Tramadol (Ultram) concentrations in death investigation and impaired driving cases and their significance

We reviewed a series of 66 deaths in Washington State between 1995-2000 in which tramadol (Ultram and Ultracet, Ortho-McNeil) was detected in the decedent's blood, in order to assess the role tramadol was determined to have played. Additionally, we reviewed a series of 83 impaired driving cases in which tramadol was detected in order to establish a non-lethal blood tramadol concentration reference range. In both populations, tramadol was consistently found together with other analgesic, muscle relaxant, and CNS depressant drugs. Death was rarely attributable to tramadol alone. However, tramadol may be a significant contributor to lethal intoxication when taken in excess with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased CNS depression. Although the incidence of tramadol detection has increased consistently over the last eight years, there is no evidence of a corresponding increase in the number of cases in which death was attributed solely to tramadol. Blood drug concentrations in many deaths exceeded the therapeutic serum range of 0.28-0.61 mg/L; however, the concentrations overlapped almost completely with the range identified in living subjects arrested for impaired driving. These findings suggest caution in the interpretation of blood tramadol concentrations outside of the recognized therapeutic range. It also suggests that the drug, even when used in moderate excess, is not a principle cause of death in suicidal or accidental deaths.     

A review of blunt force injury homicides of children aged 0 to 5 years in bexar county, Texas, from 1988 to 2009

ABSTRACT: It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.     

Standing My Ground: A Voice for Nature Conservation

Standing My Ground: A Voice for Nature Conservation. By Alan F. Mark (Dunedin: Otago University Press, 2015), pp.312. ISBN978‐1‐927322‐04‐8. NZ$45.00 (pb).     

Tattoos and Human Identification: Investigation into the Use of X‐Ray and Infrared Radiation in the Visualization of Tattoos

Any person with a tattoo known to their family or friends could potentially be identified from the presence of such personal identifying markers. Problems in identification utilizing tattoos may arise when these markers are removed or defaced in some way. This paper uses infrared wavelengths at 760, 850, and 950 nm to improve the visualization of laser‐removed or covered up tattoos and also to establish whether the ink pigments used can be observed on radiographs from any metal that may be present. The results obtained indicate that some older inks have a high enough metallic content to allow them to be viewed on a radiograph, while infrared light can demonstrate latent ink still present in the skin after laser removal and can also be utilized to distinguish an original tattoo through a secondary “cover‐up” tattoo. Infrared photography and radiography have been shown to improve tattoo visualization in a forensic context.     

Who are ‘we’? Don’t make me laugh

This paper explores the implications of uses of the word ‘we’ in post-apartheid South African fiction. ‘We’ in these novels is typically a contested linguistic site – which tells of the loss of inherited communities, and reflects the ethically complex negotiations of a ‘we’ perhaps still to come. Yet if the internal narratives assert a loss of community, each event of the novel’s being-read inaugurates a new ‘community’ of readers. The paper considers the ethical implications of the act of reading a literary text in post-apartheid South Africa. In the course of the argument, I draw links between African philosophies of community, and Jean-Luc Nancy’s proposition that ‘I’ does not precede ‘we’. Thus I suggest some ways in which philosophies from Africa contribute towards current debates about ‘we’ in contemporary continental philosophy.

Attempt: The Conduct Requirement

The law relating to the conduct requirement for criminal attemptsis confused and incoherent. This article examines this incoherence,rejects the Law Commission's provisional proposals to splitthe crime of attempt into two separate inchoate offences andsuggests a reformulation of the conduct requirement in attempts.