Death associated with inadvertent hydrocodone overdose in a child with a respiratory tract infection

A 3-year-old child died of the combined effects of a bacterial superinfection and a relative overdose of hydrocodone prescribed for a cough due to a presumed viral respiratory tract infection. This case illustrates the importance of evaluating the effects of prescribed medication in assessing the cause and mechanism of death in children dying suddenly of presumed natural disease.     

Toxicology and Circumstances of Completed Suicide by Means Other than Overdose*

Abstract: To determine the prevalence and circumstances of psychoactive substances amongst nonoverdose completed suicide, 1436 consecutive cases autopsied at the NSW Department of Forensic Medicine over the period 1/1/1997–12/31/2006 were analyzed. Substances were detected in 67.2% of cases, and illicit drugs in 20.1%. Alcohol was present in 40.6% of cases. Males were more likely to be positive for alcohol, cannabis, and psychostimulants, and females for pharmaceuticals. Illicits were associated with younger age. Alcohol was most prominent amongst toxicity cases, as were opioids, psychostimulants amongst gunshot cases, and pharmaceuticals amongst drownings. Cases in which drug and alcohol histories were noted were more likely to have a substance detected. Alcohol was more common where a suicide note was left and where relationship problems were involved. Pharmaceuticals were more common where a previous attempt was noted. Licit and illicit substances are strongly associated with suicide, even when the method does not involve drug overdose.     

Innovation or Inertia: The U.S. Military and the Learning of Counterinsurgency

Following its encounter with insurgent violence in Iraq, the U.S. Department of Defense (DoD) has sought to improve the U.S. military's ability to conduct counterinsurgency. This effort suggests a potential turning-point in the history of the U.S. military, which has traditionally devoted its attention and resources to “high-intensity” or “conventional” combat. Given this institutional culture, what are now the prospects of the U.S. military ‘learning counterinsurgency’? In many ways, the ongoing reorientation is promising and targeted, informed directly by the U.S. campaign in Iraq. At the same time, Pentagon priorities still reveal a remarkable resistance to change, and this in spite of the radically altered strategic environment of the War on Terror. Given this intransigence - and the eventual fall-out from the troubled Iraq campaign - the ongoing learning of counterinsurgency might very well fail to produce the type of deep-rooted change needed to truly transform the U.S. military.