Clifford Raabe Weiss, M.D.

• Medical Director, The Johns Hopkins Center for Bioengineering, Innovation and Design (CBID)
• Associate Professor of Radiology and Radiological Science

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0015953/clifford-weiss

The use of expired carbon dioxide monitoring devices is now Another valuable emergency technique is intraosseous required for almost all deeply sedated children (with rare needle placement for vascular access allergy medicine chlorpheniramine buy beconase aq on line. Intraosseous needles are exceptions) allergy medicine for toddlers cheapest beconase aq, particularly in situations in which other means available in several sizes; insertion can be lifesaving when rapid of assessing the adequacy of ventilation are limited allergy symptoms numbness order 200mdi beconase aq free shipping. Pediatr Int 2003;45 compatible pump is required or the pump must be situated (2):180-5 allergy symptoms images best beconase aq 200mdi. Procedural sedation and analgesia for patible, including laryngoscope blades and handles, oxygen children in the emergency department. Sedation, anaesthesia and monitoring pagers, pens, credit cards, watches, surgical implants, pace for bronchoscopy. Complications of flexible bronchoscopy in children: prospective study of Nitrous oxide 1,328 procedures. Evolution of a oxide must have the capacity of delivering 100% and never less than 25% oxygen concentration at a fow rate appropriate to protocol for ketamineinduced sedation as an alternative to the size of the patient. Equipment that delivers variable ratios general anesthesia for interventional radiologic procedures of nitrous oxide >50% to oxygen that covers the mouth and in pediatric patients. All nitrous oxide-to-oxygen inhalation pediatric dentists: a 15-year follow-up survey. Pediatr Dent devices should be calibrated in accordance with appropriate 2002;24(4):289-94. Etomidate for procedural seda the National Institute of Occupational Safety and Health 464 tion in emergency medicine. Comparison of two benzodiazepines priate state or local inspections to certify proper function of used for sedation of children undergoing suturing of a inhalation sedation/analgesia systems before any delivery of laceration in an emergency department. Sedation and analgesia in pediatric istration of nitrous oxide of 50% with the balance as oxygen, patients for procedures outside the operating room. Anes without any other sedative, opioid, or other depressant drug thesiol Clin North America 2002;20(1):181-94, vii. It comparison of chloral hydrate and midazolam sedation should be noted that although local anesthetics have sedative in children undergoing echocardiography. Clin Pediatr properties, for purposes of this guideline they are not consid (Phila) 2001;40(7):381-7. Invasive procedures carried out is combined with other sedating medications, such as chloral in conscious children: contrast between North American hydrate, midazolam, or an opioid, or if nitrous oxide is used and European paediatric oncology centres. Arch Dis Child in concentrations >50%, the likelihood for moderate or deep 107,197,492,494,495 2001;85(1):12-5. Pharmacological management tioner is advised to institute the guidelines for moderate or deep sedation, as indicated by the patients response. Sedation for children requiring have no potential conicts of interest to disclose. Eur J Pediatr Surg tients receiving sedation for procedures: evaluation of 2015;25(3):250-6. Pharmacological azolam for sedation of children for neuroimaging: a ran sedation for cranial computed tomography in children after domized clinical trial. Ann Emerg Med 2000;35 propofol administered by paediatricians during procedural (1):35-42. Pediatric procedural sedation with propofol acceptable for complex sedation with analgesia. Sedation for invasive procedures in paedi and ketofol use for pediatric sedation. Managing patient stress in pediatric radio partment: getting closer: advances in decreasing distress logy. Sedation department using singlesyringe ketamine-propofol combi for pediatric diagnostic imaging: use of pediatric and nur nation (ketofol). Pharmacologic behavior management for pedi tion service provided by emergency physicians. Committee on Drugs, Section on Anesthesiology, American efcacy of sedation in children using a structured sedation Academy ofPediatrics. Paediatr Guidelines formonitoring and management ofpediatric Anaesth 2008;18(1):11-2. Sedation in the emergency depart patients during and after sedation for diagnostic and thera ment. Management of acute pain and anxiety in chil American Academy ofPediatric Dentistry; Work Group dren undergoing procedures in the emergency department. Guidelines for monitoring and management Pediatr Emerg Care 2001;17(2):115-22; quiz: 123-5. Sedation and anesthesia issues in pediatric ima nostic and therapeutic procedures: an update. J Emerg Trauma Shock 2008; guidelines for sedation and analgesiaby non-anesthesiologists. Committee of Origin: Ad Hoc on Non-Anesthesiologist pact of a paediatric procedural sedation credentialing pro Privileging. Development and im files/public/resources/standards-guidelines/advisory-on plementation of an education and credentialing pro granting-privileges-for-deep-sedationto-non-anesthesiologist. Ventilatory toring practices during pediatricprocedural sedation: a response during dissociative sedation in children-a pilot report from the Pediatric Sedation Research Consortium. A single blind study of administered by nonanaesthesiologists in a childrens hos combined pulse oximetry and capnography in children. Sedation medication received and adverse events patients in the emergency department. Pediatric toring sedoanalgesia: infuence of oxygen on the parameters procedural sedation with ketamine: time to discharge after monitored [in Spanish]. Audit of the safety and efectiveness of tive multicentre survey of 191142 patients. Z Gastro ketamine for procedural sedation in the emergency depart enterol 2013;51(6):568-72. Capape S, Mora E, Mintegui S, Garcia S, Santiago M, infusion of ketaminepropofol can be an alternative to Benito J. Prolonged sedation and airway complications intravenous infusion of fentanylpropofol for deep sedation after administration of an inadvertent ketamine overdose and analgesia in paediatric patients undergoing emer in emergency department. Utility of High-concentration nitrous oxide for procedural sedation endtidal carbon dioxide monitoring in detection of hypoxia in children: adverse events and depth of sedation. Pediatrics during sedation for brain magnetic resonance imaging in 2008;121(3):e528-32. Procedural domized clinical trial of oral transmucosal fentanyl citrate sedation with propofol: a retrospective review of the ex versus intravenous morphine sulfate for initial control of periences of an emergency medicine residency program pain in children with extremity injuries. Detection graphy and depth of sedation during propofol sedation in of hypoventilation by capnography and its association children. A randomized controlled trial of block versus ketamine plus midazolam for emergency de ketamine/propofol versus propofol alone for emergency partment forearm fracture reduction in children. Adverse events Paediatric procedural sedation based on nitrous oxide and in pediatric ketamine sedations with or without morphine ketamine: sedation registry data from Australia. Pediatr Emerg Care peridine, promethazine, and chlorpromazine for sedation 2010; 26(6):408-12. Pediatr Emerg Care of procedural sedation and analgesia in children less than 2001;17(5):351-3. Death in the dental chair: three sedation in the emergency department: an individual drug fatalities in dental patients. Provision of deep procedural sedation by a pedodontic sedation: an assessment of narcotic, local anes pediatric sedation team at a freestanding imaging center. Death after chloral hydrate sedation: critical care physician administered procedural sedation report of case. Pediatr Crit Care Med 2015; ofce anesthetic procedures: a closed-claim analysis of 13 16(1):11-20. The assessment of two outside the operating room: the role of the anesthesia care oral sedation drug regimens in pediatric dental patients.

Morphologic examination When the cell count is over 30 white cells per microliter allergy forecast rochester mn order 200mdi beconase aq with mastercard, a differential cell count is done allergy medicine reactine order beconase aq 200mdi without prescription. This may be done on a smear made from the centrifuged spinal fluid sediment allergy symptoms ginger and hon buy beconase aq 200mdi without prescription, by recovery with a filtration or sedimentation method dust allergy symptoms uk order beconase aq 200mdi otc, or preferably on a cytocentrifuged preparation (This technique requires the use of a special cytocentrifuge, such as the Cytospin). The supernatant is removed, and the sediment is used to prepare smears on glass sliders. If any tumor cells or unusual cells are encountered, the specimen should be referred for cytologic examination. With the low power objective, quickly scan both ruled areas of the hemocytometer to determine whether red cells are present and to get a rough idea of their concentration. Count five squares on each side, using the four corner squares and the center square. If the number of red cells is fairly high (more than 200 cells per ten squares) count fewer squares and adjust the calculations accordingly. If the fluid is extremely blood, it may be necessary to dilute it volumetrically with saline or some other isotonic diluent. It is preferable to count the undiluted fluid in fewer than 10 squares, if possible. Rinse a disposable Pasteur pipette with glacial acetic acid, drain it carefully, wipe the outside completely dry with gauze, and touch the tip of the pipette to the gauze to remove any excess acid. Mix the spinal fluid with the acid coating the pipette by placing the pipette in a horizontal position and removing your finger from the end of the pipette. With the low-power objective, quickly scan both ruled areas of the hemocytometer to determine whether white cells are present, and to get a rough idea of their concentration. The white cell nuclei will appear as dark, retractile structures surrounded by a halo of cytoplasm. Using the low-power objective, count the white cells in 10mm2, 5mm2 on each side of the hemocytometer using the four corner squares and the center square 7. Do a chamber differential as the white cells are counted by classifying each white cell seen as polynuclear or mononuclear. This chamber differential is inaccurate, and a differential cell counts on a stained cytocentrifuged preparation is preferred. If it appears that the number of white cells is more than 200 cells per ten squares, count fewer squares and adjust your calculations accordingly. These cavities are lined by a contiguous membrane that forms a double layer of mesothelial cells, called the serous membrane. The cavities are the pleural (around the lungs), pericardial (around the heart), and peritoneal (around the abdominal and pelvic organs) cavities. A small about of serous fluid fills the space between the two layers and serves to lubricate the surfaces of these membranes as they move against each other. The fluids are ultrafiltrates of plasma, which are continuously formed and reabsorbed, leaving only a very small volume within the cavities. Since normal serous fluids are formed as an ultrafiltrate of plasma as it filters through the capillary endothelium, they are transudates. In determining the cause of an effusion, it is helpful to 427 Hematology determine whether the effusion is a transudate or an exudate. In general, the effusion is a transudate (which is an ultrafiltrate of plasma) as the result of a systemic disease. An example of a transudate includes ascites, an effusion into the peritoneal cavity, which might be caused by liver cirrhosis or congestive heart failure. Transudates may be thought of as the result of a mechanical disorder affecting movement of fluid across a membrane. Exudates are usually effusions that result from an inflammatory response to conditions that directly affect the serous cavity. At least three anticoagulated tubes of fluids are generally collected and used as follows: 1. A sterile heparinized tube for Gram stain and culture Gross appearance Normal serous fluid is pale and straw colored. An abnormally colored fluid may appear milky (chylous or pseudochylous), cloudy, or bloody on gross 429 Hematology observation. A cloudy serous fluid is often associated with an inflammatory reaction, either bacterial or viral. Blood-tinged fluid can be seen as a result of a traumatic tap, and grossly bloody fluid can be seen when an organ such as the spleen or liver or a blood vessel has rupture. Bloody fluids are also seen in malignant diseases states, after myocardial infarction, in tuberculosis, in rheumatoid arthritis, and in systemic lupus erythematosus. Clotting To observe the ability of the serous fluid to clot, the specimen must be collected in a plain tube with no anticoagulant. Red and white Blood cell count Cell counts are done on well-mixed anticoagulated serous fluid in a hemocytometer. If significant protein is present, acetic acid cannot be used as a diluent for white cell counts, owing to the precipitation of protein. In this case, saline may be used as a diluent and the red and white cell counts are done simultaneously. A predominance of lymphocytes suggests viral infection, tuberculosis, lymphoma, or malignancy. Slides are generally stained with Wright stain, and a differential cell count is done. The white cells generally resemble those seen in peripheral blood, with the addition of mesothelial lining cells. Generally 300 cells are counted and differentiated as to percentage of each cell type see. If any malignant tumor cells are seen or appear to be present, the slide must be referred to a pathologist or 431 Hematology qualified cytotechnologist. Normal synovial fluid is an ultrafiltrate of plasma with the addition of a high molecular-weight mucopolysaccharide called hyaluronate or hyaluronic acid. The presence of hyaluronate differentiates synovial fluid from other serous fluids and spinal fluid. It is responsible for the normal viscosity of synovial fluid, which serves to lubricate the joints so that they move freely. This normal viscosity is responsible for some difficulties in the examination of synovial fluid, especially in performing cell counts. Normal synovial fluid Normal synovial fluid is straw colored and viscous, resembling uncooked egg white. About 1ml of synovial fluid is present in each large joint, such as the knee, ankle, hip, elbow, wrist, and shoulder. Since the fluid is an ultrafiltrate of plasma, normal synovial fluid has essentially the same chemical composition as plasma without the larger protein molecules. Aspiration and analysis the aspiration and analysis of synovial fluid may be done to determine the cause of joint disease, especially when accompanied by an abnormal accumulation of fluid in the joint (effusion). The joint disease (arthritis) might be crystal induced, degenerative, inflammatory, or infectious. Morphologic analysis of cells and crystals, together with Gram stain and culture, will help in the differentiation. Effusion of synovial fluid is usually present clinically before aspiration, and therefore it is often possible to aspirate 10 to 20ml of the fluid for laboratory examination, although the volume (whit is normally about 1ml) may be extremely small, so that the laboratory receives only a drop of fluid contained in the aspiration syringe. The fluid is collected with a disposable needle and plastic syringe, to avoid contamination with confusing birefringent material. A plain tube (without anticoagulant) for clot formation, gross appearance, and chemical and immunologic procedures. This is especially true when only a small volume of fluid is aspirated, giving an excess of anticoagulant, which may crystallize.

Keywords: Iron defciency anemia; Sports; Infammation; Iron Sports Anaemia and Iron Defciency liposome; Absorption Iron is the most abundant trace element in the world that plays important roles in oxygen transport allergy symptoms under eyes 200mdi beconase aq free shipping, energy metabolism allergy testing lincoln ne order beconase aq once a day, electron Introduction delivery chain and the cofactor for enzymes in biosynthesis [7] allergy medicine that makes you sleepy purchase beconase aq without a prescription. Anemia is a serious global health problem allergy medicine 013 purchase beconase aq no prescription, and its prevalence had Despite the long history of fundamental observations about iron reached 32. Anemia patients sufer from fatigue, weakness, difculty in mechanisms involved in iron metabolism are just being defned in concentrating, decreased cognitive performance or poor work recent two decades [7]. They are frequently encountered in the emergency mg of dietary iron per day) and released into the circulation system; department. It is reported High intensity of sports can develop into anaemia, which is known that signifcant iron-defciency can lead to iron defciency anemia as sports anaemia [9]. Because of the insufcient iron absorption, sweat loss of iron and children and has been considered as a major contributor to the global blood loss though foot strike haemolysis or gastrointestinal blood loss burden of disease [3-5]. Terefore, anaemia has aroused the world [10,11], the iron in the plasma cannot meet the demand of the human wide attention. Moreover, hepcidin levels were signifcantly elevated at the early anaemia such as chronic disease, sports and infammation [1,6]. It is critical to investigate the causes and strategy iron efux from enterocytes and macrophages into the plasma [13,14]. Terefore, iron levels are decreased in the serum, which afects the work performance of iron-defcient athletes. Chronic infammatory of human body is reported to induce and are usually produced in the form of lipid microcapsules with anaemia of chronic kidney disease resulted from the iron defciency aqueous phase cores. In turn, Iron liposomes have high efciency of absorption is mainly because more iron supplementation was administrated, which not only injures they can enter the body easily through membrane fusion, membrane the mucosa of the upper gastrointestinal tract but also aggravates the difusion or phagocytosis and enter the blood circulation directly, burdens or iron contents in organs without relief of iron defciency in which can avoid passing through protein-mediated transport pathways serum. As is known, extraneous iron will cause oxidative stress lipid Traditional Iron Supplements peroxidation. Furthermore, they have no toxicity and adverse efects and facilitate compliance [4]. Iron supplements can be minimal side efects to the body than unencapsulated iron reagents. The grow more happily with iron and iron supplements will exacerbate the regularly used iron supplements in clinic include ferrous sulphate, disease of sports anemia. However, only ferrous sulphate with mucoproteose is the best tolerated Perspectives iron supplement with extended-release [4]. From animal experiments, it cause cell toxicity and side efects such as constipation, abdominal demonstrates that iron liposome is a new form of iron supplement discomfort, nausea, respiratory morbidities and an increased risk of with high efciency of absorption and low side efects compared with infection [4,21,22]. What is more, ferrous sulphate with mucoproteose the traditional iron supplements. S4-002 Page 3 of 3 advantages: they are physically stable, non-toxic, gradually released, 9. However, there is a long way to apply iron liposomes on in strenuously exercised rats. Int interactions between iron and other micronutrients (especially zinc) J Sport Nutr Exerc Metab 21: 19-26. Science new strategy for designing iron supplements to prevent and treat 325: 877-880. Kaitha S, Bashir M, Ali T (2015) Iron defciency anemia in infammatory China (30871260) and the Natural Science Foundation of Hebei bowel disease. Avni T, Leibovici L, Gafer-Gvili A (2012) Iron supplementation for the systematic analysis of global anemia burden from 1990 to 2010. Blood treatment of chronic heart failure and iron defciency: systematic review 123: 615-624. National Efects of routine prophylactic supplementation with iron and folic acid Sports Research Centre. Skin pustules, impetigo as well as more serious infections such as bacteremia, osteomyelitis, renal abscess, pneumonia, endocarditis, Reagent 2 (Hybridization Buffer). Reagents in this kit contain sodium azide which may react with lead coagulase tests are commonly used to identify S. Upon disposal of these reagents, always dilute the material with a the tube coagulase test is thought to be the more definitive of the two, large volume of water to prevent azide buildup in the plumbing. The slide coagulase test may yield a negative result for up to 10 to 15 percent F. If spills of these reagents occur, dilute with water before Because of the existence of problem clinical isolates that may not be wiping dry. The Selection Reagent allows for the differentiation of morphology suggestive of staphylococci may be tested. If broth cultures are to be tested, do not Swabs should not be used due to the small volume of liquid in add Reagent 1 to the Probe Reagent Tubes. If a single colony is to be tested, it should be at least 1 mm in mixed broth culture into the labeled Probe Reagent Tubes as diameter. Reagent 1 (Lysis Reagent) to remove the cells if testing growth from solid media and mix thoroughly from solid media and mix 4. Remove the Probe Reagent Tubes from the water bath or the Probe Reagent Tubes, as described below. When the analysis is complete, remove the tube(s) from the Hologic Heating Block (Cat. The Hybridization Reaction should be started within 1 hour of each laboratory according to local regulations. Open the foil pouch by cutting evenly across the top of the maintained to ensure that the entire liquid reaction volume in the pouch. Reseal the pouch by folding the opened edge over several times and securing with E. Samples producing signals greater than or equal to these cut-off *Site 2 used Staphaurex (Wellcome Diagnostics) for their original values are considered positive. The efficacy of this test has not been demonstrated on direct replicates in a single assay. Of the between-run precision was calculated by assaying the same two these, 309 were S. Sample A B Number of Replicates 12 12 Five strains of coagulase-positive Staphylococcus hyicus and Mean Response 101,064 70,622 Staphylococcus intermedius were evaluated. Other Staphylococcus species and the representative phylogenetic cross-section of species did not react using this kit. The presence of these non-target species did not interfere with the positive signal of the S. Hypochrom ic m icrocytic anem ia F ound in: Irondeficiency Thalassaem ia And anyof the conditions leadingto m icrocytosis M icrocytosis found in: Hypochrom ia found in: Irondeficiencyanaem ia Irondeficiency Thalassaem ia Thalassaem ia Sideroblastic anaem ia And anyof the conditions leading L ead poisoning to m icrocytosis Anaem ia of chronic disease Case 3 59yF feelingw ashed out. Alw ays had low blood,tx w ith severalcourses of ironw ith no difference onhis health orblood counts. In Abstract the United States the prevalence of anaemia in childhood is decreasing Background: In developed countries, dietary intake of pre from 7. Defciencies are frequently caused provisions, but due to picky eating and behavioural feeding by inadequate qualitative and/or quantitative dietary intake [3,4]. Micronutrient defciency could be a result, but is most of the time diffcult to detect due to failing laboratory evaluations. In developed countries, these defciencies can also occur in the Iron defciency is the most common detected nutritional defciency general population, not due to low-income, but to inadequate intake in children; other defciencies may be present but are also hidden in childhood. Dietary habits of most children aged 1 to 4 consist because they cannot always be found in routine evaluations.

Syndromes

• You will be asked to breathe into a medical device called an incentive spirometer. This helps keep your lungs working well so that you do not get pneumonia.
• Biliary cirrhosis
• Able to transfer objects from one hand to the other
• Irregular skin shape (contour)
• Bleeding
• You become pregnant during this cycle
• Shortness of breath
• Blood tests to check for connective tissue diseases

There are products on the market today purporting to cleanse the urine prior to a drug test allergy forecast in tampa florida discount beconase aq 200mdi without prescription. There are also products designed specifically for urine specimen substitution allergy san antonio 200mdi beconase aq visa, including drug-free urine allergy medicine you can take with zyrtec buy generic beconase aq 200mdi online, additives allergy testing questions purchase cheap beconase aq online, and containers/devices to aid 7-19 concealment. Some include prosthetic devices to deceive the observer during an observed collection. Abnormal levels of urine creatinine may result from excessive fluid intake, glomerulonephritis, pyelonephritis, reduced renal blood flow, renal failure, myasthenia gravis, or a high meat diet. For urine, the specific gravity is a measure of the concentration of dissolved particles in the urine. Decreased urine specific gravity values may indicate excessive fluid intake, renal failure, glomerulonephritis, pyelonephritis, or diabetes insipidus. Increased urine specific gravity values may result from dehydration, diarrhea, excessive sweating, glucosuria, heart failure, proteinuria, renal arterial stenosis, vomiting, and water restriction. A specimen reported as invalid for pH, creatinine, specific gravity, or nitrite reported as >200 mcg/mL and <500 mcg/mL by a nitrite confirmatory test may not be sent out for additional testing. Recent products entering the market and intended as substitute specimens have included creatinine and other biological materials (such as uric acid) to defeat the laboratory biomarker assays. A certified laboratory may complete analyses for biomarkers to attempt to detect the use of substitution to defeat the drug testing process. A specimen that has been altered, as evidenced by test results showing either a substance that is not a normal constituent for that type of specimen or showing an abnormal concentration of an endogenous substance. An initial drug test using technology other than immunoassay to differentiate negative specimens from those requiring further testing. A sample of known content and analyte concentration prepared in the appropriate matrix used to define expected outcomes of a testing procedure. The test result of the calibrator is verified to be within established limits prior to use. The documents may account for an individual specimen, aliquot, or batch of specimens/aliquots and must include the name and signature of each individual who handled the specimen(s) or aliquot(s) and the date and purpose of the handling. Procedures that document the integrity of each specimen or aliquot from the point of collection to final disposition. A second analytical procedure performed on a separate aliquot of a specimen to identify and quantify a specific drug or drug metabolite. A second test performed on a separate aliquot of a specimen to further support a specimen validity test result. A sample used to evaluate whether an analytical procedure or test is operating within predefined tolerance limits. A urine specimen with creatinine and specific gravity values that are lower than expected but are still within the physiologically producible ranges of human urine. It may be a paper (hardcopy), electronic, or combination electronic and paper format (hybrid). The form may also be used to report the test result to the Medical Review Officer. Gender identity means an individuals internal sense of being male or female, which may be different from an individuals sex assigned at birth. An analysis used to differentiate negative specimens from those requiring further testing. The first analysis used to determine if a specimen is invalid, adulterated, or (for urine) diluted or substituted. A permanent location where (for urine) initial testing, reporting of results, and recordkeeping are performed under the supervision of a responsible technician. A permanent location where initial and confirmatory drug testing, reporting of results, and recordkeeping are performed under the supervision of a Responsible Person. For quantitative assays, the lowest concentration at which the identity and concentration of the analyte. A licensed physician who reviews, verifies, and reports a specimen test result to the federal agency. The monitors gender must be the same as the donors (which is based on the donors gender identity), unless the monitor is a medical professional. Same as a routine collection except the monitor provides visual privacy while being alert for signs of tampering. The monitor listens at the door of a restroom with no stall or enters a stall restroom with the donor, but must stay outside the individual stall. The monitor must not touch or handle the collection container, unless the monitor is also serving as the collector, and must not watch the donor urinate into the collection container. Same as a routine collection except the observer is in the restroom or stall and watches the urine pass from the body of the donor to the collection container. The observer maintains visual contact with the specimen until the donor hands the container to the collector. The collection container cannot be handled by the observer unless the observer is also serving as the collector. The observers gender must be the same as the donors (which is based on the donors gender identity). The observer is not required to be a trained collector, but must be trained as an observer. The donors gender identity may be the same as or different from the donors sex assigned at birth. Before an observer is selected, the collector informs the donor that the gender of the observer will match the donors gender, which is determined by the donors gender identity. The term used to describe naturally occurring substances known as alkaloids derived from the opium poppy plant. A term that has expanded in scope over time and is used broadly to describe various compounds that bind to specific receptors in the central nervous system and have analgesic as well as narcotic effects. The broadly used term opioids includes naturally occurring alkaloid compounds known as opiates. An oral fluid specimen is collected from the donors oral cavity and is a combination of physiological fluids produced primarily by the salivary glands. A substance that acts alone or in combination with other substances to oxidize drug or drug metabolites to prevent the detection of the drugs or drug metabolites, or affects the reagents in either the initial or confirmatory drug test. A performance testing sample, calibrator, or control used during testing; or a representative portion of a donors specimen. Fluid or material collected from a donor at the collection site for the purpose of a drug test. A collection in which the specimen collected is divided into a primary (A) specimen and a split (B) specimen, which are independently sealed in the presence of the donor. Reference material of known purity or a solution containing a reference material at a known concentration. A specimen that has been submitted in place of the donors urine, as evidenced by creatinine and specific gravity values that are outside the physiologically producible ranges of human urine. The cross-reactivity of the immunoassay to the other analyte(s) within D-1 the group must be 80 percent or greater; if not, separate immunoassays must be used for the analytes within the group. Alternate technology: Either one analyte or all analytes from the group must be used for calibration, depending on the technology. At least one analyte within the group must have a concentration equal to or greater than the initial test cutoff or, alternatively, the sum of the analytes present. Substituted A laboratory will report a urine specimen as substituted when both the initial and confirmatory tests. D-3 Adulterated A laboratory will report a urine specimen as adulterated when both the initial and confirmatory test results. Invalid Result A laboratory will report an invalid result for a urine specimen when results for two separate aliquots meet one of the following criteria: 1. The creatinine concentration is less than 2 mg/dL on both the initial and confirmatory creatinine tests and the specific gravity is greater than 1.

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