dismembered, scattered and mixed up. This is so because researchers have established that long bone length correlates with stature. Nine parameters of the tibia bone were measured using anthropometric board, anthropometric tape and digital caliper. Five of the nine parameters that could be read on anterior-posterior x-ray radiograph of the tibia measured using a transparent meter rule were used in this study. A total of 600 sample of N = 600, (300 right and 300 left bones) and (320 males: right = 160; left = 160; 280 females: right = 140; left 140 radiographs) obtained from Anatomy museums and hospitals in the six geo-political zones of Nigeria were used in this study. No significant difference (p < 0.05) in the mean value was found between measurements from the bones and those from the anteroposterior x-ray radiographs. The difference in mean for all variables were seen to be significantly (p < 0.05) higher for males compared to females. Results show that the tibia proximal breadth (TPB), medial-lateral diameter at mid-shaft (MLDM) and tibia distal breadth (TDB) were the best predictors of the length of tibia. Thus, in cases of mass fatalities as could happen in a plane crash or bomb blast, the estimate of the fragmented remains of the tibia, when compared with the estimate from an anti-mortem x-ray radiograph, may reveal the identity of the missing individual.

Recovering from a Major Aviation Disaster: The Airlines’ Family Assistance Centre

An aviation disaster with mass fatalities can overwhelm an organisation and impact the lives of thousands. The response to such crises can determine the future of the organisation and, more importantly, it can have a lasting effect on the victims’ friends and families. This paper identifies and analyses airlines’ legal requirements and duty of care in relation to the operation of a family assistance centre (FAC). The case study of flight MH370 was used, and interviews with key figures in the aviation industry who have experienced disaster first-hand were conducted. The study highlighted that subtle differences in response significantly impact the quality of care provided. The research also outlined the importance of training and preparedness. Choosing the right people to work in the FACs and to care for friends and families is integral. The study concluded that the speed and accuracy of communication with friends and family are critical factors in the success of any response.

Factors that affect mass fatality management and crisis standards of care: Lessons from the El Paso COVID-19 surge

This paper examines the substantial spike in fatalities that occurred in El Paso, Texas in late 2020 due to an unprecedented surge in COVID-19 infection. It also considers various explanations for the fatality surge, and the fatality management issues observed during the event. The paper suggests what lessons can be learned from this event, in particular those preventable causes that could be avoided in a future outbreak. The paper also examines the gaps in existing mass fatality management processes as they apply to planning for pandemics and mass fatality crisis standards of care.

The Public Health Role of Medical Examiner Offices During COVID-19 and Other Mass Fatality Events.

The public health role of a medical examiner office (MEO) in a pandemic is largely undefined; however, death data may be useful in strategic planning. Deaths reportable to MEO are defined in statute, with discretion as to the assumption of jurisdiction. We analyzed the daily reported death numbers (DRDNs) in our jurisdiction from March 1, 2020, to March 31, 2021, and compared them with hospital admission and COVID-19 fatality data over the same period. The DRDN from an MEO is easily obtained and may be useful as a supplemental and surrogate metric in certain pandemic mass casualty decisions. Hospital admission data were analyzed in real time and with a 2-week time-shift, as deaths lag hospital admissions as a disease surveillance metric. Moderate correlation was observed between DRDN and hospital admissions (r = 0.570), and this improved to strong correlation (0.645) when the 2-week time-shift was incorporated into the analysis. Both evaluations were statistically significant (P < 0.0001). The DRDN also moderately correlated (r = 0.412) with the number of COVID-19 deaths. Because death certification and hospital diagnosis may be delayed, real-time trend recognition in a pandemic may benefit from use of DRDN from MEO.

Computational screening of camostat and related compounds against human TMPRSS2: A potential treatment of COVID-19

The global coronavirus pandemic has burdened the human population with mass fatalities and disastrous socio-economic consequences. The frequent occurrence of these new variants has fueled the already prevailing challenge. There is still a necessity for highly effective small molecular agents to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we targeted the human transmembrane surface protease TMPRSS2, which is essential for proteolytic activation of SARS-CoV-2. Camostat is a well-known inhibitor of serine proteases and an effective TMPRSS2 inhibitor. A virtual library of camostat-like compounds was computationally screened against the catalytic site of TMPRSS2. Following a sequential in-depth molecular docking and dynamics simulation, we report the compounds that exhibited promising efficacy against TMPRSS2. The molecular docking and MM/PBSA free energy calculation study indicates these compounds carry excellent binding affinity against TMPRSS2 and found them more effective than camostat. The study will open doors for the effective treatment of coronavirus disease 2019.

Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series

IntroductionIn April 2020, novel coronavirus SARS-CoV-2 (COVID-19) produced an ongoing mass fatality event in New York. This overwhelmed hospital morgues necessitating emergent expansion of capacity in the form of refrigerated trucks, trailers, and shipping containers referred to as body collection points (BCPs). The risks for musculoskeletal injury during routine and mass fatality mortuary operations and experiences of decedent handlers throughout the "first wave" of COVID-19 are presented along with mitigation strategies MethodsAwareness of the high rates of musculoskeletal injury among health care workers due to ergonomic exposures from patient handling, including heavy and repetitive manual lifting, prompted safety walkthroughs of mortuary operations at multiple hospitals within a health system in New York State by workforce safety specialists. Site visits sought to identify ergonomic exposures and ameliorate risk for injury associated with decedent handling by implementing engineering, work practice, and administrative controls. ResultsMusculoskeletal exposures included manual lifting of decedents to high and low surfaces, non-neutral postures, maneuvering of heavy equipment, and push/pull forces associated with the transport of decedents DiscussionRisk mitigation strategies through participatory ergonomics, education on body mechanics, development of novel handling techniques implementing friction-reducing aides, procurement of specialized equipment, optimizing BCP design, and facilitation of communication between hospital and system-wide departments are presented along with lessons learned. After-action review of health system workers' compensation data found over four thousand lost workdays due to decedent handling related incidents, which illuminates the magnitude of musculoskeletal injury risk to decedent handlers.

Neonicotinoid Pesticides Cause Mass Fatalities of Native Bumble Bees: A Case Study From Wilsonville, Oregon, United States.

In June of 2013 an application of dinotefuran on an ornamental planting of European linden trees (Tilia cordata Mill. [Malvales: Malvalceae]) in a shopping mall parking lot in Wilsonville, Oregon provoked the largest documented pesticide kill of bumble bees in North America. Based on geographic information systems and population genetic analysis, we estimate that between 45,830 and 107,470 bumble bees originating from between 289 and 596 colonies were killed during this event. Dinotefuran is a neonicotinoid that is highly effective in exterminating and/or harming target pest insects and non-target beneficial insects. Analysis to detect the concentration of pesticides in flowers that received foliar application revealed that the minimum reported dinotefuran concentration of a sampled T. cordata flower was 7.4 ppm, or in excess of 737% above the LC50 of the beneficial pollinator, the honey bee (Apis mellifera Linnaeus, 1758 [Hymenoptera: Apidae]). Furthermore, sampled Vosnesensky bumble bees (Bombus vosnesenskii Radoskowski, 1862 [Hymenoptera: Apidae]) were found to have an average dinotefuran concentration of 0.92 ppm at the time of death, which exceeds the maximum LC50 of A. mellifera (0.884 ppm). Our study underscores the lethal impact of the neonicotinoid pesticide dinotefuran on pollinating insect populations in a suburban environment. To our knowledge, the documentation and impact of pesticide kills on wild populations of beneficial insects has not been widely reported in the scientific literature. It is likely that the vast majority of mass pesticide kills of beneficial insects across other environments go unnoticed and unreported.

The Holodomor Genocide or the result of bad planning?

The 1932-33 famine in the Soviet Union killed an estimated six to eight million people. Although the famine extended throughout the Soviet Union the highest concentration of deaths was within the Ukraine and Ukrainian populated areas with an estimated three to five million fatalities. This article examines the growth of nationalism within the Ukraine, the famine related policies implemented by the Soviet government, and the death rate per capita in both the Ukraine and Russia. The famine coincided with a campaign against Ukrainian nationalism and targeted peasants who had shown resistance to Soviet policies. The disproportionate number of deaths within the Ukraine and Ukrainian populated areas combined with the deliberate actions of the Soviet government which worsened conditions within the Ukraine show that the famine was a genocide which was intended to create mass fatalities and remove Ukrainian nationalist opposition.

Establishing an Analogue Based In Silico Pipeline in the Pursuit of Novel Inhibitory Scaffolds against the SARS Coronavirus 2 Papain-Like Protease.

The ongoing coronavirus pandemic has been a burden on the worldwide population, with mass fatalities and devastating socioeconomic consequences. It has particularly drawn attention to the lack of approved small-molecule drugs to inhibit SARS coronaviruses. Importantly, lessons learned from the SARS outbreak of 2002–2004, caused by severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), can be applied to current drug discovery ventures. SARS-CoV-1 and SARS-CoV-2 both possess two cysteine proteases, the main protease (Mpro) and the papain-like protease (PLpro), which play a significant role in facilitating viral replication, and are important drug targets. The non-covalent inhibitor, GRL-0617, which was found to inhibit replication of SARS-CoV-1, and more recently SARS-CoV-2, is the only PLpro inhibitor co-crystallised with the recently solved SARS-CoV-2 PLpro crystal structure. Therefore, the GRL-0617 structural template and pharmacophore features are instrumental in the design and development of more potent PLpro inhibitors. In this work, we conducted scaffold hopping using GRL-0617 as a reference to screen over 339,000 ligands in the chemical space using the ChemDiv, MayBridge, and Enamine screening libraries. Twenty-four distinct scaffolds with structural and electrostatic similarity to GRL-0617 were obtained. These proceeded to molecular docking against PLpro using the AutoDock tools. Of two compounds that showed the most favourable predicted binding affinities to the target site, as well as comparable protein-ligand interactions to GRL-0617, one was chosen for further analogue-based work. Twenty-seven analogues of this compound were further docked against the PLpro, which resulted in two additional hits with promising docking profiles. Our in silico pipeline consisted of an integrative four-step approach: (1) ligand-based virtual screening (scaffold-hopping), (2) molecular docking, (3) an analogue search, and, (4) evaluation of scaffold drug-likeness, to identify promising scaffolds and eliminate those with undesirable properties. Overall, we present four novel, and lipophilic, scaffolds obtained from an exhaustive search of diverse and uncharted regions of chemical space, which may be further explored in vitro through structure-activity relationship (SAR) studies in the search for more potent inhibitors. Furthermore, these scaffolds were predicted to have fewer off-target interactions than GRL-0617. Lastly, to our knowledge, this work contains the largest ligand-based virtual screen performed against GRL-0617.

Importance of sexual dimorphism of the maxillary sinus and mandibular inter coronoid distance of Vijayawada City population in Andhra Pradesh: An original research

Background: Mass fatality incidents occur due to environmental, medical, vehicle, industrial, or terrorist events that can involve large numbers of victims. Identification of these victims is of utmost importance in these situations. Cone-beam computed tomography (CBCT) may be helpful in some forensic contexts, offering several advantages for postmortem forensic imaging. Aim: The research study aims to evaluate the sexual dimorphism of the maxillary sinus and inter coronoid distance to estimate sex by using CBCT. Materials and Methods: In 40 CBCT scans of 20 males and 20 females, maxillary sinuses height, width and inter coronoid distances of mandible were measured for forensic analysis. In high quality, reconstructed images of bilateral maxillary sinuses, height, and width were measured, and in mandible, inter coronoid was measured in axial view. Results were tabulated and analyzed using an unpaired t-test and discriminant function analysis used to compare differences in the measured parameters between males and females. Results: Mean values of inter coronoid in males and females are (♂ =88.1, ♀ =78.1). The maxillary sinus right side height and width (♂ =32.2, ♀ =24.6) (♂ =19.7, ♀ =19.6) left side height and width (♂ =32.7, ♀ =23.6) (♂ =18.1, ♀ =17.8), respectively. A statistically significant (P

Medico-Legal Opinion Based on Autopsy Findings of a Victim of an Explosion Involving Mass Fatality.

Investigation into explosions is one of the major areas in forensic medicine and pathology. Medico legal issues associated with these deaths are diverse and forensic experts are often expected to make clarifications. Assistance of a methodical scientific investigation of such a death in evaluation of unanswered medico legal issues, of an autopsy of one of the victims of Easter Sunday explosions is discussed. The deceased was a 15-year-old girl who was participating in the Easter mass at St. Sebastian's Church - Kattuwapaitya, Negombo, Sri Lanka when a suicide bomber blew himself up. The mother of the deceased noticed the deceased being rushed to the hospital. However, she was pronounced dead on admission. Pre-autopsy radiology revealed spherical shrapnel in the temporal region. At autopsy, the fatal injury was found on the head and a detailed study revealed skull fractures associated with penetration by 3 shrapnels. There was a keyhole lesion among the penetrations. Internal examination revealed an extensive dural tear underlying the compound fracture. The brain was grossly edematous with lacerations on the frontal and parietal lobes associated with localized subarachnoid hemorrhage. There were multiple underlying contusions on bilateral frontal white matter. Small subarachnoid haemorrhage was noted on the basal aspect of the brain. Careful evaluation of the autopsy findings assisted in formulating the opinion scientifically on event reconstruction including the proximity of the victim to the epicenter of explosion and nature of explosive device, period of survival, mechanism of causation of skull fractures and the mechanism of death in addition to the cause of death. A forensic pathologist following a meticulous autopsy examination, along with a team of ballistic experts and specially trained police personnel play a pivotal task in analyzing a scene of explosion and an autopsy of a victim, in concluding the case and in bringing justice to all the victims and survivors of the catastrophe.

The Culling: Pandemic, Gerocide, Generational Affect.

Old age has been central to public health rationalities and contestations of the 2019-2020 coronavirus pandemic. This article thinks through what age is and does in pandemic times by juxtaposing four domains of ethical publicity in which age comes to matter: (1) mass fatality of old persons under conditions of variable unpreparedness; (2) circulation of social-Darwinist argument for herd immunity through culling of the weak; (3) everyday challenges of late life care as these are amplified under quarantine; and (4) long-term conditions of economic and political impasse and environmental collapse, experienced as failure of older generations and abandonment of younger ones, a situation here termed generational affect. It asks to what extent the figure of the cullable old renders racialized disparities natural and makes sense through a generational affect in which the world feels as if the survival of the young is in question.