Report 2012 Department of Forensic Medicine. of the Netherlands Forensic Institute

Report 2012 Department of Forensic Medicine of the Netherlands Forensic Institute

Contents 1 Organisation 4 1.1 NFI 4 1.2 Department of Forensic Medicine 4 1.2.1 Staff and formation 5 1.2.2 Management meetings 6 1.2.3 Quality Management and Accreditation 6 1.2.4 Investments 6 1.2.5 Book acquisitions and subscriptions 7 1.3 Scientific activities 8 1.3.1 Research organization 8 1.3.2 Trainees 9 2 Forensic Pathology 10 2.1 Staff members 10 2.2 Memberships and Consultancy 10 2.2.1 Medical Staff 10 2.2.2 Non-medical staff 11 2.3 On-going training and congress participations 11 2.3.1 Medical Staff 11 2.3.2 Non-medical Staff 12 2.4 Publications and lectures 13 2.4.1 Medical Staff 13 2.4.2 Non-medical Staff 14 2.5 Case-related activities 15 2.5.1 Pathology 15 2.5.2 Histology 17 2.5.3 First NFI data from PALGA 19 2.5.4 External consultations and co-operation 23 2.5.5 Other case-related activities 24 2.5.6 Delivery times 25 2.5.7 Periodical case-related meetings 25 3 Forensic Medicine 26 3.1 Staff members 26 3.2 Memberships and Consultancy 26 3.3 On-going training and congress participations 27 3.4 Case related activities 28 3.4.1 Other case-related activities 29 3.4.2 Delivery times 29 3.4.3 Periodical case-related meetings 30 3.5 Publications and lectures 30 4 Forensic Anthropology 33 4.1 Staff members 33 4.2 Memberships and Consultancy 33 4.3 On-going training and congress participations 33 4.4 Case related activities 34 4.4.1 Other case-related activities 34 4.4.2 Delivery times 35 4.4.3 Periodical case-related meetings 35 4.5 Publications and lectures 35 5 Forensic Toxicology 36 5.1 Staff members 36 Annual report 2012 Department of Forensic Medicine, March 2013 Page 2 of 39

5.2 Memberships and Consultancy 37 5.3 On-going training and congress participations 37 5.4 Case related activities 37 5.4.1 Other case-related activities 37 5.4.2 Delivery times 38 5.4.3 Periodical medical meetings 38 5.5 Publications and lectures 38 Annual report 2012 Department of Forensic Medicine, March 2013 Page 3 of 39

1. Organisation 1.1 NFI The Netherlands Forensic Institute (NFI) is an agency of the Dutch ministry of Security and Justice and comes under the Directorate General Administration of Justice and Law Enforcement. The NFI consists of eight scientific departments and seven Head Office departments. The department of Forensic Medicine (MFO) is one of these eight scientific departments. Further information about other NFI departments is to be found on the website www.forensicinstitute.nl. Figure 1. The NFI s organisational structure 1.2 Department of Forensic Medicine The department of Forensic Medicine (MFO) consists of four divisions forensic pathology, forensic medicine, forensic anthropology and forensic toxicology. One representative for each division participates in the management of the department. Further, facilitating and supporting services consist of the staff of the histology laboratory, technical post mortem assistants, medical photographers, logistics and the secretariat. The organisation of the department is given below. Annual report 2012 Department of Forensic Medicine, March 2013 Page 4 of 39

Department Manager Secretariat, Logistics and Quality Assurance Forensic Pathology Forensic Anthropology Forensic Medicine and Paediatrics Forensic Toxicology 1.2.1 Staff & formation Table 1: An overview of the formation of the department in 2012 Position Formation total in 2012 Formation filled in by the end of 2012 Specification Pathologists 7 5 Histology technicians 4 3.8 1 stationed in VUmc 1 Technical assistants (post mortem) 7 6 Forensic photographers 4 4 Due to illness 1.0 fte filled in by free lancers Forensic physicians 3.5 3,2 1 vacancy will be filled in from 01/01/13 Forensic paediatric physicians 3.5 3.2 Forensic anthropologists 2 3.1 of which 1.0 fte research assistant Toxicologists 6.4 7.4 of which 0.9 fte research assistant Logistics staff 1 3.0 Of which 2.0 fte also work at other departments Secretary staff 2.4 4.0 of which 0.8 fte permanently stationed outside the department and 0.6 fte longstanding sickness leave Management assistant 1 1 Quality management staff 0.4 0.4 AMC 2 staff stationed at NFI 0.5 0.5 0.2 radiologist; 0.3 resident 1 VUmc = department of pathology Vrije Universiteit Amsterdam 2 AMC = medical centre of the University of Amsterdam Annual report 2012 Department of Forensic Medicine, March 2013 Page 5 of 39

1.2.2 Management meetings The following management meetings take place during the year: Management team meeting: a monthly meeting of one representative from each division and the management Plenary management meeting: a bi-monthly meeting of the forensic department experts and the management Pathology staff meeting: a monthly meeting of the pathologists (practical time planning, development of projects, etc.) Forensic medicine staff meeting: a monthly meeting of all forensic physicians and the department manager. Forensic toxicology staff meeting: a bi-monthly meeting of all forensic toxicologists with their team leader (practical time planning, monitoring of the workload, development of projects etc.). Anthropology staff meeting: a weekly meeting of the 2 anthropologist and the management (practical time planning, monitoring of the workload, development of projects etc.) Forensic paediatric medicine staff meeting: a bi-weekly meeting with all forensic paediatric physicians (practical time planning, monitoring of the workload, development of projects etc.) 1.2.3 Quality management and accreditations In 2012 one internal review on process and quality management activities took place. No nonconformaties were detected. The accreditation application for the prolongation of the two weeks traineeship for pathology residents has been submitted to the MRSC in November. 1.2.4 Investments Table 2: An overview of the investments at the department of Forensic Medicine in 2012 Division Planned investments Realised Costs (K ) Pathology Cooling unit (whole body) Yes 33 Microwave KOS Yes 14 Microscope No - Digital slide scanner + archive* Yes 250 Pathology/Toxicology Cooling Unit (tissue samples) Yes 35 Anthropology Skeletal models No - Anthropology Tooth microtome Yes 14 Additional investments Pathology Paraffin embedding station yes 86 Cryostat Tissue processor Laboratory dishwasher Freezer 3 Xylene reduction system 6 Cassette printer 44 Forensic light sources Yes 8 General Conference flat screen Yes 7 Total 500 * will be delivered in March 2013 Annual report 2012 Department of Forensic Medicine, March 2013 Page 6 of 39

1.2.5 Book acquisitions and subscriptions Table 3: Books and scientific journals Title Animal Abuse and Unlawful Killing: Forensic veterinary pathology Histology for Pathologists Diagnostic Atlas of Renal Pathology Forensic pathology reviews - Vol. 6 Forensic Pathology of Fractures and Mechanisms if Injury: Postmortem CT Scanning Paediatric Neuropathology: A Text-Atlas Bone and Soft Tissue Pathology: A Volume in the High Yield Pathology Series Introductory Techniques for Processing Mineralized Bone and Implants: Methods, Supplies and Equipment Textbook of Veterinary Histology Quality Management in Anatomic Pathology: Promoting Patient Safety Through Systems Improvement and Error Reduction Histotechnology: A Self-Instructional Text Histotechnology : A Self-Assessment Workbook Laboratory Safety A Self-Assessment Workbook Handbook of Practical Immunohistochemistry; Frequently Asked Questions Theory and Practice of Histotechnology Basic Histopathology and Anatomical Pathology Services for Developing Countries with Variable Resources Histologic Preparations: Common Problems and Their Solutions Atlas of Radiologic-Cytopathologic Correlations Non-Neoplastic Hematopathology and Infections Histology for Pathologists The Developing Human Brain: Growth and Adversities Netter s Essential Histology: with Student Consult Acces Prostate Biopsy Interpretation; An Illustrated Guide Pathology of the Placenta Pathology of human placenta Moss & Adams' Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult Wound Ballistics: Basics and Applications Annual report 2012 Department of Forensic Medicine, March 2013 Page 7 of 39

1.3 Scientific activities 1.3.1 Research organisation In 2012 a start was made to reorganize the research activities of the whole Forensic Medicine department into theme groups, in which all relevant specialties are represented. The following research lines were established: 1. Forensic paediatrics and child pathology Lead: R.A.C. Bilo and V. Soerdjbalie Members: H.G.T. Nijs, W.A. Karst, A. Maes, R.R. van Rijn, B. Kubat, I. Bosman 2. Forensic osteology Lead: R.R. Gerretsen Members: M. van Wijk, M. de Haas, P. Van Driesssche, B. Kubat, V. Soerdjbalie, A. Maes, R.R. van Rijn, I. Bosman 3. Soft tissue wound.dating Lead: B. Kubat Members: R.R. van Rijn, H. Niessen (VUmc), P.M.I. Van Driessche, I. Bosman 4. Forensic radiology Lead: R.R. van Rijn Members: R.R.R. Gerretsen, B. Kubat, R.A.C. Bilo, W.A. Karst, H.G.T. Nijs, D. Botter, A. Maes 5. Forensic toxicology Lead: I. Bosman Members: M. Buiskool, B. Kubat, H.G.T. Nijs, A. Maes 6. Age estimation and taphonomy Lead: B. Kubat Members: R.R.R. Gerretsen, M. van Wijk, H.N.J.M. van Venrooij, D. Botter, B.F.L. Oude Grotebevelsborg, P.M.I. Van Driessche, M. de Haas 7. Forensic testing location Lead: B.F.L. Oude Grotebevelsborg Members: D. Botter, H.N.J.M. van Venrooij, R.R.R. Gerretsen, P.M.I. Van Driessche, I. Bosman, R.R. van Rijn, A. van Asten (NFI, WISK) and various other experts from the Front Office and the department of Microscopic Traces. 8. Quality of forensic medical reports Lead: H.G.T. Nijs Members: W.A. Karst, R.A.C. Bilo, S. Wiersma (NFI, Legal Affairs), C. Berger (NFI, WISK), M. Sjerps (NFI, WISK), R.R. van Rijn, R. Oosting, B. Kubat Annual report 2012 Department of Forensic Medicine, March 2013 Page 8 of 39

1.3.2 Trainees In 2012 the department provided training facilities for a large number of students and pathology residents from various high schools and universities. These traineeships vary from two weeks for co-assistants up to more than six months for graduate students. In table 4 an overview of trainees and their topic is given. Table 4: Overview of trainees in 2012 Initials Period Institute Position Theme/Title Supervisor NvdG 11 Oct 10 / Jan 6 EMC Co-assistent Forensic PA practice BK ED Jan 4 / Feb 3 AMC Research Forensic PA practice PD DW Jan 9 / Jul 8 HvA Research Literature study RG AV Feb 13/May 18 UL Research Thyreoglobulin in strangualation FT Mar 5 / Jun 29 UVA Research Decalcification of bone BK AvL Mar 12 / Apr 6 EMC Co-assistent Forensic PA practice BK MS May 1 / Nov 30 SZ Aug 15 / 13 Feb 15 LB Aug 15 / 13 Feb 15 RdW Aug 29 / 13 Jan 14 NRP Oct 1 / Oct 20 Portugal Pathology resident KT Dec 1 / 13 Jun 1 MS Dec 12 / 13 Jan 31 PM Dec 24 / 13 Jan 4 LJ SM-K Jan 2 / June 29 Feb 15 / March 8 Long-term research projects DvB 11-13 UL Medical student LB 11-13 UL Medical student Avans Research Coupes RG UVA Research Subdural hematomas BK UL Science Age estimation in teeth RG BK/IB HvA Research Forensic photography AvdB Forensic PA practice EMC Research Congestion in forensic practice HvA Research Forensic PA Practice RG UMC Co-assistent Forensic PA practice BK UvA Research Postmortem TOX results IB UU Research Drugs related death KL Age estimation of fractures Age estimation in teeth HP 11-15 IRAS PhD student Postmortal re-distribution IB TS 09-13 AMC PhD student Post-mortem Paediatric RvR Radiology AvdB = A. van den Bosch (MFO photographer); IB=Ingrid Bosman; PD = P.M.I. Van Driessche; RG = R.R.R. Gerretsen; BK = B. Kubat; RvR= R.R. van Rijn; VS = V. Soerdjbalie; KL=K.J. Lusthof BK VS BK RG Furthermore, the following students study projects at the Academisch Medisch Centrum-UvA were undertaken under the supervision of dr. R. van Rijn: FP Medical student - Dating subdural hematomas on CT and MRI; a meta-analysis BX Bachelor Forensic Science- The value of liver and pancreatic enzyme values in dating blunt abdominal trauma in children RD & GE medical student - The evidence in the medical differential diagnosis in Abusive Head Trauma: a systematic review ES Medical student- Foetale leeftijdbepaling aan de hand van postmortale radiologie, een kritische literatuur analyse en toepassing in een forensische populatie Annual report 2012 Department of Forensic Medicine, March 2013 Page 9 of 39

2. Forensic pathology 2.1 Staff members Table 5: Overview of the pathologists and their sub-specializations Pathologist Registration 1 Re-registration 1 Sub-specializations Mrs. M Buiskool 2 2010 P.M.I. Van Driessche 2007 2012 Air crash and traffic accidents investigation Microanalysis Invasive Trauma (MIT) Forensic veterinary pathology (in cooperation with veterinary pathology) Forensic medical illustration Neuropathology Mrs. B. Kubat 2002 2012 Neuropathology Air crash and traffic accidents investigation Cardiopathology Wound age estimation Histology laboratory techniques Education instructor Mrs. A. Maes 1989 2010 Paediatric pathology Fracture age estimation Mrs. V. Soerdjbalie 2005 2010 Paediatric pathology Wound age estimation Fracture age estimation Diving accidents investigation Deputy education instructor 1 MRSC registration 2 training in forensic pathology since March 2011; final examination scheduled in 2013 2.2 Memberships & consultancy 2.2.1 Medical staff Mrs. M. Buiskool MD Member of Dutch Pathology Society (NVVP) Member of Dutch-Belgian working group for forensic medicine P.M.I. Van Driessche MD Member of Dutch Neuropathology society en EURO-CNS Member of Dutch Pathology Society (NVVP) and official contact person NFI-NVVP Member of ITMA (International traffic medicine association) Member of Dutch-Belgian working group for forensic medicine Mrs. B. Kubat MD, PhD Member of Dutch Pathology Society (NVVP) Member of European Council of Legal Medicine (ECLM) Member of Dutch-Belgian working group for forensic medicine Member of International Society of Forensic Radiology and Immaging (ISFRI) Member of Forensisch Medisch Genootschap (FMG - The Dutch Forensic Physician Society) Member of Dutch Neuropathology Society Member of European Confederation of Neuropathology Societies (EURO-CNS) Member of Deutsche Gesellschaft für Neuropatholgoie und Neuroanatomie (DGNN)Member of Integraal Kankercentrum Limburg (IKL), working group Tumours of the CNS Annual report 2012 Department of Forensic Medicine, March 2013 Page 10 of 39

Member of Advisory Committee for Forensic Pathology of the Netherlands Register of Court Expeerts (NRGD) Official consulting forensic neuropathologist of the Forensic Institute, University of Gent, Belgium Consulting neuropathologist and extraordinary staff member, department of Pathology, Atrium medisch centrum Parkstad, Heerlen Consulting neuropathologist, department of Pathology, Orbis Ziekenhuis, Sittard Mrs. A. Maes MD Member of Royal Dutch Association of Medicine (KNMG) Member of Dutch Pathology Society (NVVP) Member of Dutch-Belgian working group for forensic medicine Member of Dutch working group paediatric pathology (WKPLL) Member of British Association in Forensic Medicine (U.K) Member of Forensisch Medisch Genootschap (FMG - The Dutch Forensic Physician Society) Member of Society for Pediatric Pathology Member of Dutch SIDS working group (LWW) Member of Dutch Integral Cancer Center (IKNL) Mrs. V. Soerdjbalie MD, PhD Member of Dutch Pathology Society (NVVP) Member of Forensisch Medisch Genootschap (FMG - The Dutch Forensic Physician Society) Member of Dutch-Belgian working group for forensic medicine Member of WFP (Werkgroep Forensische Pediatrie) Member of International Paediatric Pathology Association (IPPA), Member of Dutch working group paediatric pathology (WKPLL) 2.2.2 Non-medical staff Management The department manager, Mrs. Dr. P.M. van Berkel, is a committee member of the board of the Forensisch Medisch Genootschap (The Dutch Forensic Physician Society). Histology laboratory staff The technicians are members of the VAP (Vereniging Analisten Pathologie Association of Pathology Technicians). Post-mortem technical assistants The post-mortem technical assistants are all member of Vesalius, a professional organisation in The Netherlands and Belgium for post mortem assistants. Forensic photography A.C.M. van den Bos NVMAC (Nederlandse Vereniging voor Medische Audiovisuele Communicatie) 2.3 On going training and congress participations 2.3.1 Medical staff Mrs. M. Buiskool MD Course: Neuropathology, Aachen 2012 Congress: General Pathology in the Netherlands, 19, 20 April 2012 Meeting: Symposium Air Crash Investigation, Antwerp, Belgium, November 23 Annual report 2012 Department of Forensic Medicine, March 2013 Page 11 of 39

P.M.I. Van Driessche MD Congress: AAFS, USA (February 2012) Congress: General Pathology in the Netherlands, 19, 20 April 2012 Meeting: NvvN, Symposium Air Crash Investigation, Antwerp Belgium, November 23 Mrs. B. Kubat MD, PhD Meeting: IVe Symposium Neuro-oncologie in de Praktijk - Brain Tumors: The Future is Now! The Hague, January 27 Congress: USCAP, Vancouver, Canada, March 17-23 Workshop: Kwaliteitscyclus: de sleutel tot verbetering (Quality, the key to improvement), Utrecht, April 13 Symposium TMFI (The Maastricht Forensic Institute). Maastricht, April 21 Congress: Legal protection for children, Paediatric forensic medicine (Storia Moria), Oslo, Norway, May 3-5 Congress: ISFRI (forensische postmortale radiologie), Zurich, Switserland, Mey 14-15 Course; Adult Cardiovasculat Pathologie, London, GB, May 17-18 Congress: EUCCAN (child protection and child abuse), Amsterdam, May 23-25 Course: Euro CNS Leukencephalopathies, Edinburgh GB, June 4-6 Congress: 10th European congress of neuropathology, Edinburgh GB, June 6-9 Course: Masterclass - Coachen van aios (coaching of residents), Baarn, November 12-13 Meeting: Symposium Air Crash Invetigation, Antwerp, Belgium, November 23 Mrs. A. Maes MD Meeting: KNMG Symposium arts en strafrecht, Utrecht, February 16 Congress: 64th Annual Scientific Meeting American Academy of Forensic Sciences, February 20-25, Atlanta, USA Meeting: Perinatal Audit,, Leiden, March 3 Meeting: Dutch Association of Pathology meeting, Zeist, April 20 Course: Liver pathology, Amsterdam, April 29-30 Meeting: Histopathology of thyroid cancer, September 18 Course: Breast Cancer, Tiel, October 5 Meeting: Symposium Aircrash Investigation, Antwerp, Belgium, November 23 IKNL, Dutch Integral Cancer Center meetings WKPLL, Dutch Working Group for Pediatric Pathology meetings LWW, Dutch SIDS Working Group meetings Mrs. V. Soerdjbalie MD, PhD Course: Onderwijs MTC (Mark Two Communications) nascholing voor artsen: NFI in samenwerking met MTC, april 2012. Titel: aspecten van kindermishandeling Congress: EUCCAN (child protection and child abuse), Amsterdam, May 23-25 Course: Onderwijs Stichting Haagse Genootschap (huisartsen, arbo-artsen, apothekers) Den Haag en omstreken, November. Titel: kindermishandeling. Course: NODO-pathologentraining, November, Titel: klinische vaardigheden en pitfalls bij de kindersectie, met casuïstiek en discussie 2.3.2 Non-medical staff Histology laboratory staff All three technicians attended the autumn congress of the WIHC Neuropathology, November 3 Post-mortem technical assistants Mr. J. Barendrecht Meeting: Voorjaarssymposium, Deventer, April 21 Meeting: Najaarssymposium, Maastricht, November 17 Mr. E. van Houten: Course: Vesalius, April 21 Course: Vesalius, November 17 Meeting: Voorjaarssymposium, Deventer, April 21 Meeting: Najaarssymposium, Maastricht, November 17 Annual report 2012 Department of Forensic Medicine, March 2013 Page 12 of 39

2.4 Publications and lectures 2.4.1 Medical staff Scientific publications: Mr. P.M.I. Van Driessche MD Forensic and medical illustrations in publication Cutaneous manifestations of child abuse and their differential diagnosis: blunt force trauma, R.A.C. Bilo, A.P. Oranje, T. Schwayder, C.J. Hobbs, 2012 Springer books Mrs. B. Kubat MD, PhD. Begieneman M, Kubat B, Ulrich M, Hahn N, Stumpf-Stolker Y, Tempelaars M, Middelkoop E, Zeerleder S, Wouters D, van Ham M, Niessen H, Krijnen P, Prolonged C1 Inhibitor Administration Improves Local Healing of Burn Wounds and Reduces Myocardial Inflammation in a Rat Burn Wound Model. J Burn Care Res. 2012 Jul;33(4):544-51. doi: 10.1097/BCR.0b013e31823bc2fc Kubat B, van Suylen R.-J. An unusual cardiomyopathy in a cocaine user. Forensic Sci. Med. Pathol. 2012 in press [Epub ahead of print] Kubat B, Duist W. Dying in the arms of Dutch governmental authorities. J Forensic Leg Med, in press (accepted August 2012); http://dx.doi.org/10.1016/j.jflm.2012.09.024 Mrs. A. Maes MD Soerdjbalie-Maikoe V, Maes A, Meijerman L, de Wijs-Heijlaerts K, Verheugt AJ. Neonaticide in the Netherlands: a comprehensive review of pathologic and psychological findings. International Journal of Legal Medicine (IALM) 2012, Volume 126. Supplement 1. July 2012. Abstract. Mrs. V. Soerdjbalie MD, PhD Soerdjbalie-Maikoe V. Handboek kindermishandeling (komt uit in 2013). Hoofdstuk 29. Gerechtelijke secties op minderjarigen. Lukkassen IMA, van de Putte EM, Russel IMB, Teeuw AH Edt., accepted Soerdjbalie-Maikoe V, Naipal K, Hovinga-de Boer M, G. Maat G.A histological comparison of the mastoid bones in strangulation and drowning. International Journal of Legal Medicine (IALM) 2012, Volume 126. Supplement 1. July 2012. Abstract. Soerdjbalie-Maikoe V, Maes A, Meijerman L, de Wijs-Heijlaerts K, Verheugt AJ. Neonaticide in the Netherlands: a comprehensive review of pathologic and psychological findings. International Journal of Legal Medicine (IALM) 2012, Volume 126. Supplement 1. July 2012. Abstract. Sieswerda T, Soerdjbalie-Maikoe V, van Rijn R. Pneumomediastinum and soft tissue emphysema in paediatric hanging; a case report. Journal of Forensic Sciences 2012, accepted. Ceelen, M, Dorn T,,Naujocks T, Stomp J, Soerdjbalie-Maiko V, Das C. NODOmeldplicht: overleden minderjarigen gemeld door behandelend artsen aan de gemeentelijk lijkschouwer. Medisch contact. Accepted. Lectures: Mr. P.M.I. Van Driessche MD Wetenschapscafé (Science café) Erasmus Medical Centre, Rotterdam (11 juni 2012) Lecture on the importance of photography in forensic neuropathological investigations for the professional union of Medical Photographers, NVMAC (Nederlandse Vereniging voor Medische Audiovisuele Communicatie, (3 feb 2012) Educational lectures and presentations (through the NFI-academy) for police forces (Politie-academie), university Forensic Science (HvA) and others (2012) Annual report 2012 Department of Forensic Medicine, March 2013 Page 13 of 39

Mrs. Dr. B. Kubat, MD, PhD van der Steen J, Kubat B. Verder onderzoek naar doodsoorzaken van forensische secties met het label: geen anatomische doodsoorzaak (GADO).Barend Cohen Lezing, Den Haag, The Netherlands, January 2012. (Ancillary investigations of the cause of death (COD) in forensic autopsies with no COD at post mortem) Kubat B. Neuropathology, a problem as delicate as the child itself. (invited lecture). European Conference on Child Abuse and Neglect, Amsterdam, The Netherlands, May 2012 van den Bos D, Gerretsen R, Kubat B. Comparison of Fracture Dating Methods.. European Conference on Child Abuse and Neglect, Amsterdam, The Netherlands, May 2012 Sieswerda-Hoogendoorn T, Bilo R, Kubat B, van Duurling L, van Rijn R. Social paediatric aspects of abusive head trauma, analysis of 68 cases.. Twelfth International Conference on Shaken Baby Syndrome/Abusive Head Trauma, September 29, 30, & October 1, 2012 The NFI Protocol Air Crash investigation. Symposium Air Crash Invetigation, Antwerpen Belgium, November 23 Mrs. A. Maes MD NODO lectures, NFI Academy, several Case presentation WKPLL, Dutch Working Group for Pediatric Pathology. March 19 Case presentation IKNL, Dutch Integral Cancer Center. October 29 Mrs. V. Soerdjbalie MD, PhD Forensische pathologie in Nederland. Onderwijs HOVO-cursus voor ouderen, Universiteit Leiden, February Histologie van mastoiden in forensische casuïstiek. NVVP Pathologendagen, April 2012. Poster Neonaticide in Nederland. NVVP Pathologendagen, April 2012. Poster Aspecten van kindermishandeling Onderwijs MTC (Mark Two Communications) April 2012 Forensic Autopsy in the Netherlands. European Conference on Child Abuse and Neglect (EUCCAN) in Amsterdam, May 23-25 A histological comparison of mastoid bones in drowning and strangulation. IALMS (22nd Congress of the International Academy of Legal Medicine, Istanbul, Turky Juli Poster Neonaticide in the Netherlands. IALMS (22nd Congress of the International Academy of Legal Medicine, Istanbul, Turky Juli Poster Forensische pathologie: pittfalls en overeenkomsten tussen klinische en forensische pathologie Pathologie LUMC Leiden, September 17 Pittfalls in de forensische pathologie. Thema-avond werkgroep Pathologie IKNL October 29 Kindermishandeling. Onderwijs Stichting Haagse Genootschap (huisartsen, arboartsen, apothekers) Den Haag, November Klinische vaardigheden en pittfalls bij de kindersectie, met casuïstiek en discussie. NODO-pathologen training, November Kindermishandeling Surinamedag, November 11 2.4.2 Non-medical staff Books and scientific publications: A.C.M. van den Bos Van den Bos A, Bel F, Nijs HGT. Forensic photography in suspected child abuse. Chapter 9, in: Cutaneous Manifestations of Child Abuse and Their Differential Diagnosis. Editors: Bilo RAC, Oranje AP, Shwayder T, Hobbs CJ. Springer, Heidelberg 2012, ISBN 978-3-642-29286-6. Annual report 2012 Department of Forensic Medicine, March 2013 Page 14 of 39

Lectures: A.C.M. van den Bos Symposium Forensic Medical Photography (Medical Photographers), NFI Den Haag, February 3 2012 Forensic Photography (Forensic Investigators), Politieacademie Apeldoorn, 27 April, 2012 Forensic Photography (Forensic Investigators), Politieacademie Apeldoorn, 5 Juli, 2012 Forensic Photography (1rd year Forensic Science students), HvA Amsterdam, 10 t/m 14 September, 2012 Forensic Medical Photography (4rd year Forensic Science students), HvA Amsterdam, 18 September, 2012 Forensic Photography (Forensic Investigators BES eilanden), Bonaire, 26 t/m 30 November 2012 Forensic Photography (3rd year medical students), AMC Amsterdam, December 6, 2012 2.5 Case-related activities 2.5.1 Pathology The department of Forensic Medicine performed a total of 4954 investigation of which 970 were forensic pathology cases; of these 340 were post mortems: 309 adult cases(2 of bodyparts), 31 paediatric cases (0 to 18 years). In 240 of the 970 cases other types of investigations were performed, such as DNA and toxicology sampling on location in The Netherlands and special case work, e.g. second opinions, answering additional questions, court testimonies and case reconstructions. The total numbers of post mortems in the past years are given in figure 2. Figure 2. Number of post mortems performed in the NFI in the years 2005 2012 Figure 3 illustrates the number of post mortems per pathologist in 2012. M. Buiskool only performed post mortems under supervision. One post mortem case was a forensic anthropology case and was performed by the forensic anthropologist, R.R.R. Gerretsen. One post mortem of the announced 341 was cancelled. Annual report 2012 Department of Forensic Medicine, March 2013 Page 15 of 39

PD = P.M.I. Van Driessche; BK = B. Kubat; AM = A. Maes; VS = V. Soerdjbalie; MB = M. Buiskool Figure3. Number of post mortems per pathologist in 2012 The total number of brain post mortems between 2005 and 2012 performed in NFI cases as well as on consulting basis by the neuropathologists (B Kubat and P.M.I. Van Driessche) are illustrated in figure 4. Figure 4. Number of neuropathology investigations In 2010 post mortem muscle pathology was introduced as one of the ancillary investigations in cases where no cause of death was apparent at the end of the autopsy. In 2010 11, in 2011 52 and in 2012 48 investigations were performed by the neuropathologists. Annual report 2012 Department of Forensic Medicine, March 2013 Page 16 of 39

2.5.2 Histology After 2007 the total number of histological slides (figure 5) stabilized at approximately 26.000. Amongst the aforementioned production were 241 whole paraffin embeddings of decalcified laryngeal material from a total of 39 cases. The production per technical laboratory assistant in 2011 was 11.804 slides per fte compared to 9.376 in 2012. Figure 6 shows the average numbers of slides per post mortem. In 2012 10 new antibodies for immunohistochemical stains were introduced. These were antibodies against toxoplasmosis, TBC bacillus, desmin, myoglobulin, CD34, Glycoforine C, Herpes Simplex Virus, CD 138, CD68 macrophage and myoglobulin. Furthermore in 2012 a new decalcification method for bone tissue by means of EDTA-buffer and KOS microwave was tested. This innovation should achieve better histological preservation and (better) immunohistochemical-staining properties of the tissue. Further testing shall be performed in 2013, after which the method shall be implemented to the routine procedures. In 2012 a beginning has been made with the introduction of whole-hemispheral brain paraffin preparations to the NFI. 35000 33053 30000 25000 20000 20002 17410 19223 22497 26222 25007 26253 15000 10000 5000 0 No. of slides 2005 2006 2007 2008 2009 2010 2011 2012 Figure 5. Total number of histological slides Annual report 2012 Department of Forensic Medicine, March 2013 Page 17 of 39

100 90 80 70 60 50 40 30 20 10 0 33 39 72 67 54 25 No. of slides per post mortem 91 77 2005 2006 2007 2008 2009 2010 2011 2012 Figure 6. Number of slides per post mortem 35000 30000 3255 3190 25000 20000 1172 1901 2095 3913 2465 2096 1252 2233 2224 15000 26608 10000 19423 20214 20446 20544 5000 0 2008 2009 2010 2011 2012 HE & EvG Histochemical stains immunohistochemical stains enzymhistochemical stains Figure 7. Numbers of different staining techniques per year Annual report 2012 Department of Forensic Medicine, March 2013 Page 18 of 39

2.5.3 First NFI data from PALGA PALGA 1, founded in 1971, is the national registration of all reports generated by all pathology departments in the Netherlands. This system provides various services both within and outside hospitals: supports the processing and local archiving of patient data, including the complete pathology reports sends abstracts to the national database on a daily basis. provides ample on-line services for local and national retrieval purposes (patient care, research) due to its open architecture, it provides high flexibility and optimal possibilities for linkage with all kind of systems (e.g. digital hospital systems, GP-communications systems) it enables the use of speech recognition systems The contents of this national database are the abstracts of the pathology reports. An abstract consists of encrypted patient identification, a summary of the report, and diagnostic terms in line with SNOMED terminology. To date about 53 million abstracts of more than 11 million patients are stored, each year more than 2 million abstracts are added. The NFI pathology laboratory was the last to join in this registry. Due to its special tasks within the legal system special security measures had to be developed and guarantees obtained concerning the non-disclosure of judicially sensitive data. After these hurdles had been taken, in 2012 the NFI gladly joined in because the system enables digital and thus easy and fast analysis of the NFI pathology data. Because the PALGA primarily aimed to service clinical pathology laboratories no forensic coding terminology existed. After the agreement between PALGA and the NFI the development of forensic coding was started, which was added to the system. The presented overview summarizes the data of the first PALGA mediated analysis of the forensic post mortems from the years 2008 to 2012, which have retrospectively been registered in this system. After the completion of the post mortem and ancillary investigations the causes of death (COD) can be divided into natural, unnatural and undetermined. Natural COD is death due to disease. Unnatural COD is diagnosed when the death was caused by other factors but disease. This category comprises (self) inflicted fatal injuries and fatal (auto) intoxications. In a small number of cases no COD is detected at post mortem. The distribution of these categories in our population is given in figure 8. The relative high number of not specified cases in 2012 is caused by the fact that not all cases have been closed to date. 1 http://www.palga.nl Annual report 2012 Department of Forensic Medicine, March 2013 Page 19 of 39

600 500 400 300 200 100 0 484 437 415 401 347 325 340 311 287 175 139 95 81 46 58 62 1813 32 2942 1216 19 7 2008 2009 2010 2011 2012 total natural death unnatural undetermined not specified Figure 8. The distribution the causes of death (2008-2012) Few of these cases are investigations of body parts. In an analysis of the outcome of post mortems in the NFI between the years 2006 and 2012 a total of 16% of the whole body post mortems did not reveal a cause of death. However, 6% of these victims were found in water, thus drowning was a very probable cause of death, whereas in 10% of our post mortems no (probable) cause of death was identified. This outcome appeared to be comparable to the results of other studies (table 6). Possibly this percentage would be even slightly lower if medical history were available and genetic testing for inborn arrhythmias were possible in the framework of the forensic post mortem investigation. This, however, is not the case under the Dutch law. Table 6: Percentages of negative post mortem outcome Population type [N] Tox. Age (years) Neg. outcome (%) Driscol et al 2 Clinical [12] No 1 22 42% 1985 Shen et al 3 Clinical [54] No 20 40 13% 1995 Nordrum et al 4 1998 Forensic [59] Yes > 1 11% Morentin et al 5 2003 Forensic [107] Yes 1 35 38% Cohle et al 6 1 5% 2001 Schwartz et al 7 2007 0 young adult 10 30% Tox. = Toxicology testing performed The COD can become apparent at different stages of the investigation. Sometimes it is evident after the completion of the actual post mortem, in some cases only after ancillary testing. Figure 9 gives the percentages regarding the stages of the investigation at which the COD was established. 2 David J. Driscoll et al (1985), Sudden Unexpected Death in Children and Adolescents, JACC Vol. 5, No. 6, pag. 118B 121B 3 Win-KuangShen, et al (1995), Sudden Unexpected Nontraumatic Death in 54 Young Adults, The American Journal of Cardiology, Vol. 76, pag. 148 152 4 IvarNordrum, et al (1998), Unexplained and explained natural death among persons above 1 year of age in a series of medico legal autopsies, Forensic Science International 93, pag. 89 98 5 Benito Morentin, et al (2003), Sudden unexplained death among persons 1 35 years old, Forensic Science International 135, pag. 213-217 6 Stephen D. et al (2001), The negative autopsy: Sudden cardiac death or other? Cardiovascular Pathology 10, pag. 219 222 7 Peter J. Schwartz and LiaCrotti (2007), Postmortem Long QT Syndrome Genetic Testing for Sudden Unexplained Death in the Young, Journal of the American College of Cardiology, Vol. 49, No. 2, pag. 247 249 Annual report 2012 Department of Forensic Medicine, March 2013 Page 20 of 39