PurposeHeroin has a half-life of 2–6 min and is metabolized too quickly to be detected in autopsy samples. The presence of 6-acetylmophine (6-AM) in urine, blood, or other samples is convincing evidence of heroin use by a decedent, but 6-AM itself has a half-life of 6–25 min before it is hydrolyzed to morphine, so 6-AM may not be present in sufficient concentration to detect in postmortem samples. Codeine is often present in heroin preparations as an impurity and is not a metabolite of heroin. Studies report that a ratio of morphine to codeine greater than one indicates heroin use. We hypothesize that the ratio of morphine to codeine in our decedents abusing drugs intravenously will be no different in individuals with 6-AM present than in individuals where no 6-AM is detected, and we report our study of this hypothesis.MethodsAll accidental deaths investigated by the Jefferson County Coroner/Medical Examiner Office from 2010 to 2013 with morphine detected in blood samples collected at autopsy were reviewed. Five deaths where trauma caused or contributed to death were excluded from the review. The presence or absence of 6-AM and the concentrations of morphine and codeine were recorded for each case. The ratio of morphine to codeine was calculated for all decedents. Any individual in whom no morphine or codeine was detected in a postmortem sample was excluded from further study. Absence or presence of drug paraphernalia or evidence of intravascular (IV) drug use was documented in each case to identify IV drug users. The proportion of the IV drug users with and without 6-AM present in a postmortem sample was compared to the M/C ratio for the individuals.ResultsOf the 230 deaths included in the analysis, 103 IV drug users with quantifiable morphine and codeine in a postmortem sample were identified allowing for calculation of an M/C ratio. In these IV drug users, the M/C ratio was greater than 1 in 98 % of decedents. When controlling for the absence or presence of 6-AM there was no statistically significant difference in the proportion of IV drug users when compared to non IV drug users with an M/C ratio of greater than 1 (p = 1.000).ConclusionThe M/C ratio in IV drug users, if greater than 1, is seen in deaths due to heroin toxicity where 6-AM is detected in a postmortem sample. This study provides evidence that a M/C ratio greater than one in an IV drug user is evidence of a death due to heroin toxicity even if 6-AM is not detected in the blood. Using the M/C ratio, in addition to scene and autopsy findings, provides sufficient evidence to show heroin is the source of the morphine and codeine. Listing heroin as a cause or contributing factor in deaths with evidence of IV drug abuse and where the M/C ratio exceeds 1 will improve identification of heroin fatalities, which will allow better allocation of resources for public health initiatives.

BackgroundClinical laboratories use internal quality control (QC) data to calculate standard deviation (SD) and coefficient of variation (CV) to estimate uncertainty of results and to interpret QC results. We examined the influence of different instruments, and QC and reagent lots on the CV calculated from QC data.MethodsResults for BioRad Multiqual frozen liquid QC samples over a 2-year interval were partitioned by QC and reagent lots. The mean and CV were calculated for each partition for each of three Abbott Architect c8000 instruments for measuring serum alanine amino transferase (ALT), creatinine (enzymatic), glucose and sodium.ResultsCVs differed among partitions and instruments for two QC levels by 5.8- and 3.3-fold for ALT, by 4.7- and 2.1-fold for creatinine, by 2.0- and 2.6-fold for glucose, and by 2.1- and 2.0-fold for sodium. Pooled CVs for two QC levels varied among instruments by 1.78- and 1.11-fold for ALT, by 1.63- and 1.11-fold for creatinine, by 1.08- and 1.06-fold for glucose, and by 1.24- and 1.31-fold for sodium.ConclusionsThe CVs from QC data varied substantially among QC and reagent lots and for different identical specification instruments. The CV used to estimate uncertainty for a measurement result or as the basis for interpreting individual QC results must be derived over a sufficient time interval to obtain a pooled CV that represents “typical” performance of a measuring system. An estimate of uncertainty provided to users of laboratory results will itself have uncertainty that can influence medical decisions.

At the first Third World Filmmakers Meeting held in Algiers in 1973, participants resolved that the cinema they envisioned could conscientize audiences and continue Indigenous and African storytelling traditions. Today, there is a robust canon of Black diaspora cinema, which should be preserved, archived and analysed. Yet when coupled with filmmaking practice, it can become living history as a tool in the application of critical pedagogy. This article considers Black diaspora film and filmmaking practice as mechanisms for the radical transformation of education. It examines how oppositional cinematic representations can spark critical consciousness and how filmmaking practice can put emotional intelligence at the centre of learning.