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.     

Nothing to Lose: An Insurance Company's Duty of Good Faith and Fair Dealing,Punitive Damages,and The Legacies of Campbell

This article explores the potential evisceration of the deterrence function of punitive damages, one of the only economic incentives that deters insurance companies from opportunistically breaching their insurance policies. Readers will gain an understanding of why large punitive damages awards are essential in the insurance coverage field and how such awards may implicate due process standards. The article explains the constitutional limitations set forth by the U.S. Supreme Court in imposing punitive damages, and provides a roadmap of how lower courts and practitioners are presently applying these rules.     

More than bricks and sticks: Five components of community development corporation capacity

Abstract

Community development researchers, practitioners, and funders have recently begun to emphasize the need for community development corporations (CDCs) to build capacity. However, the practice of using the term capacity without carefully defining it allows for a wide range of meanings to be assigned to the term and hinders efforts to study and measure it. Capacity is often defined narrowly in terms of housing production, oversimplifying a complex concept and process.

To remedy this shortcoming, we create a framework that views capacity more broadly by dividing it into five components: resource, organizational, programmatic, network, and political. We believe that this more concrete way of thinking about capacity will be particularly useful to practitioners, funders, and policy makers. We apply our definitions to CDCs, particularly those that work with local intermediaries called community development partnerships (CDPs), in order to better understand the role of CDPs in the process of building capacity.     

Genotyping the future: scientists' expectations about race/ ethnicity after BiDil

The ongoing debate about the FDA approval of BiDil in 2005 demonstrates how the first racially/ethnically licensed drug is entangled in both Utopian and dystopian future visions about the continued saliency of race/ethnicity in science and medicine. Drawing on the sociology of expectations, this paper analyzes how scientists in the field of pharmacogenetics are constructing certain visions of the future with respect to the use of social categories of race/ethnicity and the impact of high-throughput genotyping technologies that promise to transform scientific practices.