ACBNews
The Association for Clinical Biochemistry | Issue 575 | March 2011
In this issue
Blood
Sample
Conservation
Cardiff Style
More Fun
for the
Over Fifties
Trace
Elements
at the
College
Future
Pathology
Leaders Step
Forward
Please
About ACB News
The editor is responsible for the final
content. Views expressed are not
necessarily those of the ACB.
Editor
Dr Jonathan Berg
Department of Clinical Biochemistry
City Hospital
Dudley Road
Birmingham B18 7QH
Tel: 07973-379050/0121-507-5353
Fax: 0121-507-5290
Email: jon@bergfamily.co.uk
Associate Editors
Mrs Sophie Barnes
Department of Chemical Pathology
St Mary’s Hospital
Imperial College Healthcare NHS Trust
Praed Street
London W2 1NY
Email: Sophie.Barnes@imperial.nhs.uk
Mr Ian Hanning
Department of Clinical Biochemistry
Hull Royal Infirmary
Anlaby Road
Hull HU3 2JZ
Email: ian.hanning@hey.nhs.uk
Dr Derren Ready
Microbial Diseases
Eastman Dental Hospital
University College London Hospitals (UCLH)
256 Gray's Inn Road
London WC1X 8LD
Email: d.ready@eastman.ucl.ac.uk
Mrs Louise Tilbrook
Department of Clinical Biochemistry
Broomfield Hospital
Chelmsford
Essex CM1 5ET
Email: louise.tilbrook@meht.nhs.uk
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ACBNews
The monthly magazine for clinical science
Number 575 • March 2011
General News
page 4
Practice FRCPath Style Calculations
page 12
A Personal View
page 14
Feedback from the Readership
page 15
Meeting Reports
page 18
Training Matters
page 26
Obituary
page 28
ACB News Crossword
page 29
Situations Vacant
page 30
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Front cover: Dewi Holt from Cardiff writes about patient sample
conservation good practice in this issue.
ACB President
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© Association for Clinical Biochemistry 2011
Issue 575 | March 2011 | ACB News
4 | General News
Primary Care and
Laboratory Medicine
Two-Day
Communication Course
Last month ACB Members received their free
copy of this latest book in the series from
ACB Venture Publications. Written by Stuart
Smellie, Cliodna McNulty and Mike Galloway,
the authors provide comprehensive answers to
those queries we all receive in the laboratory
on a daily basis from primary care. The design
of the book with its question and answer
format allows readers to access information
quickly and to dip in and out as required.
As the title suggests, it includes all aspects of
laboratory medicine. Topics covered include
fertility investigations, thyroid disorders,
kidney function and electrolyte disorders,
cardiovascular disease and hypertension,
infection, anaemia, anticoagulation, allergy
and inflammation etc.
Copies can be purchased from the ACB
website (www.acbstore.org.uk), or contact the
ACB office directly on Tel: 020 7403 8001,
or via e-mail: admin@acb.org.uk
ACB Members receive a 10% discount on the
£30 price and bulk discounts are available for
orders of 10 copies or more.
The Centre of the Cell in London are putting on
a two-day course which has been specially
developed for Pathologists, Scientists and
Trainees by the renowned Science
Communication Unit at The University of the
West of England, Bristol. It is recognised for
CPD. Deadline for applications is 9th May 2011.
To find out more, visit http://bit.ly/etokKN
Trainees can also enter a competition to win a
free place on this course. For more information
on how to enter visit http://bit.ly/hzFNnL I
Primary Care and Laboratory Medicine:
Frequently Asked Questions
Authors: Stuart Smellie, Cliodna McNulty
and Mike Galloway
ISBN: 978-0-902429-46-8
Price: £30 (10% discount for ACB Members)
plus p&p and VAT if applicable I
ACB News | Issue 575 | March 2011
Sudoku
This month’s puzzle
Last
month’s
solution
6 | General News
Focus on Change in Harrogate
Ashley Garner, Scientific Committee
Whether you embrace it, fear it or crave it,
change is inevitable - especially it seems if you
work in the NHS! So, with a focus on change,
the scientific programme for Focus 2011
promises to deliver an interesting array of
talks and interactive sessions pertinent to
clinical biochemistry. Highlights include
sessions on new technologies, blood science
laboratories and clinical biochemistry in an
age of austerity – who can afford to miss that?
those that enjoy a good debate, we’re
anticipating a lively CPS session on harmonising
laboratory profiles and the need for familial
hypercholesterolaemia genetic screening.
In contrast, the audit session will give a chance
for the evidence to do the talking.
This year the breakfast workshops will be
running all day, so even those who struggle to
make an early start can still catch a workshop
on a wide range of topics from urinary
C-peptide to adding value. The old favourites
complete the programme with the ever
popular clinical cases and for something a
little more morbid, there is also a session on
coronary cases.
So show no fear, embrace the change and
we’ll see you in Harrogate!
Full details of the scientific programme
can be found on the website
www.focus-acb.org.uk I
But while we’re scrimping and saving, there
are still opportunities to gain funding for
research, so if you fancy tapping into it, be
sure to attend our research session.
There will be plenty of opportunities to have
your say on the hot topics including HbA1c for
diabetes diagnosis, POCT accreditation and the
use of high sensitivity troponins. Also for
Dramatic Reduction in Focus Abstract Rejection Rate
A total of 303 abstracts were submitted for Focus 2011. The most popular topics were Audit
(39), Methods (28), Endocrinology (26), Toxicology/TDM (23) and Case Histories (22).
Submissions for other specialties included Molecular Genetics (8) and Haematology (2) but
there were none for Immunology, Microbiology or Neurochemistry. This year only two
abstracts were rejected due to there being insufficient laboratory data in the abstract.
ACB News | Issue 575 | March 2011
General News | 7
ACB Wales Region
Spring Scientific Meeting
Renal Stones Made
Crystal Clear
Tuesday 5th April 2011
The Barn, Brecon
Morning Session
10.30
11.00
11.35
12.10
12.45
13.00
Registration and Coffee
Updates in the Biochemical Analysis of Renal Stones
Pervaz Mohammed, Sandwell and West Birmingham Hospitals
Medical Evaluation and Management of Renal Stone Disease
Dr Yee Ping Teoh, Betsi Cadwaladr University Health Board
Metabolic Syndrome – Stones and Cardiovascular Risk
Dr Bill Robertson, Royal Free and University College Medical School
Open Discussion and Summary
Lunch
Afternoon Session
14.00
14.35
15.10
15.40
16.15
16.30
Paediatric Renal Stones
Dr Judith Van de Voort, Cardiff and Vale UHB
Investigating Hyperoxaluria
Dr Gill Rumsby, University College London Hospitals
Tea
Urological Management of Renal Stones
Mr Raj, Cardiff and Vale UHB
Open Discussion and Conclusions
Wales Annual General Meeting
Registration information:
Day delegate rate: £35 for ACB Members, £40 for non ACB Members.
Registration via the ACB website. CPD accreditation: 4 points.
Issue 575 | March 2011 | ACB News
8 | General News
UK Newborn Screening Laboratories Network
Annual General Meeting
Wednesday March 23rd 2011
Postgraduate Centre, QE Hospital, Birmingham
Morning Chair: Paul Griffiths
09:30-10.30
10:30-10:35
10:35-10:50
10:50-11:20
11:20-11:40
11:40-12:10
12:10-12:40
12:40-13:30
Registration/Coffee
Introduction
Luminex
Sickle and Thal Programme Update
HB Variants
BPSU Study
European Tender Project
Lunch
Paul Griffiths
TBC
Allison Streetly
Lisa Farrar
Rachel Knowles
Gerard Loeber
Afternoon Chair: Pippa Goddard
13:30-13:50
13:50-14:15
14:15-14:35
14:35-14:55
15:00-16:00
GSP Evaluation
UKNSPC Update
Extended Newborn Screening Update
Early MCADD 5 Cases
Business Meeting
Cat Dibden
Cathy Coppinger
Jim Bonham
Anthea Patterson
Organiser: Dr Pippa Goddard, Department of Clinical Biochemistry,
Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH
Tel: 0121 333 9927 Fax: 0121 333 9913
Email: philippa.goddard@bch.nhs.uk
Registration fee: £25
Registration forms available from the organiser
Annual General Meetings
Monday 23rd May 2011
The fifty-eighth Annual General Meeting of the
Association for Clinical Biochemistry will take place in the
King’s Suite, Harrogate International Centre.
The Federation of Clinical Scientists’ Annual General Meeting will
commence at 17.15 and the Association for Clinical Biochemistry
Annual General Meeting will commence at 18.00. An informal drinks
reception will be held prior to the AGMs from 16.30 - 17.15.
ACB News | Issue 575 | March 2011
General News | 9
Microbiology
In The News
South West and Wessex
Spring ACB Meeting
Guardian - TB Rates
Highest for 30 years
An Immunological
Focus and AGM
The number of cases of tuberculosis hit a 30
year high in 2009, with 9,040 cases reported in
the UK. This is an increase of more than 400
cases compared with reports from 2008 and
represents a rising trend. The number of
drug-resistant cases have doubled in the same
period, with 28 cases reported in 2008 and 58
in 2009. Efforts are being made to improve
public awareness of the disease, especially in
vulnerable groups through a website
(www.thetruthabouttb.org).
www.guardian.co.uk/world/2010/nov/04/
tuberculosis-figures-high
Mirror - Probiotic Bedding
A mattress has been developed which has
been reported to incorporate ‘Friendly’
bacteria within microcapsules to reduce
moisture content and mould growth and to
prevent dust mites settling.
www.mirror.co.uk/news/topstories/2010/11/11/win-a-kingsize-silentnightpocketzing-bed-115875-22708142
BBC - Bacterial Attendance
at Oktoberfest 2011
Organisers of next year’s annual beer festival
in Munich, Oktoberfest are concerned about
the odours emanating from the famous beer
tents which won’t be masked by cigarette
smoke as smoking inside the tents will be
banned. To reduce the odour, a bacterial
solution called Elbomex will be poured onto
the floorboards of the tents and in the toilets.
It has been suggested that waste products
from the multiplying bacteria will then replace
the unpleasant smell with an earthy smell.
www.bbcnewsamerica.com/bacteria-tocombat-odour-oktoberfest-2010.html
April 8th 2011
Southampton General Hospital
10:00-10:30
Registration and Coffee
10:30-11:00
Immunoglobulins in Health
and Disease
Dr E Eren
11:00-11:30
Primary Immunodeficiencies
Dr T Williams
11:30-12:00
Secondary Immunodeficiencies
Dr E Hodges
12:00-12:30
Interactive Session with
Case Discussions
Dr E Eren/R Goswami
12:30-13:30
Lunch
13:30-14:00
IVIg in Therapy
Dr D Sammut
14:00-14:30
Antibody Therapy in
Autoimmune Disease
Dr B Davidson
14:30-15:00
Primary Immunodeficiency
and Transplantation
Dr G White
15:00-15:30
Coffee
15:30-16:30
Annual General Meeting
Registration costs:
£25 for ACB Members, £10 for formal
pre-Registrant Clinical Scientist Trainees,
£15 for retired Members and £40 for non-Members.
Cheques made payable to ACB.
Lunch will be provided.
The closing date for registration is
Friday March 18th 2011.
Please register on-line at acbsww.org.uk
Contact Mandy Perry (Mandy.Perry@rdeft.nhs.uk)
for further details
Microbiology in the News is supplied by Zoie Aiken
Issue 575 | March 2011 | ACB News
10 | General News
ACB NI Region
and ACB Ireland
Friday 8th April 2011
Radisson SAS Hotel, The Gasworks, Belfast
09.45
Registration and Coffee
10.20
Opening Remarks
Dr M Lynch, Chairperson, ACBNI
Morning Session
Chair: Dr Colin Graham, Consultant Clinical Scientist, Regional Genetics, BHSCT
10.30
Modernising Scientific Careers
Professor Bernie Hannigan, Chief Scientific Advisor
11.10
Highly Sensitive Troponin has Arrived - A Great Assay But What Does it Tell Us
and How Should We Use It?
Dr James Shand, Specialist Registrar, Cardiology, Southern HSC Trust
11:50
Keto Acidosis Guidelines in Children
Mr Paul Newland, Clinical Director for Pathology, Alder Hey Children’s Hospital
12.30
Lunch
Afternoon Session
Chair: Ms Liz McClean Consultant Clinical Scientist, Regional Toxicology, BHSCT
13.30
Measuring Wear in Metal-on-Metal Hips: The Role of Trace Element Analysis
Barry Sampson, Principal Biochemist, Charing Cross Hospital, London
14.10
Standardisation of Adjusted Calcium
Mrs Annette Thomas, Consultant Clinical Biochemist, WEQAS, Quality Laboratory
14.50
To Screen or Not to Screen for Vitamin D Deficiency
Mrs Margaret McDonnell, Consultant Clinical Scientist, Regional Endocrine, BHSCT
15.30
Tea & Coffee
15.50
Point of Care Services - Room for Improvement
Ruth O’Kelly, Principal Biochemist, Coombe Women’s Hospital, Dublin
16.30
Closing Remarks
Dr D McKillop, Meetings Secretary, ACBNI
Please register online before 20 March 2011 at www.acbi.ie
There is a form for ACBI Members and a separate form for ACBNI Members and non-Members.
If you have any queries please contact Dr Derek McKillop, ACB (NI) Meeting Secretary on Tel: 028 3861 3709.
ACB News | Issue 575 | March 2011
General News | 11
Trade Union Statement
Section 32A of the Trade Union and Labour Relations (Consolidation) Act 1992 requires
the annual statement to members to be published as follows:
“A member who is concerned that some irregularity may be occurring, or have
occurred, in the conduct of the financial affairs of the union may take steps with a view
to investigating further, obtaining clarification and, if necessary, securing regularisation
of that conduct. The member may raise any such concern with such one or more of the
following as it seems appropriate to raise it with: the officials of the union, the trustees
of the property of the union, the auditor or auditors of the union, the Certification
Officer (who is an independent officer appointed by the Secretary of State) and the
police. Where a member believes that the financial affairs of the union have been or
are being conducted in breach of the law or in breach of rules of the union and
contemplates bringing civil proceedings against the union or responsible officials or
trustees, he should consider obtaining independent legal advice.”
Clinical Cases
Done Three Ways
Next month we will be looking in detail at
the Interpretative Comments NEQAS
Scheme. Organisers explain key features of
the scheme while a group of users look at
how it works back in the tea room – along
with a tray of donuts! I
Issue 575 | March 2011 | ACB News
12 | Practice FRCPath Style Calculations
Deacon’s Challenge
No 118 - Answer
Your laboratory has recently changed assays for HDL cholesterol. A bias study established that
the relationship between the new assay (y) and the old assay (x) is described by the formula
y = 1.07x + 0.06. Given between-day imprecisions of 2.3% for the new assay and 2.8% for the
old assay, and assuming a within-subject biological variation of 7%, determine whether an
apparent increase in a patient’s HDL from 0.8 to 1.0 mmol/L following the method change
represents a true increase.
FRCPath, Spring 2010
1. First convert the initial HDL result to the value which would be expected by the new method:
New assay result = (1.07 x Old assay result) + 0.06
Substitute 0.8 mmol/L for the old assay result
Initial sample new assay result = (1.07 x 0.8) + 0.06
= 0.856 + 0.06 = 0.92 mmol/L (2 sig figs)
2. Next calculate the rise in HDL cholesterol using both values for the new method:
Rise in HDL cholesterol = 1.00 - 0.92 = 0.08 mmol/L
3. Next calculate the total imprecision for both the old and the new methods:
Total CV = √ ( Analytical CV2 + Biological CV2)
For old method, total CV
= √ (2.82 + 72) = √ (7.84 + 49) = √56.84 = 7.54%
For new method, total CV = √ (2.32 + 72) = √ (5.29 + 49) = √54.29 = 7.37%
4. Next convert total CVs to total SDs at the concentrations (using new assay results) for both
patient specimens:
SD = Value (mmol/L) x CV (%)
100
For initial result, SD = 0.92 x 7.54 = 0.069 mmol/L
100
For final result, SD = 1.00 x 7.37 = 0.074 mmol/L
100
5. Next calculate the combined SD for both methods:
Combined SD = √ (Old method SD2 + New method SD2)
= √ (0.0692 + 0.0742)
= √ (0.00476 + 0.00548) = √0.0102 = 0.10 mmol/L
ACB News | Issue 575 | March 2011
Practice FRCPath Style Calculations | 13
6. Finally calculate the minimum rise in HDL which would be significant using P = 0.05. The rise
in HDL chol, if not significant, will be normally distributed with a mean of zero and SD of the
combined total SD calculated for each method.
z = Rise in HDL chol
Combined SD
For P = 0.05, z = 1.96. Substitute 0.10 for the combined SD:
1.96 =
Rise in HDL chol
0.10
Rise in HDL chol = 1.96 x 0.10 = 0.20 mmol/L (2 sig figs)
Since the actual rise in HDL cholesterol (0.08 mmol/L) is a lot less than 0.20, it is NOT
statistically significant and so does not represent a true increase.
Alternatively, since the two total SDs including both the old and new assay imprecisions are
very similar (0.069 and 0.074 mmol/L) they can be assumed to be approximately equal and
the value of 2.8 SDs which must be exceeded before a change is significant can be used.
Using a mean value of 0.0715 mmol/L the value for 2.8 SD becomes 0.20 mmol/L which yields
the same result.
The difference in analytical CVs for the two methods is small in comparison to the biological
CV so that there is little change in total CV. Ideally total analytical CVs should be used rather
than between-day imprecisions. I
Question 119
A chromatographic method for a drug (A) described in the literature, appears
satisfactory for routine use. However, when you set up the method in your
laboratory you discover that one of the drug’s metabolites (B) co-elutes with the
drug. On further investigation you observe that A and B have over-lapping
absorption spectra with maxima at 580nm and 630 nm respectively.
Fortunately your HPLC system is equipped with a diode array detector.
Use the following data to calculate the urinary drug concentration:
Sample
Drug A standard solution (100 µmol/L)
Metabolite B standard solution (100 µmol/L)
Urine
Absorbance (mA)
580 nm
600 nm
100
50
25
50
50
40
Issue 575 | March 2011 | ACB News
14 | A Personal View
Blood Sample Conservation
Already Practised in Cardiff
Dr Dewi Holt, Clinical Scientist, Haematology, Cardiff and Vale University
Health Board
Response to Phlebotomy
Article in ACB News,
September 2010
Both as a scientist in Haematology and as a
patient who is regularly bled I can identify
with many of the problems alluded to in the
article on Phlebotomy published last
November. I wanted to give you an example of
good practise that happens here in our
laboratory that might perhaps serve as a
model for others to follow.
I work in a specialist molecular laboratory
involved with diagnosis and monitoring of
leukaemia and lymphomas. It is not
uncommon for us to receive the remains of a
4 mL blood sample that, before it reaches us,
has first passed through the routine section for
FBC analysis, then immunophenotyping,
followed by cytogenetics. Each specialist
section of the department takes what they
need before passing on the tube in a timely
manner. We then use all of what is left to
isolate nucleic acids so none of the sample is
wasted. We even store DNA and/or RNA for as
long as possible so that any further tests not
initially requested can still be done from the
same material, thus avoiding another sample
being taken. Very occasionally the amount of
material left is insufficient and we do need to
request more but the default mechanism is
that one tube makes its way through all the
sub-specialties.
Labs and Instrument Manufacturers
Need to Cooperate
Of course a smaller tube might be more cost
effective for the vast majority of blood
samples if it is unlikely that further tests will
be required. I would therefore propose that
the clinician needs to consider at the outset
whether several tests are needed and can they
all be done from the same sample. The
laboratories and possibly also instrument
manufacturers then need to cooperate to
make that achievable, and of course be
realistic about the volumes they require. The
prospect of electronic requesting has potential
to dramatically improve these situations.
Software could be written that automatically
calculates how much blood is required, into
which type of tubes, and to which labs they
need to go. However, the layers of
bureaucracy that surround big projects like
this tends to prevent the necessary direct
communication required for a successful
outcome. I
ACB News | Issue 575 | March 2011
Feedback from the Readership | 15
More Fun for the Over Fifties
Jonathan Berg, Editor
It can be a bit full-on with ACB News. Most of
the feedback one gets by the nature of the
beast is somewhat negative . . . people are
much more ready to criticise than compliment
in this life. Sometimes it can be good to take a
view from readers away from the email inbox
and distracting mess of the editorial office.
A year or so ago we shared lunch with some
Trainees on Liverpool Docks. Last month we
went to the other end of the readership to
spend some time with a range of retired
readers. Well . . . when I say retired, of course
that is only partially true as these were people
who are far too full of energy to spend too
much time in the garden. Really the term
“retired” does not sit well with any of them.
Walk to Wembley Was Fun
Peter Broughton left his final position at the
Wolfson Research Laboratories in University of
Birmingham in 1988 and is now 86, though he
points out the oldest member is currently 94
years old! Since retiring he has had more time
to enjoy his passion of walking and indeed
back in 1995 he and Dave Worthington were
key to a sponsored “Walk to Wembley” that a
number of ACB Members undertook. The walk
followed the whole of the Grand Union Canal
from Gas Street Basin in Birmingham to Little
Venice in London and raised money to help
people attend the 1996 World Congress of
Clinical Chemistry at Wembley.
In retirement Peter has been a stalwart for
ACB News when it has come to making sure
that Obituaries have ended up in print.
Actually, Peter had more than a passing
interest in ACB News Editorial in the 80s
having been the brains behind and, until now,
anonymous series entitled “Benchcomber”.
His view on the current magazine was frank as
usual . . . “Where has all the fun gone, the
cartoons, the Christmas caption competition
. . . it is all very serious now!”. I reminded
Peter of an after-work session they put on at
the Wolfson for innovators that he chaired in
Issue 575 | March 2011 | ACB News
16 | Feedback from the Readership
the 80s. All Biochemists in the Region were
invited along to it … but Peter said he could
not remember it. Perhaps it was just a dream
but I found it very formative at the time!
Time for Some Hobbies
Dave Worthington retired very early after
being one of the leaders in the profession in
the West Midlands that I always admired, and
whose views I always listened to. The rumour
had always been that he retired at
the age of 53 but he pointed out that was
incorrect and actually he retired at just turned
51, and never expected to do any more work
in the field of laboratory medicine. Of course
that was not to be, and I have met Dave a
number of times on the train to London and
he tells me he has been working on average
2-3 days a week in areas of laboratory-based
screening programmes. In this semi-retired
state Dave has learnt how to service Atmos
clocks, a mechanical clock manufactured by
Jaeger-LeCoultre in Switzerland. Although
information is not readily forthcoming about
this unusual hobby I gleaned from Janet Smith
and Peter that these clocks do not need to be
ACB News | Issue 575 | March 2011
wound manually, rather using changes in
room temperature to provide the energy they
need to run, without human intervention, for
years.
Janet is of course a much more recent
retiree, and indeed one duty was to hand over
the rather prime-ministerial photo of her
retirement bash from the front cover of
ACB News for her to hang on her wall. We
spoke about how she did not really keep in
touch with what was going on in her old
department . . . or indeed whether they ever
replaced her post . . . which the word on the
street is they did not. It certainly reinforced
what I had already observed . . . that when
you offer firm leadership in a laboratory, once
it is relinquished you have to keep your nose
right out. However, Janet has been kept more
than busy working voluntarily with the IFCC.
All three were interested to discuss where
the “leadership” for the future in clinical
biochemistry was to come from. We agreed
that there was, really for the first time in
generations, much stronger leadership from
the Department of Health, but at local
regional level the old style professorial leaders
Feedback from the Readership | 17
seemed now to be lost forever. Partly this was
seen to be due to the competitive edge
between laboratories that the more market
driven environment had produced.
Peter asked me if I knew how many of my
readership were retired and also pointed out
that an obituary does not need to fit on one
side of ACB News . . and so it went on.
Certainly an interesting lunch with a bit of
space to reflect . . . and plenty of robust
advice, which was after all what I had hoped
for. Now I must give John the cartoonist a
quick email and see if we can start a regular
cartoon slot off again! I
Issue 575 | March 2011 | ACB News
18 | Meeting Reports
Trace Elements Meeting
Karolina M Stepien, Nottingham City Hospital & Claire Meek, Lister Hospital,
Stevenage
The ACB Trace Elements
Day was held at
The Royal College of
Pathologists in London
The day was themed around developments in
trace elements and micronutrients. High
quality talks were given by speakers with
experience in biochemistry, toxicology and
pharmacology.
The morning session was chaired by
Dr Andrew Taylor and the first talk was given
by Alan Jackson, Professor of Human Nutrition
from the University of Southampton. He
discussed the essentiality of trace elements
and the challenges of assessing nutritional
deficiency in the population. Many patients
with excessive nutritional intake of
macronutrients (for example, in obesity) may
have an inadequate intake of micronutrients.
He also discussed the potential negative
effects of over-supplementation, and shared
some of his research interests, particularly
regarding the metabolism of amino acids:
glutamine/arginine and glycine/serine/cysteine.
Zinc Deficiency
Dr Nicola Lowe, Nutritional Biochemist at
Lancaster University introduced the physiology
of zinc metabolism and related disorders.
She stressed that severe zinc deficiency is
uncommon but can cause hair loss, geophagia,
testicular atrophy, stunted growth, irritability,
failure to thrive, rash, anorexia and frequent
loose stools. However, subclinical deficiency of
zinc appears to be common but the clinical
consequences of this remain unclear. Zinc
deficiency can arise from inadequate dietary
zinc, or can be associated with several diseases
including alcoholic liver disease, renal disease,
malabsorption in Crohn’s disease and sickle cell
disease. Dr Lowe discussed how a diet low in
ACB News | Issue 575 | March 2011
animal protein, high in phosphate, phytate
and iron can increase the risk of zinc
deficiency. There are also inheritable causes of
zinc deficiency syndromes, such as
acrodermatitis enteropathica, an autosomal
recessive disorder affecting the uptake of zinc.
Dr Lowe mentioned the EURRECA
(EURopean micronutrients RECommendations
Aligned) study which is a collaborative
network to develop quality-assured nutrient
recommendations which would be harmonised
across Europe. The primary aim is to identify
the prevalence and clinical consequences of
disordered micronutrient status, particularly in
vulnerable population groups.
Finally, she discussed the limitations of the
laboratory measurement of zinc and
concluded that plasma zinc concentration does
not necessarily reflect dietary intake and can
be affected by stress and inflammation.
Wilson’s Disease
Dr Andy Duncan from Glasgow gave a
fascinating presentation about investigations
and disorders in copper metabolism. He
highlighted that the Scottish Trace Elements
and Micronutrient Reference Laboratory
(STEMRL) has recently established an EQA
Scheme for copper and caeruloplasmin. He
discussed challenges in the presentation and
investigation of Wilson’s disease. He
mentioned the limitations of standard
methods of diagnosis, such as the
measurement of hepatic copper load on
histology of a liver biopsy. This is considered
the ‘gold standard’ investigation, but
false-positive and false-negative results can
still occur. He discussed the role of the copper
uptake test which can be useful in patients
with borderline copper and caeruloplasmin
concentrations. This test involves injecting
patients with 65Cu and measuring the copper
uptake over time. Dr Duncan described several
clinical cases where this approach has been
used successfully. Negative genetic tests,
Meeting Reports | 19
though sensitive, do not exclude Wilson’s
disease as it may be caused by rare mutations.
He presented a case of a female patient with
cholangiocarcinoma who had evidence of
cirrhosis as an incidental finding during
surgery. In this patient the uptake of 65Cu was
decreased suggesting a diagnosis of Wilson’s
disease. This was confirmed by an abnormal
penicillamine test and hepatic biopsy.
Dr Duncan described other causes of a low
copper level. These included prematurity (due
to insufficient copper in the liver), inherited
defects in copper metabolism such as Menkes
Syndrome, inadequate copper absorption due
to coeliac disease, and the loss of
caeruloplasmin in nephrotic syndrome. Copper
deficiency can also be caused by excess zinc as
zinc competes with copper for absorption.
He described a female patient with zinc excess
due to high usage of a zinc-containing
denture cream. The zinc excess greatly reduced
copper absorption and the patient had to be
treated for copper deficiency.
Finally he discussed whether it was possible
to test for either copper or caeruloplasmin,
rather than both, as a cost-saving measure.
Dr Duncan suggested that the choice of test
should be determined by imprecision (CVs for
caeruloplasmin - 17%, free copper - 10%), turn
around time and cost.
Transcriptomics in Assessment of
Selenium Status
The afternoon session was chaired by Mr Ted
Sheehan and was opened by Prof John
Hesketh from the Institute for Cell and
Molecular Bioscience in Newcastle, who
discussed genomic approaches to selenium (Se)
biology and the role of selenoproteins in
metabolism. He discussed the epidemiology of
selenium deficiency which is particularly
prevalent in the Keshan province in China.
Studies have demonstrated an inverse
relationship between selenium intake and
cancer incidence and mortality. Indeed,
patients in the lowest quintile of selenium
Issue 575 | March 2011 | ACB News
20 | Meeting Reports
concentrations may be up to six times more
likely to develop cancer compared to the
general population. Some studies have
suggested that selenium supplementation
decreases the risk of developing prostate and
colon cancer by around 48%. However, more
recently, the SELECT trial indicated that Se
supplementation may have no effect on
prostate cancer but conversely increases the
risk of diabetes.
Selenium is required to synthesise
selenoproteins which have diverse metabolic
roles. 25 selenoproteins have been identified
in mammals. These include glutathione
peroxidise, selenoproteins P, W, S, H,
thioredoxin reductases and iodothyronine
deiodinases. Dietary selenium is activated prior
to its incorporation into selenoproteins using
the SECIS (selenocysteine insertion sequence).
Functional single nucleotide polymorphisms
(SNPs) in selenoproteine genes were identified
(SNP Ala234Thr) which may affect disease
susceptibility and response of selenoproteins.
Professor Hesketh concluded that
transcriptomics can help identify novel
markers for selenium status.
Trace Elements Versus Inflammation
Dr Denis O’Reilly from Glasgow gave an
eloquent presentation on the effects of
inflammation on the biochemical assessment
of trace element status. There is now a
significant body of evidence showing that
patients with an inflammatory insult, such as
surgery or infection, often have abnormal
serum concentrations of trace elements. The
catabolic effects of inflammation mediated
through cytokines such as interleukin-6 (IL-6)
and tumour necrosis factor- alpha (TNFa) cause
the release of proteins and creatine from
muscle tissue. Capillaries become more porous
and trace elements and albumin become
redistributed through the interstitial fluids,
with falling concentrations in the blood.
Correcting plasma zinc, iron, albumin and
selenium can cause more harm than good.
He discussed the dangers of using
calprotectin in this situation for diagnosis of
inflammatory bowel disease. Caeruloplasmin
concentrations are initially increased due to
ACB News | Issue 575 | March 2011
the acute phase response, but in later stages
its serum concentrations fall as the protein is
redistributed to the interstitial space. The
more ill and inflamed a patient is, the greater
the variation in results, giving a wide
interquartile range. This shows the challenges
the body faces in maintaining homeostasis in
significant illness.
The analytical challenges of measuring trace
elements in inflamed patients were discussed.
Dr O’Reilly highlighted that when the
C-reactive protein (CRP) concentration is
elevated, the concentration of trace elements
falls. The presence of a serum CRP
concentration above 150 mg/L decreases serum
zinc by 50%: measuring serum zinc at this time
will not reflect total body zinc stores. Ideally,
patients should not have trace element status
measured until their CRP is below 15 mg/L.
However, he discussed that this can be very
difficult to achieve in many patients,
particularly those on total parenteral nutrition.
Micronutrients in Critical Illness
Alan Shenkin, Emeritus Professor of Clinical
Chemistry at the University of Liverpool,
discussed micronutrient requirements in
severely inflamed patients on nutritional
support. He gave an insightful talk on ITU
dependency on artificial technical and
metabolic support for survival. He pointed out
that due to hypermetabolism, critically ill
patients have increased nutritional
requirements in view of rapid consumption of
energy for the purposes of immunity and
inflammation. According to Prof Shenkin the
main purposes of nutrient redistribution are:
N To deliver more nutrients to tissues which
have an increased requirement such as the
liver and cells involved in the immune
response.
N To deliver more nutrients to interstitial
fluid for example, for immune and
antioxidant purposes.
N To remove potentially harmful substances
from the blood stream.
He identified the main principles of
micronutrient supplementation in ITU and
provided three golden rules:
Meeting Reports | 21
N To provide normal amounts to minimise
risk of serum deficiency and meet most of
metabolic requirements.
N To add more to meet known increased
losses. For example, a patient with major
burns may lose zinc, selenium and copper
in faeces, urine and from their wounds and
would likely benefit from supplementation.
N To provide more only if clinical trials have
proven the benefits.
ITU patients are subject to oxidative stress and
activation of a systemic inflammatory
response. In healthy subjects, there is a
balance between pro-oxidants and antioxidants which favours anti-oxidants.
However, in critical illness this balance changes
to favour pro-oxidants causing depletion of
anti-oxidants and oxidative damage to cells.
Copper, zinc, manganese and selenium may
contribute to this balance. Low plasma
selenium concentrations increase morbidity
and mortality in ITU patients. Selenium
concentrations often improve without
supplementation as patients recover.
The evidence for selenium supplementation
in critically ill patients is controversial. Prof
Shenkin referred to a German study on
selenium supplementation that showed 55.6%
mortality in patients receiving selenium
supplementation and 81.5% in patients who
did not receive supplementation (p=0.04).
However, Prof Shenkin’s group in Liverpool
were unable to replicate these findings. He
also discussed the SIGNET trial, to be published
soon, which found no significant difference in
mortality when critically ill patients were
supplemented with selenium, glutamine or
both.
Prof Shenkin concluded that supplementation does not necessarily improve prognosis
and sometimes can even hinder recovery. One
example is iron, which can hinder resolution of
infection and supplementation of iron is
associated with poor outcome in patients with
critical illness.
ICPMS Method and Problems
The evening session was chaired by Dr Denis
O’Reilly and started by Dr Andrew Taylor,
Consultant Clinical Scientist at the Royal Surrey
County Hospital in Guildford. Dr Taylor gave a
presentation on using ICPMS-methods for
trace element analysis and talked about his
experiences with the quantification of lead
and arsenic. Lead analysis can identify the
presence of several different isotopes which
are present in varying quantities in different
continents. This can help to identify the source
of the lead. Lead is also found in cosmetics and
ayruvedic medicines.
Arsenic, is used in the treatment of
leukaemia and ulcerative colitis, but can be
toxic in its inorganic form. Organic forms
found in fish and seafood are readily absorbed
and excreted without any toxic effect.
Dr Taylor also discussed that gadolinium
from intravenous contrast can interfere with
selenium analysis. This is because certain
isotopic forms share a common mass to charge
ratio causing a single ICPMS peak.
Application of Boron Isotope in
Radiotherapy
Ted Sheehan, Clinical Scientist from City
Hospital Birmingham gave a talk on the
application of boron isotope 10B in
radiotherapy of high grade glioma - BNCT
(Boron Neutron Capture Therapy). It is a
radiation therapy technique which is based on
the principle of irradiating boron atoms with
neutrons. The 10B will capture a neutron
forming 11B which then spontaneously decays
to form 7Li and an alpha particle (4He).
Mr Sheehan’s team have been investigating
this technique with the Medical Physics
Department at their establishment. They hope
that the release of alpha radiation can be used
to target cells of a high grade glioma brain
tumour providing a targeted radiotherapeutic
agent.
Mr Sheehan discussed how a project of this
magnitude can take many years. We look
forward to hearing of future applications.
Lead Poisoning
The next speaker, Dr Paul Dargan, Consultant
Physician and Clinical Toxicologist from Guy’s
and St Thomas’ Hospital in London focused on
clinical aspects and treatment of lead
Issue 575 | March 2011 | ACB News
22 | Meeting Reports
poisoning. He discussed the epidemiology of
lead poisoning in the United Kingdom where
there are around 120 hospital admissions per
year. Symptoms of lead toxicity include
abdominal pain, lethargy, anaemia and
neuropathy. Severe lead excess, with a serum
concentration above 75 µg/dL can result in
encephalopathy and death.
Dr Dargan discussed the common sources of
lead available in the UK. Petrol used to be a
common source but most countries are now
using unleaded petrol. Paint continues to be
an available source of lead, particularly in
houses dating from Edwardian or Victorian
times. Some paint can contain up to 30% lead:
toxic levels can be achieved quite quickly. This
can be a common source for children and for
people employed in the painting-decorating
trade.
Another common source of lead is in goods
imported from other countries, particularly
from South East Asia and South America. Some
lead-containing imports include surma
cosmetics, ayurvedic medicines from China and
pottery from South and Central America.
Dr Dargan presented a case of a 60 year old
ACB News | Issue 575 | March 2011
man who was taking ayurvedic medicines for
diabetes. He had symptoms including
abdominal pain and motor neuropathy.
Ironically, he took additional tablets every
time he felt unwell with abdominal pain.
The ayurvedic tablets contained significant
amounts of lead and were likely to be causing
his abdominal pain, rather than providing the
desired therapeutic effect. This patient had a
serum lead concentration of 331 µg/dL, with a
microcytic anaemia and raised zinc
protoporphyrin. He underwent multiple
treatments with chelating agents such as EDTA
(intravenous) and DMSO (oral). Three years
later Pb was still detectable in his plasma. As
lead is predominantly deposited in bone, it can
take a long time to reduce lead concentrations
to safe levels.
There are known to be over 6000 ayurvedic
medicines and at least 40% of these contain a
heavy metal. Many agents contain several
potentially toxic heavy metals. The literature
has numerous cases involving lead (>90%
published cases) and other metals such as
mercury (12%).
He discussed the risk of lead poisoning in
Meeting Reports | 23
patients with embedded lead shot.
Interestingly, when the shot was embedded
close to a joint space or fracture, more lead
was absorbed, increasing the risk of toxicity.
Many patients with embedded lead shot do
not develop lead toxicity.
Pseudotumours in Hip Joint
Mr Barry Sampson, Consultant Clinical Scientist
from Charing Cross Hospital in London gave an
overview of chromium and cobalt toxicity in
patients with orthopaedic prostheses.
Around 50,000 hip replacement operations
are performed in the UK each year. Prostheses
are prone to wear and tear as they form a
major load-bearing joint. Many hip
replacements involve metal-on-metal
prostheses which, when damaged, can release
cobalt and chromium into the periarticular
tissue and into the joint space. Recent national
guidelines have recommended that patients
should be followed up for five years after hip
replacement surgery with a metal-on-metal
prosthesis and that patients with pain in the
area of the prosthesis should have blood taken
for measurement of cobalt and chromium
concentrations.
Increased concentrations of these trace
elements in synovial fluid are associated with
soft tissue necrosis and possible teratogenic
effects. Accumulation of affected fluid in the
joint space results in a cyst or pseudotumour
known as ALVAL (aseptic lymphocytic vasculitis
associated lesions). There is no known risk of
malignancy with these prostheses.
In summary, the Trace Elements Day was
enjoyable and varied, with a range of
eminent speakers both from clinical and
academic backgrounds. It addressed analytical,
pathological and clinical aspects of disease
and stimulated us with developments from
current research. I
Issue 575 | March 2011 | ACB News
24 | Meeting Reports
Frontiers in Laboratory
Medicine – FiLM 2011
Ian Hanning, ACB National Meetings Secretary
FiLM 2011, the 10th in
this successful series of
meetings, was held in
Austin Court, Birmingham
on 1st/2nd February 2011
There was a capacity audience, perhaps
reflecting the current interest in the future
direction of laboratories in the UK. As in
previous years, the meeting was jointly
organised by the ACB and Robert Michel of
The Dark Report, with Neil Anderson chairing
the Organising Committee. One of the aims of
this meeting is to bring together best practice
from across the pathology disciplines, not only
in the UK, but from across the world, with
speakers this year from Denver, Michigan, Eire,
Auckland, Indianapolis and Toronto.
Comparing Pathology Costs
The meeting started with a fascinating lecture
by Ian Cumming, Chief Executive, West
Midlands Strategic Health Authority, who
discussed ‘Financial and quality challenges
meeting the NHS’. This included a comparison
of healthcare costs, showing that health
spending in the UK per capita was about 40%
of that in America, and about half when
expressed as % Gross Domestic Product. This
was against a background of similar numbers
of both physicians and nurses per 1000
population. The obvious interpretation is that
the UK health service is much more efficient
than that in America (accepting the limitations
of such comparisons), at a time when the NHS
is being directed to cut costs. He also
compared pathology statistics across Trusts,
with the all-too-familiar dramatic difference in
pathology costs, differences in the number of
biochemistry tests per A&E admission and the
ACB News | Issue 575 | March 2011
number of FBCs requested on at least 3
consecutive days. Dramatic potential savings in
pharmacy costs were also highlighted,
including an estimated £3 million saving if
generic statins were prescribed across England.
Subsequent updates included:
N Publication of ‘Improving outcomes; a
strategy for cancer’, with relevant sections
for our colleagues in Histopathology, in
particular.
N Benefits of lean management at the
University of Michigan, with potential
savings of $1 million being identified in the
first four weeks! The outlay of $0.5 million
to bring in lean experts was well valued,
with an additional $2 million of savings per
year. An interesting quotation was ‘Using
lean for a workforce reduction is suicide!’
N Current status in Path Links, who have
already ‘leaned’ their organisation and are
entering their next 5 year cycle.
N Excellent work of NHS Improvement was
showcased in a series of parallel breakout
sessions, covering Histopathology,
Microbiology and Phlebotomy, as well as
BNP modelling.
We then moved on to giving patients access to
their records, including pathology results, a
subject that used to be controversial, but is
now recognised as the way forward. This eas
presented by Dr Brian Fisher, GP and Director
of Patient Access Electronic Records System,
UK (a private company). The work to date has
been in conjunction with EMIS and so offers
access to around 60% of the practices in the
UK. The system is available and working and
has been developed with patient input. Could
this be the solution for access to patient
records by out-of-hours GP service providers?
The first day ended with Paul Jennings, NHS
Warwickshire Chief Executive, reviewing the
implications of the White Paper to Pathology.
Meeting Reports | 25
His entertaining style of presentation helped
to focus our minds on the challenges ahead,
including GP Commissioning.
What Do GPs Really, Really Want?
Photos: Jonathan Middle
On the second day Dr Desai, a general
practitioner gave his views on ‘What does
primary care really want?’ He felt we needed
to think ‘out of the box’. He certainly felt that
there was a role for Pathology in the
commissioning process, whilst accepting that
‘Any Willing Provider’ had to be considered.
His final message was ‘lead or be led’.
The power of databases speaking to each
other was then demonstrated by Rick Jones
from Leeds, who is working on clinical
engagement within the NPfIT team in the
Yorkshire and Humber SHA. By linking into
national databases, he was able to produce
comparative statistics at any level (regional,
SHA, GP practice, individual GP), giving
powerful information on how well the
pathology service is being used. Examples
included number of HbA1c samples requested
in known diabetic patients, showing a wide
variation between users. The evidence-base for
best-practice included NICE guidance and
Better Testing.
Throughout the meeting there were panel
discussion following each group of lectures,
giving good opportunities for questions and
the added benefit of getting a series of points
of view from the speakers.
The unequivocal message from the meeting
was to become involved, talk to service users
and be clear about the value we add. This was
an excellent meeting that had delegates from
across pathology leaving enthused and
returning to their laboratories to try and take
forward some of the ideas that had been
presented. I
Top: Dr Julian Barth, President ACB
Middle: Phil Hudson, Collinson Grant Healthare Ltd
Bottom: Robert Michel, The Dark Report
Issue 575 | March 2011 | ACB News
26 | Training Matters
Future Pathology Leaders
Emerge Stepping Out
Carrie Chadwick, Liverpool
Back in January 2010 my attention was drawn
to the opportunity to apply to take part in
the national leadership development
programme for emerging leaders in
pathology. The course was sponsored by
Dr Ian Barnes, and commissioned and funded
by the Department of Health.
I had not heard of the course before and was
not aware of colleagues in the region having
attended any similar courses. With some
trepidation I decided to apply. The application
process included a questionnaire and telephone
interview. Competition for a place was strong,
with only twenty-five positions available. I was
successful and found myself travelling in April
to Rushton Hall in Kettering to attend the first
out of four two-day modules. I did note that
out of the twenty-five participants there was
only one Clinical Biochemist (myself) and one
Chemical Pathologist, both of us from the
North West region.
ACB News | Issue 575 | March 2011
Phoenix Consultancy were commissioned to
deliver the programme which was facilitated
by Merlin Walberg (President, Phoenix
Consultancy USA Inc) and Penny Humphris.
A warm welcome was given to all and then
the hard work of transforming all of us into
self-aware, emotionally intelligent individuals
who can listen on three levels whilst practicing
Stephen Covey’s seven habits of an effective
leader began!
On a Personal Journey
The main objective of the course was to
develop each individual participant by
taking us on our own personal leadership
journey. The course leaders supported us to
develop, design and implement a project.
The project could be based within our own
organisation, or as a conduit to develop a
network with other NHS and social care
organisations.
Training Matters | 27
Over the period of nine months the
programme offered participants learning
modules, which focused on different aspects
of leadership development including personal
leadership qualities, leading service
improvement and quality. A number of
excellent guest speakers, including Peter
Nelson and Vivienne Parry gave presentations
on negotiation skills and effective
communication.
We also had three two-hour coaching
sessions to help develop our leadership skills.
These sessions were particularly effective as
you are given a total of six hours to focus on
your aims and visions for the department in
which you work and, more importantly, what
your own personal goals are. By being
proactive and using the skills learned on the
course and reflecting every day, I could feel my
confidence and self-awareness increase. This
was encouraged by consultant colleagues.
At the final meeting in December each
participant had the opportunity to give a short
presentation discussing their project. It was
agreed by all at the meeting that the poster
presentations were of a very high standard
and they demonstrated how much we had
learned, whilst enjoying the course. Awards
were given to those projects and presentations
which were shown to have led to outstanding
development of staff or organisation, greatest
increase in productivity, outstanding impact on
patient services or greatest innovation and
outstanding application of learning.
More Leaders on the Way
The course is not only about developing one
member of the laboratory, as the skills learned
will ultimately benefit all members of the
laboratory. The development process is
continual, and the participants on our course
all hope to meet this summer to share our
experiences. In the current climate, openness,
effective communication and a team approach
with all colleagues is paramount to ensure the
delivery of the vision for future pathology
services.
Similar programmes for senior leaders in
pathology are now being funded for each
SHA. Please keep a lookout for the one in your
region or express your potential interest even
before the flyers are distributed by contacting
Phoenix Consultancy via the website
www.phoenixconsultancy.org I
Issue 575 | March 2011 | ACB News
28 | Obituary
Kind, Considerate Pioneer
Professor Barbara Evelyn
Clayton, DBE, MD, PhD, FRCP,
FRCPath, C Biol, born 2nd
September 1922, died 11th
January 2011.
Barbara, later to become
Professor Dame Barbara Clayton,
graduated in Medicine from
Edinburgh University shortly
after the war. She went on, most
unusually for the time, to do a
PhD in Biochemistry at the MRC
Clinical Endocrinology Unit
where she was a research
assistant. Her work on
oestrogens, and shortly
thereafter on the adrenal
hormones and ACTH, that she
undertook in the Department of
Chemical Pathology at
St Thomas’s Hospital Medical
School under George Prunty,
brought her national recognition
in the rapidly expanding field of
endocrinology. The development
of this field owed so much to
advances in clinical biochemical
techniques.
From 1959 to 1978, Barbara
was the Consultant in Chemical
Pathology at the Hospital for
Sick Children, Great Ormond
Street and, concurrently from
1968 to 1978, Professor of
Chemical Pathology at the
Institute of Child Health,
London. During this time, she
made very significant
improvements to the
biochemical investigation of sick
children and developed a service
of international repute for the
diagnosis of inherited metabolic
disorders. She made a major
contribution to the introduction
of the national neonatal
screening programme for
phenylketonuria and in
optimising the very restricted
diet required for this disorder
and for other inherited defects.
This included appropriate
vitamin and trace element
supplementation. Another
significant contribution was the
recognition of the significant
environmental exposure of
children to lead in the 1960s and
the possibility that this might be
damaging to the developing
brain. Advised by the Royal
Commission on Environmental
Pollution, of which she was a
member (1981-1986) the
Government introduced
legislation to reduce this,
including prohibiting addition of
lead to petrol. In consequence
blood lead levels of the general
population have fallen to very
low levels.
In 1979, after her husband
died, Barbara accepted the Chair
of Chemical Pathology and
Human Metabolism at
Southampton University Medical
School. With Trevor Delves, who
moved with her, she maintained
her interest in trace elements,
particularly in selenium, and also
in nutrition – now in the elderly.
She was Dean of the Faculty of
Medicine from 1983-1986. After
her retirement in 1987, she
maintained a very heavy work
schedule, being in regular
ACB News | Issue 575 | March 2011
demand to serve on, or Chair,
committees as diverse as the
Royal Committee on
Environmental Pollution,
1981-96; The COMA Panel on
Dietary Reference Values,198791; The Standing Committee on
Postgraduate, Medical and
Dental (formerly Medical)
Education, 1988-99; and others
too numerous to mention.
Barbara was an early member
of the Association for Clinical
Biochemistry and its President
from 1977-8. She subsequently
became the first, and so far only,
Chemical Pathologist and
woman President of the Royal
College of Pathologists
(1984-1987). In 2000 she was
elected a Fellow of the Acadamy
of Medical Sciences and was
honoured by being asked to
deliver eponymous lectureships,
with the award of Honorary
Doctorates by Universities and
Learned Societies in Britain and
Overseas.
She received a CBE in 1983
and in 1988 was made Dame of
the British Empire.
Whilst becoming one of the
country’s most distinguished
medical scientists Barbara
nevertheless found time to bring
up a son and daughter from her
marriage to Professor William
Klyne, a distinguished steroid
chemist, to whom she was
married for 28 years until his
death in 1977.
She will be remembered by all
who knew her as a kind,
considerate colleague who never
let her undoubted eminence
interfere with her friendliness
towards both her peers and her
juniors, many of whom went on
to achieve distinction in their
own right. I
VM & VW
Crossword | 29
ACB News Crossword
Set by Rugosa
Keep sane at coffee time with the ACB News Crossword. Always relating to the science and practice of
Clinical Chemistry, you will never cease to be astounded by the convoluted mind of the ACB News
Crossword compiler.
Prizes for your department: The first five correct solutions to appear on the ACB News fax machine (Fax:
0121-507-5290) will receive a copy of the new educational Calcium Cases CD-ROM by Aubrey Blumsohn,
Christina Gray, Neil McConnell, John O’Connor, Anne Pollock & Roy Sherwood and which retails at over
£50. Please state clearly the name and address of the Department that is entering the competition.
Remember that ACB News appears first as a PDF on www.ACB.org.uk around the 7th of each month.
7
9
12
15
17
18
20
21
Relieves ill at ease midwives'
distress (10)
Efficient lab receives
constituents for solution (11)
Employer is disturbed how
chemical union can increase
size (10)
Squadron leader admires
new weapons (4,4)
Medical and military field
of action (7)
Organ keyboard guide (6)
Old doctor makes
anticoagulant (5)
Most common fashion (4)
Last month’s solution
Across
1 Unfair dealings in shares? (10)
6 Lead crown (4)
8 Neglects automatic options (8)
10 Inadequate, uneatable, take
tea away (6)
11 Illuminating - surprisingly
prettier in riotous vein (12)
13 Main part remains (4)
14 Maybe noble designed
Tangiers (8)
16 Organic compound in
oyster soup (8)
17 Next in long-wavelength
entropy perturbations (4)
19 Group film about cytoplasm (4,8)
22 Straight in with typical
masculine arrogance (6)
23 Always balanced in chemistry,
could have a degree in maths (8)
24 Net medical thesaurus (4)
25 Bore thrust (10)
Down
2 Lack desire (4)
3 The first NHS challenge
assessed by labs (7)
4 Unusually silent passages (6)
5 Suspensions of insoluble material
disgrace some Rieslings (8)
6 Take it, be comforted (5)
Issue 575 | March 2011 | ACB News
30 | Situations Vacant
Imperial College Heathcare
NHS Trust
Clinical and Investigative Sciences – Pathology and Molecular Sciences
Division of Clinical Biochemistry
CLINICAL SCIENTIST
Band 8a, £45,068 - £52,838, Full Time, Permanent
HIGHER SPECIALIST TRAINEE CLINICAL SCIENTIST
Band 7, £36,552 - £46,374, Full Time, Permanent
Applications are invited for opportunities in Clinical Biochemistry for either established, HPC
registered, Clinical Scientists or candidates nearing completion of Pre-Registration training to
develop their careers in a dynamic and challenging West London environment. These posts arise
consequent to major reorganization following establishment of Imperial College Healthcare NHS
Trust (ICHNT) and partnership with Imperial College to form the first Academic Health Sciences
Centre in the UK.
ICHNT comprises Charing Cross, Hammersmith, Queen Charlotte’s and Chelsea and St Mary’s
hospitals and provides Pathology services under service level agreement to Chelsea and
Westminster NHS Foundation Trust. Clinical Biochemistry laboratories are fully CPA accredited and
provide acute services on each site with a fully automated laboratory and specialist services
centralized at Charing Cross hospital.
Clinical Biochemistry is one of the largest units in the UK, has 168 medical, scientific and specimen
reception staff and provides a comprehensive range of tests with a total test workload in excess of
12 million p.a.
Specialist services essential to a major centre of excellence for service, teaching and research include
Andrology, Endocrinology, Metabolic, Paediatric biochemistry, Point of Care, Special Proteins, Trace
Element and Tumour Marker. Supra-regional assay services are provided for Bone Markers,
Hormones, including Tumour Markers and Trace Elements. The specialist services enjoy strong
Consultant clinical scientist leadership and applicants will be encouraged to continue their careers
in one or more specialties as an element of succession planning.
Clinical Scientist applicants will be HPC registered with an MSc in Clinical Biochemistry (or
equivalent) with or working towards FRCPath Part 1 and wide experience of Clinical Biochemistry.
Trainee applicants will be expected to hold a degree (Hons.) in a relevant science subject, an MSc in
Clinical Biochemistry (or equivalent) and approaching 3 years experience as a Pre-registration
Trainee Clinical Scientist. A desire to contribute to academic clinical biochemistry is essential and
part-time registration for PhD will be actively encouraged for career development as a future
leader in the field.
Closing date: Friday 8th April 2011.
For further information or informal visits please contact Dr Richard Chapman, Consultant Clinical Scientist on 0208 331 35908
or Mr Stephen Snewin, Divisional Manager on 0208 331 35907.
Alternatively you can E-mail: richard.chapman@imperial.ac.uk or stephen.snewin@imperial.nhs.uk
To advertise your vacancy contact:
ACB Administrative Office, 130-132 Tooley Street, London SE1 2TU
Tel: 0207 403 8001 Fax: 0207 403 8006 Email: ACBNewsAdverts@ACB.org.uk
Deadline: 26th of the month prior to the month of publication
Training Posts: When applying for such posts you should ensure that appropriate supervision and training support will be available to enable you to proceed towards HPC
registration and the FRCPath examinations. For advice, contact your Regional Tutor. The editor reserves the right to amend or reject advertisements deemed unacceptable to the
Association. Advertising rates are available on request
ACB News | Issue 575 | March 2011