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.     

Giant berry aneurysms in a forensic setting: a series of 14 cases

This is a series reviewing 14 cases of giant saccular aneurysms diagnosed at the Office of the Chief Medical Examiner of New York City collected over an 11-year period. Data collected on all 14 cases included neuropathological findings, comorbidities, and toxicological findings. Of these 14 cases, 8 were in women, and the ages ranged from 3 to 79 years, with a mean and a median of 50 years. Women were overrepresented in the sixth through eighth decades. Of the 14 cases described, 11 presented with a subarachnoid hemorrhage; 3, no hemorrhage; 2, subdural hemorrhage; 8, intraventricular hemorrhage; 2, intracerebral hemorrhage; and 8, more than 1 hemorrhage type. Location of the aneurysms varied with 6 in the left side of the brain, 6 present in the right side of the brain, and 2 at the midline. We described the clinical, pathological, and toxicological findings associated with these giant aneurysms.     

Who Votes for the Future? Information,Expectations, and Endogeneity in Economic Voting

Voters’ four primary evaluations of the economy—retrospective national, retrospective pocketbook, prospective national, and prospective pocketbook—vary in the cognitive steps necessary to link economic outcomes to candidates in elections. We hypothesize that the effects of the different economic evaluations on vote choice vary with a voter’s ability to acquire information and anticipate the election outcome. Using data from the 1980 through 2004 US presidential elections, we estimate a model of vote choice that includes all four economic evaluations as well as information and uncertainty moderators. The effects of retrospective evaluations on vote choice do not vary by voter information. Prospective economic evaluations weigh in the decisions of the most informed voters, who rely on prospective national evaluations when they believe the incumbent party will win and on prospective pocketbook evaluations when they are uncertain about the election outcome or believe that the challenger will win. Voters who have accurate expectations about who will win the election show the strongest relationship between their vote choice and sociotropic evaluations of the economy, both retrospective and prospective. Voters whose economic evaluations are most likely to be endogenous to vote choice show a weaker relationship between economic evaluations and their votes than the voters who appear to be more objective in their assessments of the election. Economic voting is broader and more prospective than previously accepted, and concerns about endogeneity in economic evaluations are overstated.     

Intellectuals,International Relations and the Constant Emergency

In this essay, I return to Hans Morgenthau's and Hannah Arendt's writings on the Vietnam war and US foreign policy, which explored questions of bureaucracy, technology, emergency. On one level the essays they wrote illustrate the extent to which the discipline of International Relations (IR) has now caught up with the analyses of politics and war that they were developing in the 1960s and 1970s. We begin to see how lines of thought in Morgenthau's writing connect directly with the work of a younger generation of scholars interested in the work of intellectuals like Giorgio Agamben on the dangers of a security-obsessed politics in a ‘state of emergency’ or ‘state of exception’, or how Arendt's and Morgenthau's work on bureaucracy and war is explored in contemporary work; from a pedagogical perspective, drawing out these connections creates the possibility of a different, potentially more subversive, way of introducing students to the discipline of ir.     

Nonseparable Preferences, Measurement Error, and Unstable Survey Responses

A person has nonseparable preferences when her preference onan issue depends on the outcome of other issues. A model ofsurvey responses in which preferences are measured with errorimplies that responses will change depending on the order ofquestions and vary over time when respondents have nonseparablepreferences. Results from two survey experiments confirm thatchanges in survey responses due to question order are explainedby nonseparable preferences but not by the respondent's levelof political information, partisanship, or ideology.