The 2018 California Wildfires: Integration of Rapid DNA to Dramatically Accelerate Victim Identification

In November 2018, Butte County, California, was decimated by the Camp Fire, the deadliest wildfire in state history. Over 150,000 acres were destroyed, and at its peak, the fire consumed eighty acres per minute. The speed and intensity of the oncoming flames killed scores of people, and weeks before the fire was contained, first responders began searching through the rubble of 18,804 residences and commercial buildings. As with most mass disasters, conventional identification modalities (e.g., fingerprints, odontology, hardware) were utilized to identify victims. The intensity and duration of the fire severely degraded most of the remains, and these approaches were useful in only 22 of 84 cases. In the past, the remaining cases would have been subjected to conventional DNA analysis, which may have required months to years. Instead, Rapid DNA technology was utilized (in a rented recreational vehicle outside the Sacramento morgue) in the victim identification effort. Sixty-nine sets of remains were subjected to Rapid DNA Identification and, of these, 62 (89.9%) generated short tandem repeat profiles that were subjected to familial searching; essentially all these profiles were produced within hours of sample receipt. Samples successfully utilized for DNA identification included blood, bone, liver, muscle, soft tissue of unknown origin, and brain. In tandem with processing of 255 family reference samples, 58 victims were identified. This work represents the first use of Rapid DNA Identification in a mass casualty event, and the results support the use of Rapid DNA as an integrated tool with conventional disaster victim identification modalities.     

SCIENTIFIC‐BUREAUCRATIC MEDICINE AND UK HEALTH POLICY1

One prominent method for controlling health costs is to find measures for the management of demand. Various options exist for this; and many of them have been tried during the fifty years of the UK's National Health Service. Current policy now focuses on what may be called “scientific‐bureaucratic medicine.” This policy is based on the assumptions that valid medical knowledge is derived from accumulated research evidence and that such knowledge should be implemented through clinical guidelines which are enforced to some extent. This UK development has parallels with the US Agency for Health Care Policy and Research whose experience, therefore, raises some policy issues for the UK.     

The Family of the Juvenile Delinquent

Juvenile delinquency has historically been responded to by “de-familization” of the young offender; that is, removal to a training school or other institutional setting. The trend over the past two decades toward deinstitutionalization has meant that delinquent youngsters, who are now remaining in the context of their own communities and families, have been “re-familized.” This poses a major challenge for the juvenile justice system and community, who are stuck with the family but are not sure what to do about it. Little objective and systematic information is available concerning families of delinquents, either as an aggregate group or in individual cases. It is hypothesized that the families are as heterogeneous as are delinquent youngsters, but the juvenile justice system tends to scapegoat families and assumes they are all necessarily dysfunctional. A 10-point continuum of family functioning is proposed. It is suggested that families of delinquent youngsters are found at various points on this continuum: from the extremely impaired or criminogenic family, through the family that has serious problems but has something to offer its youngster if it receives effective help with those problems, to the family of average functioning that can serve as a major rehabilitative resource for the youngster.     

CHILD CUSTODY EVALUATIONS

Judicial and legal changes in divorce rules and precedents over the last two decades have led to increasing involvement by mental health professionals in child custody disputes. This involvement usually entails an evaluation of the child and parents, along with a recommendation to the court regarding custody. To date, there is little empirical evidence supporting the efficacy of methods typically used by professionals in making recommendations to the court. This article presents a review of assessment methods currently used in resolving child custody disputes. It also reviews the limited number of outcome studies on child custody evaluation and methods used in litigation and mediation.     

Is There a Future for Contracting in the Australian Public Sector?

Contracting has moved from the margins to the centre of public management. Significant sections of the public workforce, from benefits delivery to corporate services, now find their functions open to tender. Governments prefer to concentrate on policy analysis and development, leaving service delivery to the market. As purchasers rather than providers, governments are redefining the role and scope of the state. But are Australian governments ready for this shift to contracting? Do they possess the full array of control and reporting mechanisms necessary if contracting is to deliver its promised benefits? There are significant difficulties finding evidence that answers such questions. Yet on the basis of concerns discussed across Australian jurisdictions, it appears contracting has developed so quickly it outstrips the capacity of government to monitor what is happening, and so learn from mistakes. In time governments will become better at maintaining accountability for contracted functions, because experience reduces the risks of moral hazard.     

Digital dental radiographic identification in the pediatric, mixed and permanent dentitions.

The purpose of this paper is to investigate the utility of digital dental radiographic superimposition in the various stages of development of the human dentition. Digital, computer assisted dental identification is a means of identification which allows the spatial relationships of the root and support structures of the teeth to be compared one to the other. The technique has not been tested in patients with developing dentitions. Dental radiographs from patients in the pediatric, mixed and permanent dentition stages of development, simulating "antemortem" and "postmortem" radiographs, were digitized using a flat field radiograph scanner. Anatomic features were used as points of comparison utilizing image editing software whereby anatomic sections were digitally cut from the antemortem image and compared to the same anatomic locations on the postmortem image to assess for points of concordance. The technique was applied to 25 cases within the primary dentition, 25 cases within the mixed dentition and 25 cases within the permanent dentition. Results showed that this was a viable technique within both the pediatric and permanent dentition although it was of little value within the mixed dentition.