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In this issue

Volunteeringat theSchools Science Conference

HSST Training ProgrammeExplained byMike Thomas

Lab Managementat DisneyWorld

ACB Awards

The Association for Clinical Biochemistry & Laboratory Medicine | Issue 638 | June 2016

ACBNews

About ACB NewsThe Editor is responsible for the finalcontent. Views expressed are not necessarily those of the ACB. EditorProfessor Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07792-912163/0121-507-5353Fax: 0121-507-5290Email: [email protected]

Associate Editors Mrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: [email protected]

Dr Gina Frederick Pathology Laboratory, Level 5Royal Derby HospitalUttoxeter RoadDerby DE22 3NEEmail: [email protected]

Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Dr Derren Ready Microbial DiseasesEastman Dental Hospital University College London Hospitals (UCLH) 256 Gray’s Inn Road London WC1X 8LD Email: [email protected]

Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

Display Advertising & InsertsPRC Associates Ltd1st Floor Offices115 Roebuck RoadChessingtonSurrey KT9 1JZTel: 0208-337-3749 Fax: 0208-337-7346Email: [email protected]

ACB Administrative OfficeAssociation for Clinical Biochemistry & Laboratory Medicine130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB PresidentDr Gwyn McCreanorTel: 01536-492692Email: [email protected]: @ACBPresident

ACB Home Pagehttp://www.acb.org.uk

Printed by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry &Laboratory Medicine 2016

ACBNews

General News page 4

Practice FRCPath Style Calculations page 10

Education Matters page 12

Getting Out There page 14

Meeting Reports page 16

ACB News Crossword page 18

Issue 638 • June 2016

The monthly magazine for clinical science

Issue 638 | June 2016 | ACB News

Front cover: Dr Gwyn McCreanorpresents the ACB Medal Awardto Dr John Wadsworth

4 | General News

ACB News | Issue 638 | June 2016

SudokuThis month’s puzzle

Lastmonth’ssolution

ACB Medal Award Winner: Dr John WadsworthRunner Up: Miss Roanna George

Clinical Cases Winner: Dr Sian HancockRunner Up: Mrs Isla Wootton

Audit Posters Winner: Dr Wassif WassifRunner Up: Mr Joseph Taylor

President’s ShieldMr Geoff Lester

ACB Membership Awards 2016 These Awards were agreed at the ACB Annual General Meeting and will be presented at the July Council Meeting:

Emeritus Members Mr Steve Goodall Trent, Northern &

YorkshireDr Anne Pollock ScotlandDr Sandra Rainbow Southern

Fellow MembersDr Fraser Davidson ScotlandDr David Hullin Wales

Honorary Members Prof Paul Collinson SouthernProf Kevin Spencer SouthernProf Chris Packard Scotland �

Advancing HealthcareAwards 2016Nicola Svenson, an ACB member and Clinical Scientist in Haematology in Hull was awinner in last month’s Advancing HealthcareAwards 2016. She received the ChamberlainDunn learning Rising Star Award.Congratulations on her achievement. �

ACB Awards at Focus and AGMAnnouncements

Dr Gwyn McCreanor presents the President’s Shield toGeoff Lester at the closing ceremony at Focus 2016,Warwick University


6 | General News

ACB Chemical Pathology SpR/Consultant MeetingTuesday 22nd November 2016

Salford Royal NHS Foundation Trust, Mayo Building, Humphrey Booth Lecture Room 1, Salford M6 8HD

Registration fees: £20.00 for ACB Trainee & Retired Members,

£40.00 for ACB Members and £60 for Non-Members

Please visit the ACB National Meetings page for the current programme,registration form and online payment

ACB North West Meeting Region Summer Scientific Meeting

Faecal TestingFriday 8th July 2016

Royal Liverpool Hospital12:00 Lunch and Registration

13:00 Diet and IBDEmile Richman, Gastroenterology Dietician, Royal Liverpool & Broadgreen University Hospitals

13:45 Colorectal Cancer and Faecal Occult Blood TestingHelen Bruce, Acting Director Bowel Cancer Screening Southern Programme Hub, Surrey Pathology Services

14:30 Sponsor presentation by Biohit Healthcare Ltd

15:15 FIT – Opportunities and Challenges for Bowel Cancer ScreeningStephen Halloran, International CRC Screening Advisor, Emeritus Professor University of Surrey

16:00 Faecal Testing and CalprotectinDr Martyn Dibb, Consultant Gastroenterologist, Royal Liverpool & Broadgreen University Hospitals

16:45 Close

Please go to the ACB website Regional Meetings page for further details including registration

8 | General News


Vitamin D: Analytical and Clinical StoriesThursday 7th July 2016South Kensington Campus, Imperial CollegeMorning Session: Chair: Dr Emma Walker10.05-10.15 Welcome and Introduction10.15-10.50 25-Hydroxyvitamin D Assay Performance

Graham Carter, DEQAS Organiser, Imperial College Healthcare NHS Trust10.50-11.25 VDSP-Standardisation Issues with 25-OHD

Professor Christopher Sempos, VDSP Director, Office of Dietary Supplements, NIH, Bethesda

11.25-12.00 What Can We Learn from Measuring 24,25-(OH)2D3?Professor Glenville Jones, Department of Biomedical & Molecular Sciences, Queen’s University Kingston, Ontario

12.00-13.00 Lunch

Afternoon Session 1: Chair: Dr Jacqueline Berry13.00-13.35 The Vitamin D Metabolome: Analysis of Multiple Vitamin D Metabolites

in Serum and TissueProfessor Martin Hewison, Dept of Molecular Endocrinology, University of Birmingham

13.35-14.10 Free 25-OHD and Physiology of Vitamin D Binding ProteinsDr Inez Shoenmakers, Senior Investigator Scientist, MRC Human Nutrition Research, Cambridge

14.10-14.45 Measurement of Vitamin D Binding Protein and its’ Isoforms by LC-MS/MSDr Karen Phinney, Leader, Bioanalytical Science Group, Biomolecular Measurement Division, NIST

Afternoon Session 2: Chair: Graham Carter15.15-15.50 Vitamin D Requirements for the UK: Deliberations and Decisions from SACN

Prof Susan Lanham-New, Head of the Dept of Nutritional Science, University of Surrey

15.50-16.25 Vitamin D in Under-Researched Population Groups: The ODIN ApproachProfessor Mairead Kiely, Professor of Human Nutrition, University College Cork

16.25-17.00 Maternal Vitamin D Supplementation During PregnancyProfessor Cyrus Cooper, Director, MRC Lifecourse Epidemiology Unit, University of Southampton

17.00-17.10 Closing Remarks17.10 Drinks Reception

Cost: £25.00 ACB Member £25.00 DEQAS Member* £40.00 Non-Member*If you are NOT an ACB member but your laboratory is a member of DEQAS one person from your laboratory is eligible to register as a ‘DEQAS Member’

using your DEQAS membership number.Registration forms are available on the ACB website regional meetings page

along with maps of the venue.

10 | Practice FRCPath Style Calculations


An 8-day old baby was born at 39 weeks gestation weighing 3085 g. He developed an ischaemicencephalopathy and required ventilation. He subsequently became hyponatraemic.

You are provided with his plasma sodium concentrations. The paediatricians decide herequires intravenous sodium supplementation. Estimate his sodium deficit, and the infusion rateof 0.9% saline required to return his plasma sodium concentration to 140 mmol/L over 72 hours.

You should assume that the average healthy term infant has a total body water ofapproximately 80% body weight, divided equally between intra- and extra-cellularcompartments, and a sodium requirement of 4 mmol/kg/day.

His sodium intake between 22/3/15 and 24/3/15 was 8.5 mmol/24 hours (6.6 via IVI and 1.9 viamilk).

FRCPath, Spring 2015

Make the following assumptions:

• That pure sodium loss has occurred so that the total body water (and body weight) is unchanged.• That the sodium intake via milk will remain at 1.9 mmol/24h.• That sodium is confined to the ECF (not entirely true but there are no data on ICF sodium).• That sodium losses will continue at the same rate.

Calculation of sodium deficitTotal body sodium (mmol) = Plasma sodium (mmol/L) x ECF vol (L)

ECF vol (L) = Body weight (Kg) x Body water (%) x Proportion of ECF

= 3085 x 80 x 0.51,000 100

= 1.23 L

Target body sodium = 140 x 1.23 = 172 mmol

Actual body sodium at day 8 (24/3/15) = 115 x 1.23 = 141 mmol

Sodium deficit = 172 - 141 = 31 mmol

If this amount of Na is to be replaced over 72h (3 days) the rate of replacement will be 31/72 =0.43 mmol/h.

Calculation of rate of sodium lossThe plasma Na fell considerably (from 139 to 115 = 24 mmol/L) between 0.00h on 22/3 and21.00h on 24/3 (over a period of 24 + 21 = 45h). Therefore the rate of fall in plasma Naconcentration is 24/45 = 0.53 mmol/L/h. As the ECF volume is 1.23 L the apparent rate of totalNa loss is 0.53 x 1.23 = 0.65 mmol/h.

Deacon’s Challenge No 181 - Answer

Date 16/3/15 22/3/15 23/3/15 23/3/15 24/3/15Time 15:00 00:00 07:00 21:00 21:00Sodium 136 139 133 121 115

However, the actual rate of loss will be higher than this because Na was administeredsimultaneously.

Rate of administered Na (mmol/h) = Infusion rate (mmol/d)24

= 6.6 = 0.28 mmol/h24

N.B. The contribution from milk can be ignored if it is to be continued to be given at the samerate.

Actual rate of Na loss = Apparent rate of Na loss + rate of IVI Na

= 0.65 + 0.28 = 0.93 mmol/h

Calculation of rate of sodium infusionTotal Na infusion (mmol/h) = Rate required to correct deficit (mmol/h)

+ Rate required to combat continuing losses (mmol/h)

= 0.43 + 0.93 = 1.36 mmol/h

Calculation of rate of saline infusionNa content in (mmol/mL) of 0.9% saline

= Saline Na (% =g/100 mL) x 10 (converts g/100 mL to g/L) x 1,000 (converts g/L to mg/L)MW NaCl x 1,000 (converts mmol/L to mmol/mL)

= 0.9 x 10 x 1,000 = 0.154 mmol/mL58.5 x 1,000

Rate of infusion (ml/h) = Rate of infusion (mmol/h)Na in saline (mmol/mL)

= 1.36 = 8.8 mL/h (to 2 sig figs) = approx. 9 mL/h0.154

This figure can only be a rough guide, careful monitoring is essential.

Practice FRCPath Style Calculations | 11


Question 182Your Consultant Endocrinologist has expressed concern that two blood glucose monitors on hisward are yielding discrepant results. As part of your investigation you perform replicatemeasurements on a QC material on both instruments with the following results:

Number of results (n) Mean (m) Standard deviation (s)Instrument 1 5 5.6 0.12Instrument 2 7 6.0 0.14

Does this data support his suspicion?

Two tailed t-distribution:

P

0.10 0.05 0.02 0.01

9 1.833 2.262 2.821 3.25010 1.812 2.228 2.764 3.16911 1.796 2.201 2.718 3.10612 1.782 2.179 2.681 3.05513 1.771 2.160 2.650 3.012

Degreesoffreedom

12 | Education Matters


In the second YouTube interview with Dr Mike Thomaswe find out more about theHSST Programme

We started by ensuring we clearly understoodwhat the HSST programme is. The HigherSpecialist Scientist Training Programme (HSST)is a five-year work based programmesupported by an underpinning part-timedoctoral level programme. It has beendeveloped and is supported by the MedicalRoyal Colleges and professional bodies and isopen to clinical scientists and those seekingand achieving equivalence through theAcademy of Healthcare Science.The curriculum comprises three main

components:

� Leadership and professional development.

� Advanced clinical scientific knowledge in the specialty being followed.

� Research and Innovation skills.

There are two routes to entry for HSST. One isthrough open competition for newly createdposts by a Trust, the direct entry route, whilstthe other and more popular route is throughin-service recruitment.Posts are locally commissioned in England

through the Health Education England localoffice. Mike did not think that Blood Scienceswas lagging behind in implementing HSSTthough he did feel that Blood Sciences havepreviously been more averse to consider HSSTtraining than colleagues in the Physical Sciencediscipline. This year there are 71 commissionsproposed of which 66 are in-service and only 5 are direct entry. Of these 26 are Blood andInfection Sciences which breaks down into:

There are no ‘target numbers’ as such as theseposts are being locally commissioned withrespect to local manpower planningexpectations and there is no expectation thatHSST simply follows on from STP. Indeed thereis a recommendation that it may be useful tohave a further period to give experience in theworkplace following STP before consideringapplying for the HSST route. There is also nobar on individuals outside the NHS applyingfor the Direct Entry posts. However, there is astipulation that all those who start the HSSTprogramme are registered Clinical Scientistsand an application to the Academy must be inprogress when an application is made ifapplicants are not already Clinical Scientists.There is a training allocation of £16,000 per

year for each HSST Clinical Scientist with £3Kof this top-sliced by the lead commissioner as a contribution towards the taughtdoctorate, and with employers covering othertraining costs with remaining funding. It is expected that the HSST trainee will

significantly contribute to the local work ofthe department and indeed that much of theoutputs required will emerge from that work.The HSST trainee therefore is a truecontributor to the work of the departmentand helps its host department to develop andgrow in a rapidly changing world.

I Already Have a PhD!A research doctorate or PhD is different to aprofessional doctorate such as the DClinSci in a

HSST Programme is theFuture Path to ConsultantClinical ScientistJonathan Berg, Editor

Discipline In Service Direct EntryClinical Biochemistry 6 0Clinical Immunology 6 2Microbiology 4Virology 1Other 7

https://www.youtube.com/watch?v=hb5BjzG2zVU

Education Matters | 13


number of ways. Whilst the PhD or researchdegree focuses on a contribution to the bodyof academic literature and theory in thediscipline, the professional doctorate is anapplied degree contributing to professionaldevelopment and practice in the discipline.In selling the concept of the DClinSci to

someone who already has a PhD, Mike pointsout that both contain independent researchprojects. However there are differences. A PhDcreates, expands, and contributes to newknowledge, research while the professionaldoctorate can be seen as expanding andapplying existing knowledge and research tosolve real-world, professional problems in thefield in one of a variety of forms.A professional doctorate will be more

attractive to those who have an interest inpracticing directly within the profession. So, Mike says his response to those HSSTtrainees with a PhD who ask should they dothe taught doctorate is “Why wouldn’t you asit brings benefits far beyond those that willhave been achieved undertaking a PhD”.

Current Trainees and HSST

Regarding people already well into trainingthere is the question of who should just carryon in the traditional route and who shouldlook seriously at the in-service training route.Mike points out that it’s going to take at leastfive years for the first cohort to come throughthe system. For current trainees he feels itreally depends where they are on thepathway. If just starting out and not even asfar as Part I of the Fellowship then they shouldconsider trying to follow the HSST programme.For those further down the pathway andalready with Part I and close to fulfilling therequirements of Part II then he feels theyshould stick with that.Mike can see that there is going to be a

period of transition and it’s likely there are lotsof people in the system who will have theopportunity to become consultants withoutgoing near the HSST programme. The HSSTprogramme facilitates an individual’s access tothe Academy for Healthcare Science HigherSpecialist Science Register (HSSR) but does notguarantee a consultant post. Access to the

HSSR is not only through successful exit fromthe HSST programme and of course theCollege is still the custodian of the FRCPathexamination and curriculum. There isabsolutely no suggestion that access to thiswill be restricted solely through HSST. Having said all this Mike commends the HSSTprogramme to those considering furthertraining.The delayed appointment of Manchester

Academy of Healthcare Scientist Education(MAHSE) as the provider of the taughtdoctorate has held up the formalisation ofmany of the aspects of the programme for Life Sciences. Recent three way discussionsbetween MAHSE (as the provider of theDClinSci), the College and the School havebeen very positive and seen substantialalignment between the milestones of the HSST which are of benefit to Life Sciencetrainees and regularise the programme ofwork across all themes and specialisms.Mike is off to get his state pension soon but

would very much like to stick around in hiscurrent role to see the first HSST cohorts cometo completion. It was certainly very clear justhow much time and effort Mike Thomas hasput into ensuring the HSST programme hasevery chance of training our pathology leadersof tomorrow.

See the interview with Mike at ‘SWBHPathology TV News’ which you canreach by clicking here on the electronicversion. �

Mike and Jonathan discuss more about the HSST inthe Serology Department



On Wednesday 20th April 2016 I took the trainto London to help at the 13th Annual SchoolsScience Conference hosted by the University ofWestminster. The theme for this year'sconference was ‘Science4YourFuture’ and itsaims were to:

� Inspire students to study science.� Demonstrate the importance of science in

health and everyday life.� Showcase some of the exciting and

rewarding careers open to those who study science.

Over 200 year 8-11 pupils from schools aroundLondon came to the event and I could see thatthey were enjoying the experience! Across several rooms were stands from a

wide range scientific disciplines, from theAmbulance Service training the pupils in CPR, to Healthcare Scientists from a geneticslaboratory showing pupils what chromosomeslooked like down the microscope. Oneresearch group from University CollegeLondon had a stand which explained theirresearch into developing a biological stent to

14 | Getting Out There


Volunteering at the SchoolsScience ConferenceRachel Dale, Colchester

permanently treat newborns with heartdefects, overcoming the need for repeatedsurgery as the child grows. The pupils hadallocated time at each stall to ask questionsand participate in activities.I got involved in the Schools Science

Conference by responding to an email fromthe Eastern Region ACB TraineeRepresentative asking the STPs in our regionto consider volunteering at this event. I agreedto help out on the stall of Chrystalla Ferrier, aSenior Lecturer in Clinical Biochemistry at theUniversity. Together we decided on activitiesthat would be interactive, engaging andrelevant to the pupils. We used diabetes as amain theme and I created posters about thestructure and function of insulin and thedifferent types of diabetes to form thebackdrop of our stand.

Dipstick for Iced Tea

On the day we donned some disposable labcoats and set up our stall. I led a urine dipstickactivity using some QC material spiked with Ice

Tea, and got the pupils to figure out what was‘abnormal’ about the urine. I asked themwhether they had seen a urine dipstick beforeand explained in simple terms how the dipstickworks. Then, wearing gloves, the pupils testedthe urine specimens and I helped them tointerpret the results. All of the childrennoticed the presence of proteins and glucosein the urine and I asked them a few questionsabout what disease this might be associatedwith. Some of the older pupils knew aboutType 1 and 2 diabetes and had a vague idea ofthe difference between them.I really enjoyed participating in this event

and having the opportunity to increase pupils’awareness about diabetes and the role ofscience in diagnosing the disease. It was greatto see them keen to get involved in the hands-on activities and it was a really goodpractice for me to explain tests and diseases in simple terms. This was the 13th Annual Schools Science

Conference and I would highly recommendgetting involved with this event next year! �

Getting Out There | 15


Use it or Lose it . . .The July ACB News has a front coverbut little else. Why not considercontributing? You could:

� Write up a meeting you attended.

� Give a view of a development in your laboratory.

� Send us the details of a meeting you are organising.

� Write a personal view about something.

If you have things to say then do email the Editor at [email protected] �

In November 2015, the call came to submitabstracts to bring ‘an international dimension’to the ICE (Increasing Clinical Effectiveness)programme. ICE was launched to encouragemedical laboratory specialists to collaboratewith clinical colleagues to demonstrate thatoptimal use of the laboratory can have ameasurable impact on patient outcome. With a closing date in 4 weeks, the United

Kingdom stepped up, providing 2 of the 6winners. Dr Clare Ford from Wolverhamptonwas the overall winner, presenting on ‘HighSensitivity Cardiac Troponin I Early SafeDischarge of Patients” and I had theopportunity to present on The SUDIC-Box,which provides a complex, yet simple to usesystem of peri-mortem sampling and securesample processing, for the investigation ofsudden unexpected death in infancy andchildhood (SUDIC). The first difference from previous meetings

was the fact that the meeting of the ClinicalLaboratory Management Association,‘Knowledge Lab 2016’ was held at DisneyWorld the second being the large cohort ofmilitary lab personnel attending andpresenting. The sunshine was tolerable, themilitary ‘presence’ fascinating, informative andexcessively courteous. The differences soonevened out as our laboratory managementchallenges, issues and concerns were clearlyshared ones of safe patient care, albeitworking with different standards, governingbodies and healthcare systems. ‘How to survive the stress of the 21st

Century: insider tips to go the distance’, ‘Step up to step in’, Stress management andLab management and Leadership were titleseminently pertaining to the internationalaudience. The examples, stories, hints, tips andtools presented in these sessions, includingsquishing difficult colleagues’ heads (notliterally, naturally!), previously uncharted time

and workload management IT tools, how tosay no and strategies for preventing burnoutwere novel, and useful for all staff regardlessof level within a lab or organisation.Three specific management topics

immediately drew me in, firstly: Effectivechange management – reorganisation in alaboratory send-out department. Theemergent strategy and process of successemployed by the paediatric hospital lab tomanage tests at 100 referral labs, and the everchallenging ‘miscellaneous test’ was inspiringand relevant to our Trust, with a movetowards a Blood Sciences Sendaway Section.There is an imminent and massive growth ofboth genetic and potentially genomic testingin the future.

Value Propositions“The laboratory value proposition” is aconcept close to my heart regarding theSUDIC-Box. We in the in the lab are good and indeed excellent at what we do and are inthe ideal place to work with clinical andoutside organisation colleagues accordingly.We need to harmonise what users think of thelab and what they do with the lab’s view ofthe users, and if we don't each get involved inthe others activities, this isn't going to happen,obvious, but surprisingly infrequentlyundertaken. The presenter’s motto ‘Withoutus, they are just guessing’ – slightly arrogant,but very true! “Point of Care and the lab, offering a

perfect partnership for patient centred care” is an obvious concept but often challenging tobring to fruition. However, when presentedwith tragic cases of dichotomous lab and POCTresults not being appreciated by both lab andclinical staff, the roles and responsibilities ofall involved to provide safe patient care areapparent. The partnership however is alsomutually rewarding and I certainly rely on our

16 | Meeting Reports


Lab Management, theMilitary and Mickey MouseHeidi Cox, Hull

POCT testing team to help maintain stocked,secure and available SUDIC-Boxes within ourTrust. Now for the science bit! At Focus 2004 Eric

Kilpatrick inspired me to look deeper at dataalready available, easy to access and ‘basic’research with potentially powerful outcomes.At Disney World I was inspired to look in bothdirections with alkaline phosphatase and moveaway from the ‘greater than’ referenceintervals for ALP activity and look for levelssuggesting hypophosphatasia. Age, sex and

analyser specific reference intervals for ALP arecoming home with me, we already have the data but potentially are not looking forthe now treatable condition. A suitably time- managed project will likely be on my todo/delegate list.I am grateful to the ACB both nationally and

regionally, and my Trust R&D Department inhelping me to get to Knowledge Lab 2016 and represent the UK, NHS and my Trust and specifically getting The-SUDIC-Box outthere. �

Meeting Reports | 17


ACB Meeting for Retired MembersACB Office, 130-132 Tooley Street, LondonMonday 27th June 201612.00-13.25 Registration, networking and sandwich lunch13.25-13.30 Welcome13.30-14.15 Think Kidney’s AKI Programme

Dr Robert Hill14.15-15.00 The Education Agenda

Dr Frances Boa and Miss Laura Tooth15.00 Tea and Close

Cost: £10 – pay on the day if you wish or via website.Please visit the ACB website for details on how to register online or simply print out

and complete a registration form and send to the ACB Office.

18 | Crossword


Last month’s solution

Across 1 Muscle follows blockhead taking

a synthetic cannabinoidpreparation (6)

4 Sharp leading investmentconsultant finishes accountidentification (6)

9 An examination of the mouth (4)10 Extend yoga work out for an

optimum tissue state (10)11 Holding some defence

statements (6)12 Odour envelops the harmful

deposit (8)13 Accost in mid-afternoon about

drugs (9)15 Union agreement (4)16 Make better preserve (4)

17 Male French friend has no current identification forcompound (5,4)

21 Sets free after grounding; lot safer at sea (8)

22 Yellow French car with bearing failure (6)

24 Mistakenly incineratediagnostically useful metabolicend product (10)

25 Distressing xeroderma but noorder for test (4)

26 Gas ring coordinates information (6)

27 Complex tests first establishidentity of trypanosome vector (6)

Down 1 Sit out in bar, a coffee shop

employee indicated (7)2 Rest from realistic false

eyelashes (5)3 Abandon tasks involving

sports jacket design (7)5 Central Europeans report

set-backs (6)6 Rambling radiographers with

no mobile internet connectionsystem get GI upset (9)

7 Took the best away but trounced in the US (7)

8 Cagy about abnormal anatomiesdeveloped in men (13)

14 Consequence of coal lorry crash (9)

16 So long, farewell, aufwiedersehen, goodbye (7)

18 Centre of new, superior andunusual clues (7)

19 Exclude divorce (7)20 Hide gangster inside

compound (6)23 Rate end product having

changed act leading to 6 across (5)

ACB News CrosswordSet by RugosaRunning Low on Trained Staff . . .When you are trying to do something new in the laboratory you have to be sensitive to thepressures around you. We have been keeping you informed on our ideas to produce a series ofeducational short videos. However, we are looking at real issues with keeping core services going atpresent at ‘St Elsewhere’s’ laboratory. Not the right time to start putting tripods down in the laband asking people if they are OK to be in a YouTube video when you are struggling with staffunder pressure with 24 hour services to maintain.

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