Forensic pathologists commonly use computed tomography (CT) images to assist in determining the cause and manner of death as well as for mass disaster operations.Even though the design of the CT machine does not inherently produce distortion, most techniques within anthropology rely on metric variables, thus concern exists regarding the accuracy of CT images reflecting an object's true dimensions. Numerous researchers have attempted to validate the use of CT images, however the comparisons have only been conducted on limited elements and/or comparisons were between measurements taken from a dry element and measurements taken from the 3D-CT image of the same dry element.A full-body CT scan was performed prior to autopsy at the Office of the Chief Medical Examiner for the State of Maryland. Following autopsy, the remains were processed to remove all soft tissues and the skeletal elements were subject to an additional CT scan. Percent differences and Bland-Altman plots were used to assess the accuracy between osteometric variables obtained from the dry skeletal elements and from CT images with and without soft tissues. An additional seven crania were scanned, measured by three observers, and the reliability was evaluated by technical error of measurement (TEM) and relative technical error of measurement (%TEM).Average percent differences between the measurements obtained from the three data sources ranged from 1.4% to 2.9%. Bland-Altman plots illustrated the two sets of measurements were generally within 2mm for each comparison between data sources. Intra-observer TEM and %TEM for three observers and all craniometric variables ranged between 0.46 mm and 0.77 mm and 0.56% and 1.06%, respectively. The three-way interobserver TEM and %TEM for craniometric variables was 2.6 mm and 2.26%, respectively. Variables that yielded high error rates were orbital height, orbital breadth, inter-orbital breadth and parietal chord. Overall, minimal differences were found among the data sources and high accuracy was noted between the observers, which prove CT images are an acceptable source to collect osteometric variables.

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Caffeine, 1,3,7-trimethylxanthine, is the most widely consumed legal stimulant. The most potent form is over the counter oral tablets. The estimated average daily adult caffeine consumption is 300 mg. Rarely, serious toxicities such as seizure and cardiac arrhythmias have caused death. Caffeine concentrations of 80 mg/L are considered lethal. Cases investigated over 10 years by the Office of the Chief Medical Examiner for the State of Maryland (OCME) whose cause of death was solely or in combination due to caffeine intoxication were reviewed. A total of eight adult cases were identified consisting of two suicides and six undetermined manners. The average postmortem caffeine concentration was 140.4 mg/L. This is the largest case series reported to date of lethal caffeine intoxication. Large doses of prescription medications and/or over the counter medications were abused. No overdoses were from consumption of caffeine-containing foods. Comprehensive postmortem toxicological testing should test for caffeine to capture these rare deaths.

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Tapentadol (Nucynta) is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe acute pain. Its efficacy is believed to be due to μ-opioid receptor agonist activity and inhibition of norepinephrine reuptake resulting in increased norepinephrine concentrations. There is only one other case in the literature relating to the toxicity of this agent or report of a fatality. This case report documents a case in which tapentadol was identified as the cause of death. The tapentadol concentration found in the heart blood submitted in this case was more than 20 times the upper limit of the therapeutic range. Possible mechanisms of death include respiratory depression, central nervous system depression, and serotonin syndrome. Based on the scene investigation and autopsy findings in this case, the medical examiner determined that the cause of death was narcotic (Nucynta) intoxication and the manner of death was undetermined.