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One challenge facing the laboratory forensic toxicologist today is verifying the validity of the random urine specimen submitted for workplace drugs of abuse analysis. Determining whether urine substitution has occurred is best accomplished through the inspection of the specimen's appearance and the performance of specific laboratory tests, such as determining the concentration of biochemical metabolic waste products and measuring indices of urine concentration. Criteria for classifying submitted urine as substituted are postulated after an extensive review of the published scientific literature. Relevant studies that were evaluated include normal random urine reference interval studies, clinical studies involving the analysis of random urine specimens, theoretical dilutional limits, medical conditions resulting in overhydration, and water-loading studies. After compilation of the study data, derived substituted criteria of urinary creatinine < or = 5.0 mg/dL and urinary specific gravity < or = 1.001 are suggested. A urine specimen meeting these criteria may be considered substituted because it is not consistent with the clinical characteristics associated with normal human urine.

The Mandatory Guidelines for Federal Workplace Drug Testing Programs provide criteria for specimen validity testing, including urine pH cut-offs, to report a urine specimen as adulterated or invalid. Since the urine pH criteria for invalid classifications, > or = 3 and < 4.5 or > or = 9 and < 11, became effective in November 2004, a number of specimens with results within the upper invalid limits, typically in the range of 9.1 to 9.3, have been reported with no evidence of adulteration. This study evaluated the hypothesis that these pH findings were the result of exposure to increased environmental temperatures during specimen standing and transport. Indeed, increased storage temperatures were associated with increased urine pH, with the magnitude of the change related to both storage time and temperature. The pH values of specimens stored at -20 degrees C are relatively stable, whereas pH results > 9 are achieved at storage temperatures of room temperature or higher. It is noteworthy that no condition(s) produced a specimen with a pH > 9.5. Degradation of nitrogenous urine analytes is most likely responsible for the noted increases in pH. These findings are intended to supplement information used by the Medical Review Officers who are responsible for interpreting such marginally invalid pH results.

Purpose Rural communities have limited knowledge about genetics and genomics and are also underrepresented in genomic education initiatives. The purpose of this project was to assess genomic and epigenetic knowledge and beliefs in rural West Virginia. Sample A total of 93 participants from three communities participated in focus groups and 68 participants completed a demographic survey. The age of the respondents ranged from 21 to 81 years. Most respondents had a household income of less than $40,000, were female and most were married, completed at least a HS/GED or some college education working either part-time or full-time. Method A Community Based Participatory Research process with focus groups and demographic questionnaires was used. Findings Most participants had a basic understanding of genetics and epigenetics, but not genomics. Participants reported not knowing much of their family history and that their elders did not discuss such information. If the conversations occurred, it was only during times of crisis or an illness event. Mental health and substance abuse are topics that are not discussed with family in this rural population. Conclusions Most of the efforts surrounding genetic/genomic understanding have focused on urban populations. This project is the first of its kind in West Virginia and has begun to lay the much needed infrastructure for developing educational initiatives and extending genomic research projects into our rural Appalachian communities. By empowering the public with education, regarding the influential role genetics, genomics, and epigenetics have on their health, we can begin to tackle the complex task of initiating behavior changes that will promote the health and well-being of individuals, families and communities.