october

ACBNewsThe Association for Clinical Biochemistry & Laboratory Medicine | Issue 618 | October 2014In this issueACB MedalAwardGuildfordTraceElementCentre GetsFull MarksLifetimeAllowanceExplainedGoodbye‘Old Style’TrainingCoursesBenefits toMembersLaunches atEurolabFocusSummer ofScottishSportFarewellto AramRudenski

About ACB NewsThe Editor is responsible for the finalcontent. Views expressed are notnecessarily those of the ACB.EditorDr Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-507-5290Email: jon@bergfamily.co.ukAssociate EditorsMrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: sophie.barnes@imperial.nhs.ukMr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: ian.hanning@hey.nhs.ukDr Derren ReadyMicrobial DiseasesEastman Dental HospitalUniversity College London Hospitals (UCLH)256 Gray’s Inn RoadLondon WC1X 8LDEmail: derren.ready@phe.gov.ukMrs Louise TilbrookDepartment of Clinical BiochemistryBroomfield HospitalChelmsfordEssex CM1 5ETEmail: louise.tilbrook@meht.nhs.ukSituations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: admin@acb.org.ukDisplay Advertising & InsertsPRC Associates Ltd1st Floor Offices115 Roebuck RoadChessingtonSurrey KT9 1JZTel: 0208-337-3749 Fax: 0208-337-7346Email: mail@prcassoc.co.ukACB Administrative OfficeAssociation for Clinical Biochemistry& Laboratory Medicine130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: admin@acb.org.ukACB PresidentProfessor Eric KilpatrickTel: 01482-607-708Email: president@acb.org.ukTwitter: @ACBPresidentACB Home Pagehttp://www.acb.org.ukPrinted by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry &Laboratory Medicine 2014ACBNewsThe monthly magazine for clinical scienceIssue 618 • October 2014General News page 4Practice FRCPath Style Calculations page 10Federation News page 12Training Matters page 14Meeting Reports page 16Obituary page 20ACB News Crossword page 21Situations Vacant page 22Front cover:Angie Cooper received theACB Medal for 2014Issue 618 | October 2014 | ACB News

4 | General NewsACB Extras Gives AdditionalBenefits to MembersWilliam Marshall & Andrew TaylorAs announced in the September issue ofACB News, the Association has contractedwith the company Parliament Hill to makeavailable to members a wide range of usefulbenefits. The scheme, named ‘ACB Extras’,is being launched this month and we are usingall our communication media to try and drawattention to it.Benefits include discounts on:◆ Insurance: roadside assistance, home,car, travel and life insurance.◆ Professional advice: legal and financial.◆ Home and leisure-related items:health clubs, cinema tickets, wine andmagazine subscriptions.◆ Travel: hotels, car hire and airport extras.◆ Work and business items: IT training,CV and interview assistance.Other benefits are presently being negotiatedand will be added as agreements are reached.The full range of benefits is available on theACB Extras website, accessible through theSudokuThis month’s puzzlemembers’ page of the ACB website.Suggestions from members for additionalbenefits will be welcomed.Many of the items are part of normalexpenditure so the scheme provides a realopportunity for members to save money.Indeed, looking at the range of benefitsavailable, it seems likely that many membersshould be able to more than save the cost oftheir annual subscriptions to the Associationby taking advantage of even only a smallnumber of the things on offer. Extras willnot be available to retired or CorporateMembers. ■Last month’s solutionACB News | Issue 618 | October 2014

6 | General NewsACB Medal Award 2014Eric KilpatrickThe ACB Medal Award has showcased thetalent of ACB Members in training since 1971.Traditionally, the Award is made on the basisof an oral communication at the Association’sAnnual National Meeting, Focus, but in yearswhere the ACB has been hosting internationalmeetings instead of Focus the Award has notbeen held. With EuroLabFocus being inLiverpool, this should have been an occasionwhen the Award skipped a year. However, theACB was keen to ensure that this importantevent still went ahead and so the SouthernRegion kindly agreed to host the session aspart of their regional meeting on the 5thSeptember, which also included an update onliver pathology and diagnosis.Quality Work of Direct Clinical RelevanceFour abstracts were shortlisted forpresentation and I had the privilege ofchairing the session and being one of the fourjudges. There was an eclectic mix of topicswhich started with Oliver Clifford-Mobleydiscussing an assay which could simultaneouslymeasure urinary metabolites relevant toprimary hyperoxaluria. This was followed byAngie Cooper describing how she had usedzinc transporter 8 autoantibodies to helpdiscriminate MODY from type 1 diabetes inyoung, newly diagnosed patients. KatieHadfield then told us how she had usedlaboratory data to markedly improve thedetection and documentation rates of chronickidney disease within primary care. Last topresent was Rachel Curd, who discussed howshe had developed a rapid mass spectrometryscreening test to exclude galactosaemia.The quality of the work and the way inwhich it was presented by each person wasexcellent, which made the task of the judgesextremely difficult. All four would have beenworthy winners, but it was Angie Cooper whoreceived the Award and Oliver Clifford-Mobleywho was runner-up.I was pleased that in a non-Focus year thecream of young talent in our specialities stillgot the opportunity to show us just howaccomplished they are. For those of us whoworry about the future for laboratorymedicine, the ACB Medal. ■Rachel Curd, Katie Hadfield, Oliver Clifford-Mobley and Angie Cooper presented at this year’s ACB MedalACB News | Issue 618 | October 2014

8 | General NewsGuildford SAS Trace Elements CentreOpen for BusinessThe official opening of the new GuildfordSupra-regional Assay Service (SAS) TraceElements Centre was held recently. ProfessorVincent Marks, the first Director of the SASservices at Guildford, gave a short account ofbeginnings of the Centre before cutting theribbon to mark the move to new laboratoriesbased at the Surrey Research Park. Visitorswere then invited to see the new facilities,meet the staff and join them for lunch.The Centre accommodates the SAS TraceElement Laboratory and the UKNEQAS TraceElements External Quality Assessment Schemehad previously been located on the mainUniversity of Surrey Campus for more thanforty years. However, with pressure on spaceand business expansion, it was decided torelocate to the nearby Surrey Research Park.This move has given laboratories specificallydesigned for the modern equipment used, andfor the research and development workassociated with the Centre. Deputy Director,Dr Chris Harrington, designed the newProfessor Vincent Marks Opens the SAS Trace Element Centreaccommodation, supervised the buildingprogramme and facilitated the successfulimplementation of the laboratories. The£450,000 relocation cost was funded by theRoyal Surrey County Hospital NHS FoundationTrust.Samples from Head to ToeThe analytical workload of the SAS laboratoryinvolves the measurement of trace elements inwhole blood, serum, urine, hip-fluid aspirates,herbal medicines, toenails, hair, liver biopsiesand tissue specimens. Most samples are for theinvestigation, follow-up and monitoring ofpatients for nutritional or orthopaedicreasons. Clinical advice and interpretation ofresults, as comments on written reports or indirect discussion with colleagues in otherhospitals forms an important component ofthe workload.The UK NEQAS Trace Elements ExternalQuality Assessment Scheme has over 120registered participants from 25 countriesACB News | Issue 618 | October 2014

General News | 9Dr Andrew Taylor with some of the forty visitorsaround the world and the scheme monitors34 element/matrix combinations. A newscheme for the analysis of Cu and Fe in solidmatrices was introduced in 2012 for cliniciansand laboratories testing liver biopsies for thediagnosis of Wilsons Disease andhaemochromatosis and has 19 participantsfrom 7 countries.In addition to overseeing an extensive SASrepertoire and the international ExternalQuality Assessment Scheme, Andrew Taylor,the Centre’s Director, and Chirs Harrington,teach and supervise students at the Universityof Surrey and elsewhere, manage researchprojects, as well as collaborating on numerousprojects with external colleagues.The SAS Trace Elements Centre is managedas part of Surrey Pathology Services, a jointventure between the Royal Surrey County,Frimley Park and Ashford & St Peter’s HospitalNHS Foundation Trusts.The new location of the facility is:SAS Trace Element CentreSurrey Research Park15 Frederick Sanger RoadGuildfordGU2 7YDTel: 01483 689978Email: rsc-tr.traceelements@nhs.netWebsite: www.surreyeqas.org.uk ■ACBI 201414th-15th November 2014Royal Hospital Kilmainham, DublinWhy not attend what is always an excellent ScientificMeeting in what is the ACBI’s fiftieth anniversary year?For the full programme and booking details: www.acbi.ieClick on the image for a link to the ACBI website on theelectronic version of ACB News.Issue 618 | October 2014 | ACB News

10 | Practice FRCPath Style CalculationsDeacon’s ChallengeNo 161 - AnswerA 65-year old married woman in good health has just discovered that her brother is homozygousfor the C282Y haemochromatosis gene mutation. Her sister has been tested and has the normalgenotype. Her own genotype is as yet unknown. The population gene frequency for C282Y is8%, and the lifetime penetrance is estimated to be 30%.Calculate the probability of each of the possible genotypes in both the woman and her partner,and use these data to determine the probability that their child will develop clinicalhaemochromatosis. You should ignore any possible contribution from any other genetic lociassociated with haemochromatosis.FRCPath, Autumn 2013It is only possible for her brother to be a homozygous for the C282Y gene mutation (C/C) andher sister a normal genotype (N/N) if both parents are heterozygous (N/C).Each parent has an equal chance of producing gametes that are either normal (N) or mutated(C). Therefore the probability of each possible genotype for the patient can be calculated:Patient N/N P = 0.5 x 0.5 = 0.25N/C P = (0.5 x 0.5) + (0.5 x 0.5) = 0.5C/C P = 0.5 x 0.5 = 0.25(Note that even though the patient is clinically unaffected it is still possible that she could havethe CC genotype because the penetrance of haemochromatosis is only 30%.)Since no information is available for her partner it can be assumed that he has the same risk asthe general population. The population gene frequency is 8% and the probability of eachgenotype can be calculated from the Hardy-Weinberg formulae:p + q = 1p 2 + 2pq + q 2 = 1wherep = frequency of the dominant alleleq= frequency of the recessive alleleSince the frequency of the recessive gene (C) is 8% it follows that q = 0.08 and p = 1 - 0.08 =0.92 allowing calculation of the probability for each genotype in her partner:N/N = p 2 = 0.92 2 = 0.8464N/C = 2pq = 2 x 0.92 x 0.08 = 0.1472C/C = q 2 = 0.08 2 = 0.0064ACB News | Issue 618 | October 2014

Practice FRCPath Style Calculations | 11Their child can only develop haemochromatosis if he/she is homzygous for the mutation (C/C)which can only arise by inheritrance of the mutated gene (C) from each parent which can onlyoccur if both parents are either C/C or N/C. The probability of each event occurring is the productof the probabilities of each genotype from each parent:Patient C/C and Partner C/C = 0.25 x 0.0064 = 0.0016Patient C/C and Partner N/C = 0.25 x 0.1472 = 0.0368Patient N/C and Partner C/C = 0.5 x 0.0064 = 0.0032Patient N/C and Partner N/C = 0.5 x 0.1472 = 0.0736(Note that as the normal (N/N) was excluded these probabilities do not add up to 1).The probability of transmission of the homzygous genotype for haemochromatosis for each ofthese possible crosses is then calculated:Patient C/C and Partner C/C = 1 x 1 = 1.0Patient C/C and Partner N/C = 1 x 0.5 = 0.5Patient N/C and Partner C/C = 0.5 x 1 = 0.5Patient N/C and Partner N/C = 0.5 x 0.5 = 0.25The probability that her child is C/C is the sum of the probability of each cross multiplied by theprobability that the cross will result in C/C:(0.0016 x 1) + (0.0368 x 0.5) + (0.0032 x 0.5) + (0.0736 x 0.25)= 0.0016 + 0.0184 + 0.0016 + 0.0184 = 0.04 (4%)The risk of clinical disease is the probability of the affected genotype (0.04) multiplied bypenetrance (30% or 0.3):Risk of clinical haemochromatosis = 0.04 x 0.3 = 0.012 (or 1.2%)Question 162Current guidelines indicate that a patient with familial hypercholesterolaemia who fails toachieve a 50% reduction in LDL-cholesterol concentration compared to the pre-treatmentvalue should be referred for specialist management. In your laboratory, LDL-cholesterol iscalculated using the Friedewald equation and the results of total cholesterol, triglyceridesand HDL-cholesterol.A patient has a pre-treatment LDL-cholesterol of 12.2 mmol/L. Calculate the value followingtreatment that would allow you to confirm a 50% fall in the true value with greater than95% probability.Current IQC performance shows CVs of: total cholesterol 2.9% at 7.0 mmol/L, HDLcholesterol 2.7% at 1.5 mmol/L, and triglycerides 2.5% at 1.6 mmol/L.Table of z-distribution:P(%) 10 5 2 1 0.2 0.1z 1.65 1.96 2.33 2.58 3.09 3.29FRCPath, Autumn 2013Issue 618 | October 2014 | ACB News

12 | Federation NewsAnnual Saving Allowanceand Lifetime AllowanceGeoff Lester, NHS Staff Council and Pensions Scheme Advisory BoardRepresentativePerhaps this Briefing No. r6 might beconstrued as a rather technical article but thetopic has already had significant impact onsome FCS Members and it is important toshare.BackgroundThe notion of a limit to the amount that anindividual can invest tax-free into theirpension fund was introduced by pastgovernments to close what was then perceivedas a tax loophole. The annual and lifetimelimits were set deliberately high, initially theannual limit was £215k and rose to £255k, sothat only extremely high earners wereaffected. In more recent years (post the 2008financial crisis) both limits have been reduced,in the case of the annual allowance verydramatically to £50k since 2011. The apparentobjective has been to increase personalcontributions to meeting the nation’s financialdeficit onto a larger number of higher earners.For tax year 2014-2015 the annual limit is£40,000.This limit is still a very significant sum whenconsidering defined contributions invested in aprivate pension fund. (A defined contributionscheme is where you and your employer pay astated sum or proportion of your salary into aninvestment vehicle which eventually is turnedinto your pension income.) The calculations formembers of the NHS scheme, where there aredefined (guaranteed) benefits, are lessobvious. Former pension scheme documents(http://www.nhsbsa.nhs.uk/Documents/Pensions/Annual_Allowance_Ready_Reckoner_V2.0.pdf) reassured members that only those withsalaries above £110k might be affected.FCS members, medical and scientist, may nowexceed the limit in any one year if they enjoy asignificant within year pay increase resultingfrom say a promotion, clinical excellenceaward or they start to receive a payenhancement for additional duties orresponsibilities, especially if this is in additionto incremental pay progression.For NHS Pensions Agency links on the subjectgo to: http://www.nhsbsa.nhs.uk/4221.aspxThe CalculationsFor the NHS end-salary schemes thatcalculation takes the pension benefit you haveaccrued at the end of the year (irrespective ofwhether you can actually take your pensionyet) and subtracts your pension benefit at thebeginning of the year (uplifted by inflation).This represents the increase in pension benefit“earned” during the year. That sum is thenturned into a notional capital value thatwould need to be “invested” by multiplying bya factor of x16. This factor is set by HMRC. Addto this any additional personal pensioncontributions such as AVCs.Working through the algebra:Annual contribution C = Pension year(y+1) – Pension year (y) x (1+Inflation)Where: S = pensionable salary at start ofyearR = increase in pensionable pay overthe yearF = Inflation factorA = your accrued pension years atstart of year.1. For 1995 scheme:C = 19/80x[S(1-AxF) + R(A+1)]2. For 2008 scheme:C = 16/60x[S(1-AxF) + R(A+1)]Early in your career C is dominated the termS(1-AxF) i.e. your pay point. Late in your careerC is dominated by R(A+1) i.e. your pay increasein the year multiplied by your accrued years.That is where the numbers can become large.ACB News | Issue 618 | October 2014

Federation News | 13A calculator spreadsheet is available on theFCS web pages. The Pensions Agency publishessome sample calculations: http://www.nhsbsa.nhs.uk/Documents/Pensions/Annual_Allowance_example_calculations_factsheet_082014_V4.pdfThe trap occurs because HMRC regard any“Annual Contribution” over the annual limitas taxable income in the year. This ispotentially a large sum making the payincrease or enhancement a poisoned chalice!The impact can be mitigated by off-settingunused allowance from the previous 3 yearsbut we are now in the position where thepreviously high limit of £255k no longerapplies.What Should I Do?Within year pay increases only count if theyare pensionable. The impact of a largeincrease is mitigated if it occurs later in thefinancial year – but beware of a big impact inthe following year. A pay increase in Aprilcarries most risk and in September or Octoberprobably has the lowest overall risk.Remember that your incremental progressioncontributes to the issue.If you exceed the annual limit the PensionsAgency will send you a statement and youmust declare the amount on your tax returnform. You are strongly advised to consult yourIndependent Financial Advisor (IFA). TheHMRC has produced a factsheet:www.hmrc.gov.uk/helpsheets/hs345.pdfAs the impact is a one-off (albeit potentiallya very significant tax sum) there is a facilitycalled “Scheme Pays” where the amount youowe is paid by the Pension Scheme and thenrecovered when you draw your pension.Professional advice from your IFA should besought if considering this option. Informationcan be found at: http://www.nhsbsa.nhs.uk/Documents/Pensions/Scheme_Pays_Factsheet_v4_10.13.pdfLifetime Allowance (LTA)Pensions Agency documents can be found at:http://www.nhsbsa.nhs.uk/4222.aspxThis is the (notional) total “investment” infunding your pension. For the NHS final salaryschemes, as for Annual Contribution, it isdetermined by the value of your pensionbenefits when you take them rather than thetotal amount of contributions made.Any separate personal pension investmentwill need to be added.The limit has been reducing over recentyears. On 1st April 2014 it was reduced from£1.5m to £1.25m which means it will affect:◆ Members in 1995 scheme with pension inexcess of £54378.◆ Members in 2008 scheme with apension (before taking any lump sum)of £62500.If you exceed the Lifetime Allowance thentax will be charged on NHS benefits in excessof the LTA at a rate of 55% on your lump sumand 25% of the capital value on your pension.You can apply to mitigate the impact byapplying for Individual Protection for pensionaccrued at the higher allowance that appliedto earlier years. This must be done directly toHMRC by deadline dates. Again if you are inthis situation you should seek advice fromyour IFA. ■Issue 618 | October 2014 | ACB News

14 | Training MattersLast of ‘Old Style’ TrainingCoursesSuzanne Armitage, University Hospital of South ManchesterEarlier this year I attended my first ACBTraining Course, the National Training CourseNo. 4, after successfully applying for a travelgrant from the ACB. This was the final trainingcourse in the current series and is likely to bethe final one in this format. A select group of38 Trainees descended on the University ofSouth Wales in Pontypridd on Sunday 30thJune 2014 for this event which started with apre-course buffet and quiz in the evening oncampus. The following two days were packedwith high quality lectures from experiencedstaff from the local region with a focus onpaediatric metabolic biochemistry andbiochemistry of pregnancy.The meeting opened with an introductorylecture on paediatric clinical biochemistry byDr Stuart Moat, Consultant Clinical Biochemistand Director of the Newborn Screeninglaboratory in Cardiff. Dr Moat highlighted thatpaediatric patients were not just ‘mini’ adultsand discussed the difficulty posed in obtainingsuitable samples from these patients. RoannaGeorge, a Principal Biochemist in Stuart’slaboratory, followed with excellent lectures onclinical emergencies posed in neonates withhyperammonaemia and hypoglycaemia withChemical Pathologist Dr Farrhan from AneurinBevan then covering neonatal jaundice.The afternoon sessions provided overviewsof the inherited storage disorders by ChemicalPathologist Dr Duncan Cole whilst Dr Moatutilised clinical cases to highlight the role ofcommon laboratory tests in aiding diagnosis ofa number of rare disorders.The last session of the first day was aninteractive workshop on the interpretation ofEQA, led by Consultant Clinical BiochemistAnnette Thomas, which was informative as tothe issues encountered with interpretation ofEQA reports and the identification of issuesinvolved.Case DiscussionsDay two started with an overview of CPA andthe transition to UKAS and ISO 15189standards provided by Senior CPA/UKASassessment manager Janet Chatfield. This wasfollowed by a presentation on the ClinicalPathology Quality Management System byTim Vonporkorny. After a break, the Traineestook to the stage in the interactive clinicalcases sessions that all Trainees had to preparepresentations for prior to attending thecourse. Seven trainees presented their caseswhich covered a wide range of case scenarios.The interactive aspect of the presentationsensured that all Trainees contributed to thecase discussions. Well done to all short listedtrainees who presented their cases excellently.The afternoon session provided FRCPathPart 1 essay preparation training with RCPathexaminers, Dr David Cassidy and Mrs AvrilWayte, leading interactive workshops onwriting analytical technique essays. The courseended with presentations relating to theinvestigation of infertility and thebiochemistry of abnormal pregnancy byCarol Evans and Rachel Still.Attendance at this course provided me withthe invaluable opportunity to increase myknowledge on certain aspects of the FRCPathcurriculum whilst consolidating paediatricbiochemistry knowledge. I am extremelygrateful to the ACB for providing me withthe opportunity to attend this course. I wouldlike to pass on a big thank you to all of theorganising committee of this course fromthe Wales Region from all Trainees whoattended as they put in sterling work inorganising a packed, informative conferencein great facilities and ensuring that all ransmoothly. ■ACB News | Issue 618 | October 2014

16 | Meeting ReportsDilemmas in LaboratoryMedicineEmma StevensonThe Spring ACB Wales & South West andWessex Meeting took place in Cardiff. It wasnot just the pleasant weather or views overthe beautiful Vale of Glamorgan thatbrought together so many ACB Members andnon-Members, but the chance to discuss a hottopic in laboratory medicine: to test or not totest.The focus of the meeting was dilemmas inlaboratory medicine. Accordingly, thepresenters covered some of the morecontroversial matters currently occupying theminds of biochemistry professionals, includingtumour markers and point of care testing.That is the Question . . .The first speaker was Consultant ChemicalPathologist, Dr Soha Zouwail, who gave aninteresting talk on “Benchmarking requestingprofile: A way forward to quality use ofpathology”. Perhaps, not surprisingly, around25% of pathology tests may be inappropriate,related in part to media influence and aconcerning rise in websites offering privateblood tests for conditions like “cancer”.Dr Zouwail explained to us how her laboratoryhad been measuring GP requesting activity,which showed significant variation in the rateof biochemical sets ordered by GPs.By engaging and educating GPs andimplementing a regular primary carenewsletter, she told us that local interventionappeared to be effective at tackling thisvariation. To avoid the danger ofover-diagnosing, we should take theGoldilocks approach to testing: not too little,not too much, but just right. We came awayunderstanding the need to focus on qualitynot cost-saving, through information,education and requestor accountability.Katy Heaney looked at point of care testingand introduced the POCT Manager’s role asthe work of an idealist, in the sense that avisionary is required to answer the mostimportant POCT question: “to implement ornot to implement?” Katy discussed thedecision process of the POCT committee,including practical considerations, clinicalevidence and cost-efficiency, in addition tosome amusing personal experiences of deviceimplementation. She emphasised that POCTcan result in a more positive patientexperience but left us with the big question:Can the NHS afford to give weight to patients’opinions of POCT service, even when there islittle evidence to support cost or clinicalbenefit?The final presentation of the morningsession was a clinician’s viewpoint on the useof procalcitonin in sepsis by Dr Robert Orme.He told us that diagnosis of infection is oftendifficult and procalcitonin has been welcomedas a biomarker for early diagnosis of sepsis, inmonitoring treatment success and inpredicting patient outcome. The test can beused to improve clinical decision-making andreduce the length of antibiotic courses, whichis currently an important issue owing toinappropriate antibiotic usage and the threatof resistance. Dr Orme stressed to us thatprocalcitonin is not a “magic bullet”, butmust be used in conjunction with otherinvestigations and clinical signs. He ended histhorough and interesting talk with adescription of the successful (andcost-effective) introduction of prolcalcitoninanalysis in his local Trust in Gloucestershire.Right Tests Used EffectivelyThe afternoon session commenced withDr Cathie Sturgeon, who discussed tumourmarkers and posed the question, “Are wedoing the right tests and are we using themeffectively?” From the NHS Atlas of Variation,it is clear that there is a huge variation in testrequesting. Variation is particularly evidentwith tumour marker requesting and CathieACB News | Issue 618 | October 2014

Meeting Reports | 17recommended improving upon this throughproactive engagement with users and moreinformative result reports. She concluded hertalk by telling us that we biochemists are allpart of the clinical picture as we work towardsthe 2020 Vision for Healthcare.Professor Paul Collinson on B typeNatriuretic Peptide (BNP) testing in primarycare captivated the audience. Heart failure(HF) is one of the UK’s biggest killers and NICEguidance recommends measuring serumnatriuretic peptides (BNP or NT-proBNP) aspart of the chronic HF diagnostic pathway inpatients with no previous myocardialinfarction. Paul concluded that age should betaken into account when interpreting results,but normal levels can be used to rule out HFand raised levels indicate referral forechocardiography.The penultimate talk of the day discussedthe use of faecal calprotectin in inflammatorybowel disease (IBD) and irritable bowelsyndrome (IBS). Consultant GastroenterologistDr Jonathan Tyrell Price considered the prosand the cons of faecal calprotectin in IBD andIBS from the patient’s point of view. Heexplained that it is vital to distinguish IBDfrom IBS so that the conditions can be treatedappropriately. We found out that while CRP isnot as sensitive as faecal calprotectin and acolonoscopy cannot rule out IBD, a 50 µg/gcut-off for faecal calprotectin has emerged asa useful screening test where otherinflammatory markers are unhelpful.The meeting was rounded off with someinteresting cases in endocrinology byDr Owain Gibby, with a clinical theme ofcalcium problems. Dr Nadia el Farhan thenexplained the biochemical background of thecase studies, including the calcium sensingreceptor and associated mutations.She finished the session, and the day, withexplanations of some of the more complextests for investigating abnormal calciumlevels, including the TmP/GFR test forassessing the kidneys’ phosphate andcalcium handling, and the long-forgottenEllsworth-Howard test for the diagnosis ofpseudohypoparathyroidism. ■Issue 618 | October 2014 | ACB News

18 | Meeting ReportsA Summer of SportLaura Willox, Glasgow Royal InfirmaryOn a sunny Friday at the end of May the ACBScotland Region, along with the Royal Collegeof Pathologists, met at Hampden Park inGlasgow ahead of the Commonwealth Gamesfor “A Summer of Sport”. There were a rangeof presentations from the cardiovascularbenefits of exercise to drug testing in eliteathletes, as well as a chance to tour thefootball museum at half time.Encouraging Men to Slim DownThe day kicked off with a presentation fromProfessor Kate Hunt on the Football Fans inTraining study (FFIT). This was an initiative setup to encourage men in Scotland toparticipate in weight managementprogrammes.Seventy-five percent of men in Scotland areoverweight or obese and the majority do notuse traditional weight management services.The football club setting provided a real drawfor many of the men, 95% of whom had neverattended a weight management programmebefore.Thirteen Scottish Professional FootballLeague clubs across Scotland took part in theRCT with men randomised to the controlgroup having access to the programme oncethe study was complete. The programmeinvolved nutrition classes based on portion sizeand the NHS eatwell plate, as well as alcoholawareness sessions with physical activityincorporated into each session. Men whoparticipated lost significantly more weightthan those in the control group and thisweight loss remained after 12 months.There were added benefits for other familymembers with one man’s dog losing so muchweight due to the extra exercise that it wasable to go for an operation!The programme is ongoing in the footballclubs in Scotland with plans for expansion.Does One Size Fit All?Next Dr Jason Gill spoke aboutcardiometabolic risk in people from differentethnic backgrounds. There is a large globalburden of inactivity and it is responsible formore deaths worldwide than smoking. Therelative risk of type II diabetes mellitus (T2DM)is increased in those who are less active whenadjusted for BMI.There was very interesting discussion on theincreased risk of T2DM in people of SouthAsian and native Chilean Mapuche descent,particularly when moving from rural to urbansettings, compared with White Europeanpopulations.South Asian populations living in the UKhave a 5 times higher risk of developing T2DMwhen compared with those of Europeandescent. South Asian women have anequivalent risk of developing diabetes at aBMI of 22 as white European women at BMI of30 kg/m 2 with similar risk increases seen inSouth Asian men. In addition, VO 2 max islower in South Asians than Europeanpopulations when adjusted for body fat. It isalready known that lower levels of fitnessincrease the risk of T2DM and the metabolicsyndrome.Dr Gill also explained recent findings thatSouth Asian populations need to take morephysical activity to reach the same level offitness as European populations. This equatesto 266 minutes of physical activity per weekcompared to 150 minutes per week for peopleof European descent. This may lead to physicalactivity guidelines being published fordifferent ethnic groups in order to reduce therisk of T2DM.The morning session concluded with apresentation by Declan Fields on performancenutrition. This was an interesting discussion onthe importance of meeting nutritionalrequirements in elite athletes and alsodebunked some common myths surroundingthe use of supplements. Athletes arediscouraged from taking supplements due topoor regulation and safety testing as well asthe increased risk of positive doping tests dueto unlisted ingredients.ACB News | Issue 618 | October 2014

Meeting Reports | 19At lunchtime we were given the opportunityto tour the Scottish Football Museum beforeheading back for the afternoon session.Citius, Altius, FortiusThe afternoon session was entitledProfessional Sport and Elite Athletes andcommenced with an interesting presentationfrom Professor David Cowan on the role of theWADA (World Anti-Doping Agency) accreditedlaboratory and the particular challenges whenfaced with large sporting events such as therecent London Olympics and the forthcomingCommonwealth Games. Based on the Olympicmotto of citius, altius, fortius he aimed forfaster analysis with higher sensitivity andstronger proof.During large sporting events such as theOlympics, staff numbers and equipmentnumbers need to be increased to deal with theincreased workload. It is also extremelyimportant to have simple sample preparationsteps with fast analysis, easy data review andgood selectivity. In addition they need to beflexible to new substances that may be beingabused. During the London Olympics the labanalysed 400 samples per day with a 24-hourturnaround time. The lab remained open 24hours in order to achieve this, with a massivelyincreased workforce. For the Glasgow gamesslightly shorter operating times will be in placefrom 6am-midnight.The majority of the work done is qualitative,however, with some substances concentrationneeds to be known. Analysis is mostly carriedout by GC-MS/MS, UHPLC-HRMS (which wasutilised at the last Olympics) and GC-C-IRMSwhich is useful in the identification ofpseudoendogenous compounds via isotopicdifferences. They have done a lot of work todecrease run times in order to get resultsquickly.He concluded by discussing the role ofintelligence testing and hoping that theCommonwealth Games in Glasgow may bethe first drug-free games.Looking Forward to GlasgowThe day concluded with a talk from Dr BrianWalker, Head of Sports Medicine at theScotland Institute of Sport about hisexperiences as a medic at the Commonwealthgames in Delhi, and the lessons learned whichassisted in planning for the games in Glasgow.He also discussed the preparations being madeby the athletes in order to avoid infection,ensure good nutrition and get the bestprepared team possible.This was a very well organised meeting in anexcellent setting on a range of interesting anduseful topics. Many thanks to the OrganisingCommittee. ■Issue 618 | October 2014 | ACB News

20 | ObituaryMathematician TurnedPathologist with SidewaysView on Mancunian AfflictionsAram Rudenski diedpeacefully on Saturday 27thAugust 2014. He was only58 years old and illnessdiagnosed in 2011 had causedhis premature retirementfrom his post as Consultant inClinical Biochemistry atSalford Royal NHS FoundationTrust (formerly HopeHospital).On his arrival in ourDepartment in 2001, it wasimmediately evident thatbehind his quiet manner layreal dedication and adetermination to transformand improve services. Hebrought special experience inlaboratory computing andclinical nutrition and quicklyestablished collaborationsacross the Trust, impressingcolleagues with the depth ofhis subject knowledge andability to explain complexconcepts in simple language.He had a very fine intellectand the unusual distinction ofbeing a doctor who hadstarted his academic careerwith an Open Scholarship inMathematics to Clare CollegeCambridge, graduating with aTriple First in the Mathematicsand Medical Sciences Triposes.The mathematical model ofinsulin/glucose interactionthat formed the basis of hisDPhil thesis has been highlyAram walking with John Kane andDon Barber, two colleagues fromSalfordinfluential. He publishedmany papers on a diverserange of subjects, hiscontribution often beingsophisticated mathematicaland statistical analysis.Baffled by Red andBlue LoyaltiesThose who took the troubleto get beyond his naturalreserve discovered a truepolymath with rich and broadcultural interests. He was akeen linguist, natural historyenthusiast, theatre-goer andmusic-lover. Aram could talkon almost any subject - theonly one that really baffledhim was the intense Red orBlue loyalty that afflictsmany Mancunians to varyingdegrees!He did his best to converthis laboratory colleagues tothe wonders of classical music,memorably hosting his 50thbirthday lunch in a fairlytypical Salford tavern near thehospital, having persuadedthe startled landlord that noalcohol should be served andthat the background musicwas to be his own CDs ofSchubert string quartets.The creation of his gardenwas a labour of love which heapproached with the precisionof a serious botanist, beingparticularly proud of his rosesand cultivating a wide rangeof fruit and vegetables withina fairly small space. In 2009,he thoroughly enjoyeddemonstrating the medicinalqualities of plants at theRoyal College of Pathologistsshow garden at the TattonFlower Show which won aSilver medal.His early retirement due toill health was a great loss toSalford Hospital and to theClinical Biochemistryprofession. He was cared forwith devotion during thisdifficult period by his partner,David. As friends andcolleagues, we extend ourdeepest sympathies toDavid, Aram’s sisterHannah and his wider family,many of whom live in Israel,a country very dear to Aram’sheart. ■FSACB News | Issue 618 | October 2014

Crossword | 21ACB News CrosswordSet by RugosaClinical Biochemistry Ski Trip to Zermatt and CerviniaIf you are looking for a bunch of mates to go skiing or snowboardingthen look no further. The team at SWBH in Birmingham are heading tothe Italian and Swiss Alps for a week of amazing skiing starting on 24thJanuary. We are taking our own ski guide and are a mixed ability group.If you want to tag along then you are very welcome. For further detailsplease email: jonathanberg@nhs.net. If you are reading the electronicversion of ACB News then get a feel for the amazing Zermatt ski runsby clicking here . . .Across1 Cleaner burn (4)5 Acid-base assessmentcomplicated management ofpost-operative angina (5,3)9 Assemble a crowd (5)10 Short drive in Nash-Healey’sPininfarina (4)11 NHS guilt about source ofvitamin D (8)12 Being a form of endlessroaming (8)13 Company having no clue intechnicolour process (6)14 Sharp instrument couldaccidentally slice keen beginner (6)15 Upset from criticism of herhair? (8)17 Life-saving treatment is sadlystarting in confusion (8)20 Relations disastrous, manifestlysent off (6)22 Prosaic safe surgical procedurecontains return of connectivetissue (6)24 Tie off vessel on leavingurogenital operation (8)25 A rum time changing beforebeing fully developed (8)26 Intestinal contentinvestigation (4)27 Take care surgeon, go out andabout (5)28 Order enema set for theprovision of relief (8)29 Measure gains lost from wrongdiagnoses (4)Down2 Philip took rye cocktail,upended first-class honey-baseddrink, developed metabolicproblem (15)3 Organised large container forplunder (7)4 Portable measuring instrumentprices all fluctuate (9)5 Believed stop-start made usuncertain (7)6 Kind of strength that isincongruous withoutresistance (5)7 Proverbially, what you catchchasing two hares (7)8 Metabolic syndrome outcomeresearch tool is unsettledpoint (15)16 Protection of sound mind (9)18 Slow about measure forfermentation product (7)19 Being in the black novels abouttime (7)21 Altered, subdued acceptingthanks (7)23 Sharp parachutes? Not sharp! (5)Last month’s solutionIssue 618 | October 2014 | ACB News

22 | Situations VacantTo advertise your vacancy contact:ACB Administrative Office,130-132 Tooley Street, London SE1 2TUTel: 0207 403 8001 Fax: 0207 403 8006Email: acbnewsadverts@acb.org.ukDeadline: 26th of the month prior to the month of publicationTraining Posts: When applying for such posts you should ensure that appropriate supervision and training support will beavailable to enable you to proceed towards HCPC 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 618 | October 2014