OPINION
PUBLIC ENGAGEMENT
IBMS EVENT
THE BIG QUESTION
ANTI-VAX MOVEMENT
CONGRESS 2022
What should be done to improve the profession for women? p.16
Do we need to get better at engaging for our future benefit? p.25
A final update on Congress, which takes place this month: p.43
THE BIOMEDICAL SCIENTIST
THE
MARCH 2022
BIOMEDICAL SCIENTIST THEBIOMEDICALSCIENTIST.NET
MARCH 2022
How long can we live? We investigate if advances in medicine can increase lifespan indefinitely
P01 Cover_March 2022_Biomedical Scientist.indd 1
17/02/2022 09:14
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06/08/2021 15/02/2022 15:52 12:46
MARCH 2022 Contents
EDITORIAL 5 Alan Wainwright looks back over 21 years at the IBMS
NEWS 9 Research, funding, developments and clinical updates
MARCH 2022
13 Product advances and launches
38 Blood Bikes: The charity’s work, achievements and some of the challenges faced in recent years
OPINION 14 One-to-one: Professor Fergus Gleeson on scanning technology that has identified hidden abnormalities in the lungs of long COVID patients 16 The big question: What should be done to improve the biomedical science profession for women?
COVER
COVER PHOTOGRAPHY: RICHARD GLEED
18 How long can we live? FEATURE We investigate whether advances in medicine can increase lifespan indefinitely, or if 122 years is the upper age limit for humans
3
CONTENTS IBMS.ORG
7 News in numbers
SCIENCE
THE BIOMEDICAL SCIENTIST
ADVICE 43 Congress: The latest updates for Congress 2022 44 COVID testing on wheels: Testing in the community 50 How to... Secure a placement
18
MY IBMS
25
28
53 Institute news: The latest from the IBMS 55 Regulation: An IBMS position statement 58 Journal-based learning: CPD exercises 60 Here to help: Non-accredited biomedical science degrees
25 Engaging with the anti-vax movement: Jonathan M Evans argues that we need to get better at engaging for our own future benefit
MY LAB
28 Parkinson’s disease: The eighth instalment in an ongoing series about medical eponyms
38
62 Azuma Kalu and Dean Tazzyman give a guided tour of their toxicology laboratory in Sheffield
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17/01/2022 11:49:12 15/02/2022 15:12
EDITORIAL Alan Wainwright
I
am holding the editorial pen as this is my opportunity to say farewell and thank you to all of you who have travelled with me along my career path as I am retiring this month. The Institute is in good hands and there are exciting developments on the horizon, but those are for someone else to take forward. Having spent the last 20 years extolling the virtues of reflection, I am now reflecting on all I have done and what it has meant to me. If I had to use three words to define my career, I would say meaningful, serendipitous and unexpected. I started in histology at the University of Birmingham Medical School and found there was always something new to learn, understand and put into practice. I remember the people, subjects and events that influenced me as though they were yesterday. The standards, diligence, and the desire to get the basics right because this is what you build on. These values stood me in good stead, and I enjoyed my work because it was meaningful and varied. Although CPD and lifelong learning were not concepts thought about in the early days, they were nevertheless embedded in my approach. I count myself lucky with the opportunities that came along, and this is where serendipity comes in. A senior position in the Department of Rheumatology led me to my second love – clinical immunology and a move to London, eventually to become Pathology
Institute of Biomedical Science is the professional body for the biomedical science profession. INSTITUTE OF BIOMEDICAL SCIENCE
12 Coldbath Square London, EC1R 5HL United Kingdom +44 (0)20 7713 0214 +44 (0)20 7837 9658 Email: mail@ibms.org Web: www.ibms.org
5
TIME TO SAY FAREWELL Executive Head of Education Alan Wainwright looks back over the 21 years that he has spent at the IBMS. Business Manager at Barts and the Royal London Hospital. However, my future was to be outside the laboratory, and in June 2000 my life changed. I had just been elected as the London Region representative to the IBMS Council when a vacancy at Coldbath Square appeared in The Biomedical Scientist. Instead of my first meeting as a Council member, I attended as the new executive member of staff – Head of Education. The rest is history. My work has been defined by regulatory processes, the creation of the IBMS Registration Training Portfolio, and the IBMS qualification framework. My successes have been the creation of the Specialist Portfolios, Certificates of Expert Practice and Certificate of Achievement for
Support Staff, in addition to degree accreditation and HCPC-approved routes to registration. Being involved in IBMS education and training has given me 21 years of fulfilment. I can look back with pride on everything that has been achieved as an organisation by colleagues and members. Personally, and most unexpected, it led to me becoming President of the International Federation of Biomedical Laboratory Science in 2020. This in itself exceeded any career expectations I might have had, only to be eclipsed last year by being awarded IBMS Life Membership. Yes, it’s been a good journey.
Alan Wainwright Executive Head of Education
PRESIDENT
HEAD OF COMMUNICATIONS
Debra Padgett CSci FIBMS
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EDUCATION AND TRAINING
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education@ibms.org
DEPUTY CHIEF EXECUTIVE
EXAMINATIONS
Sarah May CSci FIBMS
examinations@ibms.org
EXECUTIVE HEAD OF EDUCATION
MEMBERSHIP
Alan Wainwright CSci FIBMS
mc@ibms.org
EXECUTIVE HEAD OF MARKETING AND MEMBERSHIP
CHARTERED SCIENTIST
Lynda Rigby
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THE BIOMEDICAL SCIENTIST
chartered@ibms.org
FOLLOW THE INSTITUTE Join us on facebook.com/ biomedicalscience Follow us on Twitter @IBMScience Find us on LinkedIn
17/02/2022 09:15
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15/02/2022 12:49
NEWS In numbers
THE BIOMEDICAL SCIENTIST
7
SCIENCE NEWS
IN NUMBERS
90%
An estimated nine in 10 young teenagers in the UK are likely to have COVID-19 antibodies, new analysis suggests. The estimates, which are for children aged 12 to 15, are: Wales
While figures out at the end of January show that over 50% of people were concerned about their mental health last year – and around half also experienced stress, anxiety, low mood or depression – the majority had not sought professional help.
Since the start of the pandemic, about 8.4 million tonnes of plastic PPE waste has been generated from 193 countries.
Scotland
The figures have been calculated by the Office for National Statistics and are based on a sample of blood test results for the week beginning 3 January 2022.
2m days
Since the start of the pandemic some 2.3 million people have come forward for NHS talking therapies.
Northern Ireland
88% 90.7% 90.9% 91.7% England
MENTAL HEALTH
NHS trusts in England lost nearly two million days in staff absences due to long COVID in the first 18 months of the pandemic. MPs on the all-party parliamentary group on coronavirus estimate that more than 1.82m days were lost to healthcare workers with long COVID in the period.
P07 News In Numbers_March 2022_Biomedical Scientist.indd 7
RECYCLING
PPE
But now hundreds of tonnes of plastic PPE could be recycled as part of a new waste-reduction project that heats and compacts the plastic polypropylene into large, reusable blocks. This can provide raw materials to create new PPE products, reducing waste by around 85%.
64.6%
Two-thirds of people recently infected with the Omicron variant say they had already had COVID previously. The findings come from the large, continuing REACT study, in which 100,607 were volunteers swab-tested in January. Among the 3582 swab-positive individuals reporting whether or not they’d had previous infection, 2315 (64.6%) reported a confirmed previous infection.
17/02/2022 09:16
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7/27/21 12:03 PM 15/02/2022 12:50
NEWS Science
THE BIOMEDICAL SCIENTIST
9
SCIENCE
NEWS ARTIFICIAL INTELLIGENCE
Menstruation and vaccination Many women have reported changes to their periods after a COVID-19 vaccination. But a new observational study suggests that changes are short-lived and small, compared with natural cycle variation. The study drew on data from 3959 Americans who logged at least six consecutive cycles on a menstrual cycle tracking app. Of these, 2403 were vaccinated and the remainder acted as a control group. After accounting for other factors, the first dose of vaccine had no effect on timing of the subsequent period, while the second dose was associated with a delay of 0.45 days. Most affected were the 358 individuals who received both doses of the vaccine in the same cycle, experiencing a 2.32 day delay to their next period. In all groups, cycle lengths returned to normal by two cycles after vaccination. bit.ly/3o5WUfE
ROBOT PERFORMS LAPAROSCOPIC SURGERY WITHOUT HUMAN HELP A robot has performed laparoscopic surgery on the soft tissue of a pig without the guiding hand of a human – a significant step in robotics toward fully automated surgery on humans. The Smart Tissue Autonomous Robot (STAR) was designed by a Johns Hopkins University team. Senior author Axel Krieger, an Assistant Professor of Mechanical Engineering, said: “Our findings show that we can automate one of the most intricate and delicate tasks in surgery: the reconnection of two ends of an intestine. “The STAR performed the procedure in four animals and it produced significantly better results than humans performing the same procedure.”
The robot excelled at intestinal anastomosis – a procedure that requires a high level of repetitive motion and precision. Connecting two ends of an intestine is arguably the most challenging step in gastrointestinal surgery, requiring a surgeon to suture with high accuracy and consistency. Even the slightest hand tremor or misplaced stitch can result in a leak that could have catastrophic complications for the patient. The robot is a vision-guided system designed specifically to suture soft tissue. The current iteration advances a 2016 model that repaired a pig’s intestines accurately, but required a large incision to access the intestine and more guidance from humans. bit.ly/3H8iBmY
IMAGE: ©JOHNS HOPKINS UNIVERSITY
COVID-19
DISEASE INCIDENCE
IMAGES: ISTOCK/SHUTTERSTOCK
NEW DIAGNOSES HAVE PLUMMETED IN THE PANDEMIC New diagnoses of common chronic conditions have dramatically declined during the COVID-19 pandemic, according to a new study. Researchers in Spain analysed annual incidence rates of the main cardiovascular risk factors, chronic diseases, and some cancers in 2020, compared with data from 2017–2019. They found a reduction in newly reported diagnoses
ranging from a 36% decline for high cholesterol diagnoses, to a 50% decline in the diagnosis of pulmonary diseases, such as chronic bronchitis. Additionally, the rate of diagnosis of anxiety disorders increased by 16%, while the diagnoses of alcohol use disorder decreased by 46%. The authors note that the decline is not reflective of improved health outcomes,
P09-11 News-Science_March 2022_Biomedical Scientist.indd 9
but suggests that people are not receiving appropriate and timely health screenings that would diagnose these conditions early, when there is a greater chance of effective treatment and good health outcomes. They write that returning to the level of detection and
control of chronic diseases before the pandemic will require a substantial increase in primary care physicians and nurses; a return to face-toface visits; a reorganisation of telehealth; and the promotion of proactive care in patients who have the greatest comorbidities. bit.ly/3o3s3k0
17/02/2022 09:17
BIOMEDICAL 10 THE SCIENTIST
NEWS Science
BIOMARKERS
HOT
BLOOD MARKERS CAN PREDICT DEPRESSION IN PREGNANCY
CATS Yang the cat – the official mascot at Hexham General Hospital – could be the first ever cat to get the PDSA’s Order of Merit award, the animal equivalent of an OBE.
HOT
NIGHT When mice with cancer received chemotherapy at night time, researchers found it killed more brain tumour cells than when given in the day time.
HOT
WEARABLES Physical activity monitors, such as fitness apps and wearable activity trackers that provide direct feedback to users do help to boost activity levels in adults, finds a summary of the evidence.
Signs of inflammation in the blood can reliably predict and identify severe depression in pregnancy, reports a new study. The team’s analysis established a set of 15 biological markers found in the blood that can predict if pregnant women will experience significant depressive symptoms with 83% accuracy. The findings could give physicians a much-needed tool to identify women who may be at risk of depression and better tailor their care throughout pregnancy. Nearly one in five new mothers experience severe depression during or after pregnancy, it is reported, and an estimated 14% have suicidal thoughts. Inflammation can lead to worsening depressive symptoms, and pregnancy is a major inflammatory event. Lena Brundin, study co-author, said: “Depression isn’t just something that happens in the brain – its fingerprints are everywhere, including our blood. The ability to predict pregnancyrelated depression and its severity will be a gamechanger for protecting the health of mothers and their infants. Our findings are an important leap forward toward this goal.” The study is among the first of its kind and followed 114 volunteers throughout their pregnancies. Participants provided blood samples and underwent clinical evaluations for depressive symptoms in each trimester and the postpartum period. go.nature.com/3H9s4u3
NOT
KENT COVID-19 caused visitor numbers to halve in Kent in 2020 compared to the previous year, a report has found.
NOT
COLORECTAL CANCER A new risk score can identify the men and women under 50 who are most likely to develop a cancer of the colon or rectum, an international study shows.
Supplements taken to boost athletic performance can pose risks to the heart, according to a statement from the European Society of Cardiology.
P09-11 News-Science_March 2022_Biomedical Scientist.indd 10
IMAGES: ISTOCK/SHUTTERSTOCK
NOT
NUTRITIONAL SUPPLEMENTS
83%
THE TEAM’S ANALYSIS ESTABLISHED A SET OF 15 BIOLOGICAL MARKERS FOUND IN THE BLOOD THAT CAN PREDICT IF PREGNANT WOMEN WILL EXPERIENCE SIGNIFICANT DEPRESSIVE SYMPTOMS WITH 83% ACCURACY.
17/02/2022 09:17
NEWS Science
DIAGNOSTICS
IMAGE: ©STOYAN SMOUKOV
Lab-in-a-backpack Researchers have developed a £38 “lab-in-a-backpack” that could expand the ability of resource-poor regions to offer fast, reliable, non-invasive detection of SARS-CoV-2 – the virus that causes COVID-19. E. Emily Lin and colleagues at Queen Mary University of London are behind the new system. Efforts to bring COVID-19 vaccines to resource-poor countries are underway, but it will take two to three more years to achieve full vaccination. In the meantime, SARS-CoV-2 testing is needed to prevent spread, but many regions lack the practical and financial ability to conduct an adequate amount
P09-11 News-Science_March 2022_Biomedical Scientist.indd 11
of reliable testing. To improve COVID-19 testing options, Lin and colleagues have created a £38 lab-ina-backpack system. This system uses non-invasive saliva sampling instead of an uncomfortable nose or throat swab. It processes six samples in 90 minutes using a technique known as reverse transcription loop-mediated isothermal amplification (RT-LAMP), which has similar sensitivity to PCR testing. The cost of the chemicals needed
THE BIOMEDICAL SCIENTIST
11
to process each saliva sample is £2.62 and commercial LAMP tests cost £5.23 to £17.95 in bulk. The new standalone system is portable and can be used in settings that lack expensive infrastructure. It includes a centrifuge, named CentriDrive, that is easily constructed from recycled computer hard drives and can be powered by a rechargeable battery or hooked up to an automobile battery. It comes with straightforward instructions that can be followed with minimal training. bit.ly/3H9pcgP
17/02/2022 09:18
p12_BIO.Mar22.indd 12
15/02/2022 12:51
NEWS Technology
THE BIOMEDICAL SCIENTIST
13
TECH
NEWS BIOHIT HEALTHCARE
BRUKER
ATROPHIC GASTRITIS
DIAGNOSTICS
A clinical validation study has confirmed the high accuracy of BIOHIT Oyj’s new-generation GastroPanel test for the diagnosis of atrophic gastritis (AG) and Helicobacter pylori (Hp) infection in patients referred for gastroscopy. The test is designed for the first-line diagnosis of Hp infection and AG in patients with upper abdominal symptoms, such as dyspepsia and gastro-oesophageal reflux disease, before endoscopy. biohithealth care.co.uk
Université de Paris has installed a Bruker In Vitro Diagnostic research (IVDr) nuclear magnetic resonance (NMR) spectrometer within its MetaboParis-Santé platform. One of the most prestigious universities in France, known for its cuttingedge research in medicine and more broadly biology and health, is the first facility in the country to benefit from an IVDr instrument of this kind. MetaboParis-Santé is upheld as a national centre of excellence for metabolic analysis by NMR of human biofluids. bruker.com
CELLCENTRIC
CANCER DRUG CellCentric, a clinical-stage, private biotechnology company pioneering small molecule inhibition of p300/CBP to treat cancer, has received funding from BrightEdge, the impact venture capital fund of the American Cancer Society. The funding will be used to further progress the clinical development of its ground-breaking, targeted treatment, inobrodib (formerly known as CCS1477). Inobrodib is a first-in-class small molecule inhibitor that impacts twin regulatory proteins p300 and CBP and affects a number of established, yet elusive-to-treat oncogenes. cellcentric.com
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P13 News-Technology_March 2022_Biomedical Scientist.indd 13
rajvindergarcha@nhs.net www.bcpathology.org.uk 0121 507 5348 Clinical Biochemistry, City Hospital Dudley Road, Birmingham B18 7QH @BCPathology
BCPathology
Black Country Pathology TV News
17/02/2022 09:18
BIOMEDICAL 14 THE SCIENTIST
OPINION One-to-one
Below. Scans of healthy lungs (left) and COVID patient lungs (right).
ALTERED IMAGES
Scanning technology has identified hidden abnormalities in the lungs of long COVID patients
E
arly on in the pandemic, Professor Fergus Gleeson, Consultant Radiologist at Oxford University Hospitals NHS Foundation Trust, had the idea to use a scanning method to understand changes in lung physiology due to COVID-19. The non-invasive method of hyperpolarised xenon MRI scans has been used for some years to develop understanding of lung physiology in health and disease, and was pioneered by Professor Jim Wild and the Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS) research group at the University of Sheffield. Both Gleeson and Wild are among the research team in the EXPLAIN project – one of 19 studies into long COVID to receive £1.8 million government funding through the National Institute for Health Research, which uses hyperpolarised xenon MRI scans to look at ongoing lung damage in non-hospitalised COVID-19 patients. The project aims to improve understanding of long COVID, from diagnosis and treatment
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through to rehabilitation and recovery. Evidence has emerged in the latest pilot study from EXPLAIN, of lung abnormality in long COVID patients undetected by other scans. Participants lie in an MRI scanner and inhale one litre of xenon, which has been hyperpolarised so it can be seen using MRI. It takes only a few minutes and, because radiation exposure is not needed, can be repeated over time to see changes to the lungs. As xenon follows the pathways of oxygen when it is taken up by the lungs and can show where the abnormality lies between the airways, gas exchange membranes and capillaries in the lungs, radiologists can observe how the gas moves from the lungs into the bloodstream. A 2021 EXPLAIN study that scanned people who had been hospitalised due to COVID-19 established that they had persistent lung abnormalities several months after being discharged. Now a new EXPLAIN pilot study has investigated possible lung damage in COVID-19 patients who have not
been hospitalised but have experienced breathlessness months after a diagnosis.
Hidden impairments “Initially, we thought that there wouldn’t be any significant changes in lung gas transport, in comparison to healthy non-infected individuals, but how wrong we were,” says Dr James Grist, postdoctoral research scientist at the University of Oxford, and one of the researchers in the EXPLAIN study. “We were very surprised to see xenon gas transfer abnormalities in patients whose lungs otherwise looked healthy on conventional imaging.” Transfer of gas from the lungs to the bloodstream was “significantly impaired” in those study participants who have been diagnosed with long COVID, seen in long COVID clinics and who have had normal computerised tomography scans. “The extent of the changes in gas transfer between healthy participants and those who have had a COVID-19 infection was really surprising,” Grist says. “When we got our images from
17/02/2022 09:19
OPINION One-to-one
THE BIOMEDICAL SCIENTIST
15
correlation between our imaging results and the persistent breathlessness that some patients experience. ”
Future research
the first patient, I thought I had really messed up the data acquisition. However, we had a volunteer lined up afterwards and their images were fine. The differences really are that stark.”
IMAGES: NIHR OXFORD BIOMEDICAL RESEARCH CENTRE (BRC)/GETTY
Other infections The pilot study had 36 participants – all recruited from the Oxford Post-COVID Assessment clinic – including people diagnosed with long COVID in clinics, those who had been hospitalised with COVID more than three months ago and those who had not been experiencing long COVID. All had normal CT scans. The full EXPLAIN study will recruit about 400 participants, some of whom will have had breathlessness, some who have had COVID-19 but no symptoms, some with no breathlessness but other long COVID symptoms – such as “brain fog”, and some who have never had long COVID. “The next steps are to scan a lot more patients,” Grist says. The research team is running a multicentre study with the Universities of Sheffield, Cardiff and Manchester with
P14-15 Opinion-OTO_March 2022_Biomedical Scientist.indd 15
multiple cohorts of patients to really “dig down into the details of what we are seeing here in our initial study”, Grist says. “We are currently assessing the
JAMES GRIST 2011–2014 BSc Physics with medical physics, University College London 2010–2014 Dialysis auxiliary nurse specialist, University Hospital Birmingham 2013–2014 Research assistant in acousto-optics, University College London 2014–2018 PhD, multi-nuclear MRI, including carbon and sodium, University of Cambridge 2018–2020 Research fellow, University of Birmingham 2020–present Research Fellow, University of Oxford and Nicholas Kurti Junior Research Fellow, University of Oxford.
The next important questions to answer include how many patients with long COVID will have abnormal scans, as well as the significance of the abnormalities detected, their causes and longer-term consequences. Understanding the mechanisms that resulted in these symptoms should lead to the development of more effective treatments for long COVID, the researchers say. “We really need to perform these studies to see how the lung responds to infection after other respiratory illnesses, such as influenza, to understand whether these changes are unique to COVID-19 or not,” Grist continues. “We’ve love to expand this study to patients who have had other seasonal respiratory infections too.” Grist’s career has included being in the team to conduct the first human studies using the imaging technique hyperpolarised carbon-13 MRI to better understand multiple sclerosis, using machine learning to predict survival in childhood brain tumours and hyperpolarised xenon MRI in long COVID. “It really has been a pleasure to work with fantastic colleagues, both staff and students, and I am really proud of our accomplishments. Science really is done best in a team,” he says. “I cannot put my current career success down to anything except that I have been able to work with some really talented scientists in the right place at the right time.” The imaging techniques are ground breaking, and, he concludes, “have the potential to both push forward our knowledge of physiology, advance radiology practice, and really make a difference in the lives of patients across a wide spectrum of the healthcare system”.
17/02/2022 09:19
BIOMEDICAL 16 THE SCIENTIST
OPINION The big question
THE BIG QUESTION In 1922 a motion was passed to officially admit female members to the IBMS. To mark the 100-year anniversary of the landmark moment: THIS MONTH WE ASK
“What should be done to improve the biomedical science profession for women?”
P16-17 Big Question_March 2022_Biomedical Scientist.indd 16
17/02/2022 09:20
OPINION The big question
Zonya D Jeffrey
Alison Geddis
Senior Biomedical ScientistTraining Officer UKHSA at Manchester University NHS Foundation Trust
Past President Institute of Biomedical Science
IMAGE: SHUTTERSTOCK
W
hilst growing up, most of the scientists I came across were male. Especially on TV and in the media, where I found it was rare to see women who were scientists. These characters I saw week by week were my only reference point to achieving my career goal of becoming a scientist. Whist attending laboratories during my school work experience, careers events and university placement, I was surprised to see these women in their places of work. I never saw this reflected outside of the laboratories in the real world. As access to TV, film and social media has developed, I think now is the perfect opportunity to use these platforms to publicise women in biomedical science. We should be informing young and teenage girls at schools, via the curriculum, that women have always achieved success in science – from Marie Curie to Katherine Johnson. We need to use the voices of the many thousands of biomedical scientists across the globe to be active in informing both the next generation of young women and their parents about the potential fulfilling careers achieved by women working in biomedical science. This is a pivotal opportunity that should not be missed. Then we can continue to provide positive role models for the future generations of women aspiring to work in the field of biomedical science and contribute to producing a gender-balanced and diverse workforce.
P16-17 Big Question_March 2022_Biomedical Scientist.indd 17
O
ver the last 30 years there has been a remarkable change to the demographic of the profession. When I was recruited, it was a very male-dominated profession with the majority of managers being male. I am very happy that this is now not the case. There is of course more work to be done to encourage and support women in the biomedical science profession. But, at one stage, if you had asked me about a flexible, agile, supportive profession for women to enter, I may have suggested nursing. Now I would wholeheartedly recommend biomedical science. The profession has so much to offer regarding work–life balance, educational opportunities, a discipline to suit each individual and, very importantly, a clearly defined career structure. We need to promote the diverse routes available to join the biomedical science profession, alongside the amazing career prospects for women when they get there. This is the moment to highlight to young women that they can have flexible working, have their families, be a great mother, continue their studies and reach the top of their profession. During my time as President my passion was to provide mentoring and leadership for biomedical scientists, which I successfully implemented. The profession should take this opportunity to provide mentors and leaders to support young women who are entering the biomedical science profession today with their career choices and educational needs to ensure the profession is in safe hands for the future.
THE BIOMEDICAL SCIENTIST
17
Tahmina Hussain Lecturer in Biomedical Science University of Salford
F
rom a personal perspective, and coming from an ethnic minority group myself, I have faced my own struggles due to lack of confidence and “imposter syndrome”; it is not the norm in my culture for women to balance a career with family life. Being the first female in my family to break down these barriers and gender stereotypes, I hope I have now paved the way for the younger female generation and inspired and motivated them to do the same. It’s extremely important to help younger girls recognise their talents and encourage them to develop their knowledge, skills and career progression. Increasing flexibility within the workplace can also help with retention of highly skilled women in the science workforce. Having more female role models continuing to do outreach work giving insights into the scientific profession will inspire younger girls to pursue a career in science. I know I still have a long way to go, but 10 years ago I would never have believed I would have made it this far. The woman who encouraged me throughout my career journey is my mum – without her continuous support I wouldn’t be where I am today. I hope I can do the same for my little girl one day. My advice to women starting out in their careers is – you can be anything you want to be, there may be failures along the way but learning from those experiences will build who you are.
17/02/2022 09:20
BIOMEDICAL 18 THE SCIENTIST
SCIENCE Cover feature
HOW LONG CAN WE LIVE? MEDICAL INTERVENTIONS AND LIFESPAN
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SCIENCE Cover feature
THE BIOMEDICAL SCIENTIST
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It has been 25 years since Jeanne Calment, the oldest person to have ever lived, passed away. In the decades since, no one has come close to her 122 years. Here we investigate whether research projects and advances in medicine can increase lifespan indefinitely, or if we have hit the limit.
PHOTOGRAPHY: RICHARD GLEED
W
hen Jeanne Calment was born in 1875 in France, the life expectancy for a baby girl in a relatively advanced country was around 45 years old, and perhaps another 15 years or so if she made it through childhood and giving birth to her own infants. In the event, Calment far exceeded the expectancy and made it to her 122nd birthday – she still holds the record for the longest-lived person and remains an outlier among centenarians – her closest rivals managing just 119 years (though at the time of writing one of those, Kane Tanaka in Japan, is still clocking up the days, weeks and months). By the time Calment died in 1997, much of the world had changed beyond recognition, and the same life expectancy figure for a female, from birth, had soared to just over 80 years. Another 25 years later, the average life expectancy for a French woman is more like 85, with men a little bit behind. Back in 1875, few people made it to their 80s and centenarians were more or less mythical figures. But here in 2020, official estimates put the number of centenarians
in the UK alone at around 15,000, with a global count of anywhere between 500,000 and a million. The projected figure for 2100 is put at 20 million to 25 million. The recent surge in centenarian numbers reflects the spike in birth rates in the years immediately following the end of World War One, but the more influential factors behind the trend for greater longevity are of course vastly improved living standards and the extraordinary advances made in health and medicine during the 20th century and since. This rush of progress has shown that controlling environmental factors and addressing key physiological aspects, from fighting simple infections to conducting
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complex organ transfers, can significantly extended the human lifespan. We know it can be done, which now raises the more relevant question: just how far can the human lifespan be extended? Given that nobody in more than two decades since Jeanne Calment’s death has exceeded her milestone of 122 years, we may already have seen the natural limit to what can be achieved. But ongoing advances in research and our understanding of what triggers the events that unfold during the ageing process may also expand the horizon of possibility.
What is ageing? Some experts argue that ageing is best thought of as a disease in itself, the jumping-off point for all the other conditions that we associate with ageing, such as cancer, atherosclerosis, diabetes, dementia, osteoporosis, macular degeneration and so on. Perhaps it is better to understand it is as an agglomeration of interrelated and seemingly inevitable genetic and biological processes that upset the careful physiological balance of an organism such as the human body, limiting its function, leaving it vulnerable to other internal and external forces, and leading to further decline.
17/02/2022 09:21
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SCIENCE Cover feature
“The many research projects promise to unlock further secrets of ageing” Many of these processes are focused on the reproduction of cells. One of the key factors here is the genetic damage that gradually accumulates as time goes on and with each division of the cells. The DNA contained in the old cells should copy over perfectly to the new cells, but it doesn’t, it mutates, and to deal with this the body mobilises a DNA repair system that utilises proteins and enzymes to control any wayward replication. All well and good, but excessive levels of these molecules can be harmful, leading to the depletion of other substances crucial to
controlling DNA and cell replication, which allows mutations to proliferate. Related to this, the number of dead or senescent cells in our bodies rises as we get older, and these create an inflammatory response. The immune system is tasked with flushing these cells out, but it too begins to degrade as the body ages and has to work harder and harder to fight off all the other encroaching threats let alone eliminate the senescent cells. As senescent cells accumulate further, the
FAST FACTS: HOW LONG CAN WE LIVE?
+20m
15k Centenarians in the UK in 2020
21
inflammation intensifies, triggering all sorts of tissue damage, from skin wrinkles to hardened arteries. Another key cellular process linked to ageing is telomere shortening. Telomeres are part of the chromosome that carries no genetic information. In most cells, telomeres are gradually eroded with each replication. This is problematic because they help to shield the DNA information, but without that protection the DNA is left open to degradation. Yet another factor is metabolic decline, when the body becomes less efficient at processing energy, which is associated with changes in body composition and reduced levels of key hormones. Unfolded proteins are also linked to the ageing process: the function of each protein is often determined by its unique shape, but if that shape is compromised – that is, it unfolds – it cannot carry out its vital work within the cell, and as a consequence the cell malfunctions. Research suggests this process is related to various age-related diseases, and particularly those centred on the brain and nervous system, such as Alzheimer’s and Parkinson’s.
Research projects
Projected centenarians by 2100
Centenarians globally in 2020
21 At 115, Charlotte Hughes is the longestlived person in the UK
+500k
THE BIOMEDICAL SCIENTIST
The 21 longest-lived people in the UK are all women
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113 At 113, Henry Allingham is the longest-lived man in the UK
Of course, this is just a simplified snapshot of the many complicated, interwoven processes at work during ageing. But the many research projects currently investigating cell division and DNA replication promise to unlock further secrets of ageing. For example, proteins are the subject of some of the most recent published research on the causes of ageing. A team at the University of Edinburgh looked at the results of genetic information on hundreds of thousands of people who had taken part in major studies on ageing. From the data on more than 800 proteins, they identified two that had an especially marked impact across all the measures
17/02/2022 11:27
SCIENCE Cover feature
of ageing. High levels of the first of these proteins, apolipoprotein(a) (LPA), were seen to raise the risk of atherosclerosis, while the second, vascular cell adhesion molecule 1 (VCAM1), which helps the immune response and blood clotting, could have an impact on cognition. Appropriate drugs to combat high levels of these proteins have the potential to extend lifespans. Other research has shown that by deleting senescent cells the lifespans of mice could be lengthened by up to 25%. Meanwhile, the thinking on telomere shortening is that with the careful application of the enzyme telomarase, the telomeres needn’t shorten at all and that as well as preventing cell destruction it might even rejuvenate damaged tissue – care is needed, though, as it’s the same enzyme that allows cancer cells to divide endlessly without breaking down. Even these few strands of current research demonstrate that as our understanding of the mechanisms of ageing improve, so too does the potential for tweaking them, adjusting them, and slowing them down. It’s not hugely different to the previous medical advances that have increased human lifespans, just on a much finer and intricate scale, where the secrets may be harder won but promise even greater rewards.
Natural constraints So who is to say that if we could address the overall process of ageing and its various sub-routines with effective, targeted drugs and other therapies, while engineering the lifestyle and environmental factors (poverty, stress, pollution, mental health, bad food and
“With millions set to become centenarians in the years to come, the 122 years achieved by Jeanne Calment will become more of a routine”
so on) to be as benign as possible, that the human lifespan couldn’t extend far beyond what we see at the moment? One group of naysayers from the Albert Einstein College of Medicine in New York published a much-discussed paper in October 2016 that argued the average human lifespan was unlikely to exceed much more than 115 years. They looked at global data on life expectancy and population trends from 40 countries since 1900 and concluded “our results strongly suggest that the maximum lifespan of humans is fixed and subject to natural constraints”. While some experts in the field supported their findings, others were less charitable, criticising the methods used and the assumptions made. The titles of the follow-up briefing papers tell their own stories: “Questionable evidence for a limit to human lifespan” and “Many possible maximum lifespan trajectories”. While the human body appears to have a degree of built-in obsolescence, with everything slowing down under the weight of internal stresses and
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IMAGE: ALAMY
BIOMEDICAL 22 THE SCIENTIST
external pressures, the latest research suggests that, as with any machine, a regime of proper care and maintenance, a replacement part here and there, and an injection of super new lubricating fluid, it could run for much longer. It’s a comforting thought that with the right interventions we could look forward to a longer life and an expanded human experience.
Already buckling But if we accept the notion that human life can be extended even further, we also have to confront the question of the quality of life. Is extending human lifespans desirable when there is already so much pressure on the planet’s natural resources and economic systems, when healthcare provision is already buckling under the weight of an ageing population’s multiple morbidities? Would it not be better to concentrate on improving the quality of life of the “normal” age range rather than attempting to stretch what is feasible? The likely answer is that by addressing the first, by continuing to focus on the fundamental mechanisms of ageing and the related diseases, such as cancer and heart disease, the second will come naturally, and with many millions of people set to become centenarians in the years to come, the 122 years achieved by Jeanne Calment will become more of a routine than an exception.
17/02/2022 09:22
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10/02/2022 15/02/2022 10:51 15:16
SCIENCE Misinformation
THE BIOMEDICAL SCIENTIST
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ENGAGING WITH THE ANTI-VAX MOVEMENT Lead Biomedical Scientist Jonathan M Evans argues that we need to get better at engaging with anti-vaxxers for our own future benefit.
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W
ho doesn’t love hearing about a good conspiracy theory; from the grassy knoll to Q-anon or, my favourite, the flat earthers? In my experience, conspiracy theories always have a grain of truth and around these grains are the fantastical claims that commonly don’t stand up to critical analysis. I’ve experienced this first-hand on social media whilst
discussing laboratory testing and acknowledging that false positives do occur with PCR testing. It led to a cascade of logic that defied belief and ultimately a ridiculous conclusion that included COVID being a hoax.
There are many subgroups The COVID vaccine should be the crown jewel in our SARS-CoV-2 story; our D-Day – the defining moment that changed the course of the war against this coronaviridae. Instead, it could be the
17/02/2022 09:22
BIOMEDICAL 26 THE SCIENTIST
SCIENCE Misinformation
IMAGES: SHUTTERSTOCK/ISTOCK
“As scientists, we are inherently rational people who like data and accept what the data indicate”
battleground upon which all our responses against emerging pathogen outbreaks are fought. The new social media-driven world we live in isn’t going anywhere and whilst we may just be emerging from this coronavirus pandemic and probably think the chances of another pandemic in our lifetimes is now remote, it actually has done little to reduce the risk of major antigenic shift and an influenza pandemic. Vaccination is likely to be key in our armoury in managing that pandemic, or others that may appear, and if the anti-vax community continues to grow, we are only going to have further battles along the vaccination frontline. To me it’s quite easy for anti-vaxxers to be lazily grouped together, however, within the community there are many subgroups – too many to list here. As scientists I believe we are inherently rational people who like data and normally accept what the data indicate. We can see the obvious benefits of the vaccine, and the infinitesimally small risks. There are extreme anti-vaxxers who believe the 5G myth, that Bill Gates is at the centre of all of it and who are arguably anti-establishment contrarians who we are never likely to win over and I
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think we have to accept that. Maybe we even have tolerate their views if we are all to live in a civil society, where people can have a different opinion, however ludicrous it may seem to us.
The need to engage There are sports stars and athletes who are meticulous on a daily basis as to what they put in their bodies so that they can achieve peak performance. As we have no desire to follow their daily regimented routine to achieve exceptional performance, maybe we shouldn’t follow their lead or worry about their views on vaccinations. However the “swing voter” is somebody we need certainly to engage with and we need to have better stories, not just data, to counter their immoderate views. We must also encourage them to change their positions without feeling the need to gloat that we were correct, or they will only become in entrenched in their views. Some of the more sensible question around vaccine safety involved querying the time it takes for vaccines to be developed. Yes, it normally takes around eight years to develop a vaccine, but we’ve probably had more than eight times the normal investment and resources looking into COVID vaccines. It’s not that it normally takes eight years to “grow” a vaccine, but eight years of normal human time and ingenuity when a pandemic isn’t there to focus the mind and money.
There was a study in 2018 that highlighted how false news spreads quicker and further than truthful news. This of course helps fuel anti-vaccines myths, which in turn makes the falsehood more visible and people more likely to interact and convert. We have to accept this and counteract it, otherwise when other pathogens emerge we may not be able to encourage enough people to get vaccinated.
Open the door We have to accept that, unlike what we believe to be good scientific principles, facts alone will not change many antivaxxers’ views. We must continue to open the door to truths, but they must walk through it, we cannot push them through. And as the vaccine continues to age, continues to be used with boosters, and the 5G apocalypse predicted doesn’t happen, Bill Gates doesn’t become the world overlord and the obvious lack of increase in whatever myriad illnesses it has been linked to, whilst we also continue to see decreasing hospitalisations and thankfully less mortality linked to COVID, perhaps the swing voters will slowly walk through the door and we should be there with a warm greeting and not a smirk or an I-told-you-so. Jonathan M Evans is Lead Biomedical Scientist and Operational Manager at the Virology Specialist Centre, Public Health Wales
17/02/2022 09:22
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BIOMEDICAL 28 THE SCIENTIST
SCIENCE Parkinson’s
“A humane physician in a busy practice who cared for the poor and mentally ill, but also a talented writer who added substantially to the medical literature of his time”
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SCIENCE Parkinson’s
THE BIOMEDICAL SCIENTIST
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Left. Neurons derived from human neural stem cells. The green staining highlights the typical appearance of differentiated nerve cells. Below. James Parkinson at 1 Hoxton Sq.
MEDICAL EPONYMS PT. 8
PARKINSON’S DISEASE IMAGE: ©YIRUI SUN/WELLCOME COLLECTION
J
ames Parkinson (1755–1824) was an English physician who in 1817 published an excellent clinical essay of six persons with a specific neurological condition, titled “the shaking palsy”, which he called paralysis agitans. The importance of this eloquent and detailed clinical description was well received and included in works by Marshall Hall (1841) and Todd (1855), but little new was added. Global interest was more fully realised when an article was published in 1912 by LG Rowntree in the Johns Hopkins Hospital bulletin. In his introduction, Parkinson succinctly defines the condition: “Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from walking
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to a running pace: the senses and intellects being uninjured.” Almost 60 years after the classic Parkinson essay, Jean-Martin Charcot, the distinguished French neurologist, added rigidity to the list of symptoms and coined the syndrome as Parkinson’s disease (PD). James Parkinson was an English physician, son of John, a London
apothecary and surgeon, and mother Mary, who lived in Shoreditch, London. James was the oldest of three siblings. From 1775 he studied at the London Hospital Medical College and was then apprenticed to his father, and in 1784 he was approved as a surgeon by the City of London. He was married in 1783 and soon after took over his father’s practice in Hoxton Square, Shoreditch. James produced a number of other significant clinical reports and in 1805 he published a comprehensive clinical account of gout – a condition from which both he and his father suffered. Then in 1812 with his son John he reported one of the earliest clinical descriptions of appendicitis and showed furthermore that a perforated appendix was a cause of death. Parkinson was a political activist and an outspoken critic of the William Pitt the Younger Tory government and produced
IMAGES: COURTESY OF THE WELLCOME COLLECTION
This is the eighth in a series of short biographies of persons whose names are directly used for diseases, conditions or syndromes familiar to those in clinical pathology laboratories.
17/02/2022 09:24
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15/02/2022 15:19
SCIENCE Parkinson’s
THE BIOMEDICAL SCIENTIST
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IMAGES: WELLCOME COLLECTION
Left. Gerald Van Swieten Below. John Hunter.
pamphlets supporting general social reform, notably for the underprivileged, and the improvement of conditions in the asylums for the insane. He published medical doctrines to improve the health and welfare of people, directed not only to the medical community but also to the common people. He had a keen interest in geology and palaeontology, notably fossils, of which several were named after him. He founded the London Geological Society in 1807 and published many significant illustrated contributions. He was a religious man and believed that creation and extinction were processes guided by the hand of God. US neurologist Melvin Yahr, who was involved in early trials of levodopa treatment for PD, paid tribute to Parkinson as a humane physician in a busy practice who cared for the poor and mentally ill, but also a talented writer who added substantially to the medical literature of his time. James Parkinson died following a stroke in April 1824 and was buried and his name commemorated at St Leonards Church, Shoreditch.
The shaking palsy Advances in neurology have been briefly reviewed recently in this series for The
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Biomedical Scientist on Alzheimer’s disease and Duchenne muscular dystrophy, which will provide a useful background. Tremor, although a classical feature of PD, is a non-specific finding and had been observed from ancient times, notably by the Greek physician Galen between 169 and 180 CE, when he described two forms of tremor-trembling and palpitation. Parkinson credits Sylvius de la Boe with description of the types of tremors in 1680, and in 1749 the Dutch physician Gerald Van Swieten proposed that a tremor that persists during bedrest results from irritation with intermittent and rhythmic effects on nerve centres and is a convulsive process – tremor coactus. Alternatively, the tremor occurring during voluntary movement is a failure of stimulation of the nervous system as a paralytic tremor – tremor a debilitate. The Scottish surgeon John Hunter may have encouraged Parkinson to consider the difference between tremor with motion and tremor at rest after attending his lectures on tremor and paralysis at the Royal College of Surgeons, London in 1785. Parkinson’s six cases were all men, aged between 50 and 65 years and their symptoms
varied in their severity. Parkinson identifies the cardinal features of PD with tremor at rest, mostly affecting the hands and arms, a tendency to develop a flexed posture and a festinating gait, two men also displayed difficulties in the articulation of speech. He differentiates PD tremor from apoplexy, epilepsy, palsy, and reactions to fright or anger displays. With the limited knowledge of the brain and neuropathology Parkinson could only suggest remedial (undefined) treatment, bleeding and use of vesicatories and subsequent drainage. Later Charcot advocated vibratory therapy and designed electrically driven vibrating chairs. Other therapies included light exercise, hydrotherapy or electrical stimulation to affected muscles.
Parkinson’s legacy This stimulated research to understand the pathophysiology of PD, other symptoms and attempts to establish the cause and its treatment. Additional symptoms observed were made by French neurologists Armand Trousseau (1868), Jean-Martin Charcot (1877) and in 1888 by British neurologist William Gowers, who also observed that 15% of his PD patients had affected relatives. Charcot advocated the use the palliative effects of the plant alkaloid derivative hyoscyamine, which has anticholinergic properties. In 1895, French neurologist Edouard Brissaud noted the weakened voice without intonation and “psychic disorders”. Most significantly he suggested that PD may be due to a lesion in the locus niger – a quite remarkable prediction for that time. In 1912 Friedrich Lewy, German-born US Neurologist first described the concentric inclusions of fibrillar aggregates in the cytoplasm of neurons of the substantia nigra in the brain at autopsy, which are now regarded as the histological hallmark found in PD and a marker of
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SCIENCE Parkinson’s
THE BIOMEDICAL SCIENTIST
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Left and below. Velvet bean – a vigorous annual climbing legume originally from southern China and eastern India.
neuronal degeneration. ion. Following an influenzanzalike epidemic during g 1916–17 post-encephalitis symptoms ymptoms in some had some features of PD but with behavioural, ocular and motor problems and the condition termed ermed Parkinsonism. In 1919, Russian neuropathologist Konstantin Tretiakoff off reported his findings on the brains of six persons with PD and three with post-encephalitic Parkinsonism. He found a marked loss of pigmented neurons in the substantia nigra and fewer pigmented neurons in the zone ventrales du locus niger and proposed this was associated with changes in muscle tone in PD. During the 1950s, evidence was shown to confirm and further this hypothesis.
IMAGES: ISTOCK/SHUTTERSTOCK
Dopamine and levodopa In 1957, Katharine Montagu, a Londonbased researcher, and independently a team at the University of Lund led by the Swedish pharmacologist Arvid Carlsson, identified the presence of dopamine in the human brain. Carlsson developed a sensitive fluorometric method to estimate the amount of dopamine in brain tissues and found high levels in the basal ganglia vital in motor control. Later he used reserpine to block uptake and storage of dopamine in animals and was able to restore motor function by i.v. levodopa, the precursor of dopamine. Research by his students Ake Bertler, Evald Rosengren and Sano in Japan in 1958 demonstrated the highest concentration of dopamine was in the corpus striatum. Carlsson was awarded a share of the 2000 Nobel prize in Physiology or Medicine for his dopamine research. In 1960, research studies at the University of Vienna by Oleh Hornykiewicz and Herbert Elringer found reduced levels of striatal dopamine in a small study of post-mortem brains in PD and Parkinsonism. A year later Hornykiewicz and Walther Birkmayer conducted clinical trials of the dopamine precursor levodopa
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“Intrigu “Intriguingly, g p has been levodopa f found to be present se in the seeds of the velve velvet bean” improving mobility but with short-lived effects and dosage limited due to gastrointestinal side effects. Later successful clinical trials with oral levodopa took place, led notably by the Greek-born US neurologist George Cotzias at Long Island, New York and also by US neurologist Melvyn Yahr at Columbia University, New York, reported in 1969. It is intriguing that levodopa has been found to be present in an ancient Indian herbal ayurveda medicine in the seeds of the velvet bean and texts describe its use in neurological disorders. In 1967, Yahr and Margaret Hoene published a scale 1–5 of the progression of PD; stage 1 equates to mild, ranging to 5 when the patient is wheelchair bound. The scale has been judged as practical and allows an assessment of general functional level, motor impairment and severity.
Surgery in PD Whilst surgical approaches to PD were pioneered in the early 20th century, these were mainly unsuccessful until US neurosurgeon Russell Meyers operated on the basal ganglia with caudate resection and in 1942 reported an improvement in rigidity, tremor and walking without serious lateral damage. Ten years later, US neurosurgeon Irving Cooper accidentally damaged the anterior choroid artery during surgery for a PD patient; remarkably this stopped his tremor and rigidity. However, with inconsistent results and some controversy he introduced more successful cryosurgical
procedures for movement disorders with the substantia nigra the preferred target.
Genetics in PD In 1986, US neurologist Larry Golde investigated a family with six PD patients living in Contursi, a village and commune in the Campania region of south-west Italy. Working with Guiseppe Dilorio at the University of Naples he undertook further studies of many more descendants. It was found that of 400 members at least 61 were known to have PD. Studies by Mihael Polymeropoulos and colleagues in 1996 with samples from some members of the PD descendants and US relatives using a genome scan identified genetic marker linkage to chromosome 4q21-q23. It was also noted that there was an early onset of PD with a mean age of 46.5 years with a rapid course from onset to death of 9.7 years. In 1997 Polymeropoulos and his team identified a mutation in the α-synuclein gene, which codes for a presynaptic protein involved in neuronal plasticity in the Contursi kindred and three unrelated Greek families with autosomal dominant PD.
Current perspectives Epidemiology PD is one of the most common neurodegenerative disorders, classified as a movement disorder resulting in a progressive disability without an existing cure. Around seven million people worldwide are affected and about 1% of persons aged 60 or over. About 5% present with early onset PD between 20 and 50 years of age and a similar percentage have familial causes. There is evidence that PD is 1.5 times as common in males. Diagnosis This is clinical and based on the presence of two or three of James
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BIOMEDICAL 34 THE SCIENTIST
SCIENCE Parkinson’s
Right. Lowered brain activity in Parkinson's disease. Single-photon emission computed tomography (SPECT) DaTSCAN images.
Parkinson’s original signs – resting tremor, which may be present in 70% of PD, rigidity and bradykinesia and postural instability is a recent cardinal addition. Other non-motor symptoms include sleep disturbances, anosmia, constipation, depression and forgetfulness. Pathology The main neuropathological features are α-synuclein containing Lewy bodies and loss of pigmented dopaminergic neurons in the substantia nigra so restricting voluntary movements with characteristic motor impairment. Most patients have sporadic PD, which is likely caused by a combination of genetic and environmental factors. In 2003, German anatomist Heiko Braak and colleagues proposed that sporadic PD is caused by a pathogen entering the digestive tract to initiate the formation of Lewy bodies to progress from the enteric neural route to the peripheral and central nervous systems. There is much clinical and scientific evidence to support this hypothesis. Possible environmental risk factors include use of pesticides, herbicides and living in proximity to industrial plants or quarries. Imaging MRI may be used in differential diagnosis of PD with cerebrovascular disease and space-occupying lesions. Isotope SPEC tomography may be used to exclude other conditions, such as multiple system atrophy and progressive supranuclear palsy.
IMAGES: SCIENCE PHOTO LIBRARY/SHUTTERSTOCK
Laboratory investigations A reduced activity of CSF caeruloplasmin contributes to iron deposition in the central nervous system in PD. It has been proposed that oxidised caeruloplasmin may act as a marker for oxidative damage. A number of other CSF markers associated with PD include Aβ1-42 & P-tau181 and low levels suggest postural instability and gait disturbances will develop.
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“There is a clear need to develop therapies with long-term benefits that eliminate dyskinesia and stop the progression of PD” Treatment and management A combination of levodopa and carbidopa is regarded as the gold standard of treatment. Carbidopa is a peripheral decarboxylase inhibitor and blocks the conversion of levodopa to dopamine outside the CNS and thus inhibits unwanted side effects of levodopa and also inhibits T cell responses in PD. However, long-term use is associated with motor fluctuations and dyskinesias. Dopamine agonists, monoamine oxidase inhibitors or catechol methyl inhibitors may help to address these symptoms. Deep brain stimulation was first approved for use in PD in 1997 and is suitable for up to 10% of PD patients, particularly those no longer well controlled with levodopa medication and experiencing dyskinesia. Fine electrodes are inserted into the subthalamic nucleus or globus pallidus interna, guided by MRI, and an impulse generator inserted under the collarbone to send electrical impulse to those specific motor areas. This can lead to improved control of motor symptoms including tremor, speed of movement and dyskinesia. A number of new treatments in
medication and gene therapy were well reviewed by Robert Hauser in 2011 entitled Surfing the PD pipeline, for the interested reader.
Prognosis Before the introduction of levodopa, severe disability or death occurred in 25% of PD patients within five years. With levodopa treatment the mortality rate fell by 50% and survival time increased. However, it is considered that this improvement is due to symptomatic effects with no clear evidence that levodopa halts the progression of PD.
Concluding comments James Parkinson gave a clear description of PD over 200 years ago. Whilst much has been learnt, particularly with the introduction of levodopa treatment, the cause remains unknown. There is a clear need to develop therapies with sustained and long-term benefits that eliminate dyskinesia and stop the progression of PD for a more improved lifestyle. Stephen Clarke is a retired IBMS fellow. To read this article with full references, visit thebiomedicalscientist.net
17/02/2022 09:25
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www.clinisysgroup.com p35_BIO.Mar22.indd 35 IBMS_CliniSys_Print_255x185_v1.indd 1
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BIOMEDICAL 38 THE SCIENTIST
SCIENCE Blood bikes
BLOOD BIKES THE RIDE OF YOUR LIFE
John Stepney, Chairman of the Nationwide Association of Blood Bikes (NABB), outlines the charity’s work and achievements and some of the challenges faced over recent years.
M
any of you will already be familiar with Blood Bikes, but for some, the topic may be new. Blood Bikes are run by unpaid volunteers and provide a professional rapid response courier service, free of charge to the NHS and HSE. Each regional Blood Bike group is a registered charity in its own right, operating to defined Service Level Agreements with their client hospitals. The Blood Bike “industry” can trace its roots to the early 1960s, when Margaret Ryerson set up a group of volunteer bikers to respond to hospital requests for urgent transport in support of patient treatment. Blood Bike groups receive no government funding, so each group is responsible for fundraising to meet its running
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costs. The service provided adheres to standards as defined by the Medicines and Healthcare products Regulatory Agency (MHRA), The National Institute for Health and Care Excellence (NICE), and all road traffic and transport legislation. The 600+ hospitals and laboratories that currently use Blood Bikes will typically request their local group to move blood, platelets, plasma, tissue samples, human donor milk, pharmaceuticals and surgical instruments, which are very often for a specific patient. These requests can vary in urgency from “sometime today will do”, to a “blue light” response, provided by some groups, where a patient’s outcome may depend on rapid treatment. Two examples of the latter, from different hospitals, are: A patient with septic arthritis was in theatre. Samples were taken and the patient was held under
anaesthetic while the samples were transferred by blood bike under blue light for testing. Further surgery was indicated to ensure complete removal of infected tissue, an appropriate antibiotic was administered and the patient was moved to recovery. A patient was a critically ill, young lady having undergone a placental abruption in her home, which resulted in her baby being delivered by Caesarean section at the road side. The patient continued to bleed throughout the day with many blood products being used. Despite our routine runs being used to restock products she continued to use products quicker than we could replenish. Having run out of a frozen component that is rich in fibrinogen we asked Blood Bikes to move RiaSTAP (a fibrinogen concentrate) urgently as a blue light. This patient received more than 50 blood components. However, Blood Bikes has now been
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SCIENCE Blood bikes
IMAGES: NABB/GWAA
“NABB successfully campaigned for parity with other emergency services” forced to terminate the provision of a blue light service and it’s not clear which organisation will step in to support scenarios such as the ones above. Overall, the service provided by the NABB member groups is delivered using a combined fleet of more than 400 charityowned and dedicated vehicles (primarily motorcycles). There are approximately 4500 appropriately trained volunteers involved in delivering the service, which is made up of riders, drivers, fundraisers, despatch controllers and admin support. To date, 15 of the NABB member groups have been awarded the prestigious Queen’s Award for Voluntary Services (QAVS). NABB itself was humbled to have been voted the winner of the 2021 Third Sector Charity Awards in the category – small charity, big achiever.
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What does NABB do? NABB is a registered charity representing the collective interests of 36 independently registered Blood Bike charities across the UK and Ireland at the national level. NABB is also an associate member of the NHS Confederation. In 2008, the five extant UK Blood Bike groups got together to explore opportunities to identify best practice, to consider an active programme to roll out the concept across the country and to gain parity with the more traditional emergency services. Thus, NABB was born. Its remit was to drive the expansion of a Blood Bike service across the UK by inspiring local groups of advanced qualified motorcyclists to set up charities and adopt a defined set of professional operating standards. Over the next decade, the success of the programme was outstanding. In 2008 the five groups, operating mainly in the south of England,
THE BIOMEDICAL SCIENTIST
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responded to around 15,000 requests; by 2020 Blood Bikes operated across the whole of the UK and Ireland, collectively responding to more than 166,000 requests from hospitals, hospices and air ambulance organisations. Over the last decade, NABB has successfully campaigned on behalf of its members for government recognition and parity with other emergency services, which enabled its members to recover VAT (effective 2015) and the alignment of road tax with other emergency services vehicles (effective 2020). The vehicle excise duty alignment resulted in all charity-dedicated vehicles now being considered by the DVLA as NHS vehicles.
The pandemic The effects of the COVID pandemic were a double whammy for Blood Bikes. Firstly, the social distancing requirements effectively shut down the primary fund-raising avenues, such as giving
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BIOMEDICAL 40 THE SCIENTIST
SCIENCE Blood bikes
talks, or holding collection buckets outside supermarkets and sports grounds. For many of the groups this was a cliff-edge event for their revenue stream. Secondly, although there was a significant reduction in the number of transport requests normally associated with elective surgery, there was a greater increase in COVID-related transport. For example, transporting COVID swabs to labs for testing, PPE equipment to community hospitals and clinics and the home delivery of chemotherapy drugs for patients who would have otherwise faced a significant risk, with their suppressed immune system, when travelling to hospital for their treatment.
Our evolution Air ambulance: The Blood Bike charities services have evolved in response to the ever-changing health sector landscape. One example is the “Blood on Board” concept, that since 2013 has seen the rollout of the air ambulance capability to perform transfusions at the scene of an incident. Blood Bikes are now the primary transport provider for blood products for emergency transfusion, required by 17 air ambulance trusts across the country, delivering more than 6,000 consignments annually. Hub and spoke: Another example is the NHS transition from multiple local test laboratories to fewer, but larger and more efficient laboratories under the hub-andspoke initiative. Fewer blood science laboratories implies a potentially greater distance between the patient and the test capability, meaning that the transport element can become a significant component of the patient’s recovery pathway. 20% Blood or blood products 11% Medication 3% Donor milk 2% Docs/scans 2% Equipment 1% Other 61% Samples for analysis
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FAST FACTS: BLOOD BIKES
36 4498 416 Affiliated groups across UK and Ireland
Volunteers
Charity-owned vehicles
The criticality of a robust transport solution to support the hub-and-spoke model was acknowledged in a letter from 2017, written by Dr Suzy Lishman, the President of the Royal College of Pathologists, in which she highlights the importance of logistics to the success of the above planned strategy: “Logistics: Reliable transportation is clearly vital but not always easy to achieve. A journey from spoke to hub that takes an hour at 3am can easily take twice as long during the day. The scope of ESLs should reflect local infrastructure, which may be one-hour turnaround for a spoke close to the hub and 3-4 hours for one further away.” “Blood transfusion services: The rapid provision of blood and other components is critical to many clinical services, even in spoke hospitals.” In the context of the above statement, many of the Blood
WHAT BLOOD BIKES DO
Bike groups have quietly, but undoubtedly, become the “gap filler” where the theory and practice do not align and an urgent tactical transport solution is required. We are seeing a significant increase in long-distance intercounty relays, where regional groups work together to move samples much further afield, sometimes by a hundred miles or more. Flying along: Our members also deliver innovation themselves. One example is the link between NABB members and Civil Air Support, which is a UK-wide charity that offers aerial services to local authorities and the emergency services. One recent example of where we work together would be the transfer of an FMT (faecal microbiota transplant) consignment from the Midlands for a patient in Belfast, door to door in under four hours. Supporting neonatal intensive care units (NICUs): In 2009, just as NABB was embarking on its planned Blood Bike expansion programme across the country, we became aware of the fragility of the supply chain involved in transporting human donor milk (HDM) from the donor to the milk bank, then on to the NICUs. HDM is used most frequently to avoid the potentially life-threatening necrotising enterocolitis, associated with premature babies. Often the supply of donor milk was dependent on either the donor transporting their milk to the local milk bank themselves, or for a member of the hospital staff to collect from the donor on their way to work. So, as we love a challenge, we set out to provide a robust transport service across the country and our members now provide a full service across most of the UK and Ireland, in support of hospital NICUs. If you would like to know more, or would like to support Blood Bikes, email development@bloodbikes.org.uk, visit the website bloodbikes.org.uk or the Blood Bikes YouTube channel – bit.ly/3h6GH6l
17/02/2022 09:27
Optilite brings you a new level of: Enhanced efficiency Optimised workflow Increased confidence in results Exhibiting at IBMS, ICC, Birmingham, ham, Stand No- 506, 14-17 March 2022 Receive a live Optilite Demo Meet with our Special Protein experts p perts
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ADVICE Congress 2022
THE BIOMEDICAL SCIENTIST
43
CONGRESS IS FINALLY HERE…
S
afety is our priority, and we are aware that Congress may represent the biggest indoor gathering of people that many of our delegates will have experienced for almost two years. Consequently, we want to reassure everyone that we take the safety of our delegates, exhibitors and staff very seriously and will be implementing on-site COVID safety measures that go beyond the minimum requirement measures that are in place in the UK. All people entering the Congress areas of the ICC will be required to show a valid NHS COVID pass. In addition, all attendees will be asked to wear a face covering, if possible, while on site. All delegates and exhibition visitors will checked by ICC staff for compliance with the above requirement and will be denied entry if unable to do so, unless evidence of medical exemption is provided. Individuals who are on-site for more than two days will be required to undergo a recheck every 48 hours. In view of this additional requirement delegates are asked to allow extra time, in addition to the expected registration time
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upon arrival, in order not to miss any part of the lecture programme, which will begin at 9am each day and at 13.00 on the Monday. Once safely through the COVID checks, delegates are promised a Congress with even more new and different content. Our opening day of Monday 14 has added an entirely new lecture programme – Politics and Pathology. This new programme provides a strong complement to the Education and Training and Quality Management programmes for those who would like to choose specific talks from all of these programmes – the lecture halls are located close to each other, so transferring between programmes is easy.
Our Opening Plenary afternoon on Tuesday 15 boasts one of the fullest programmes we have ever hosted, and we are delighted to be able to welcome the Deputy Chief Medical Officer for England, Professor Sir Jonathan Van Tam, to Congress. Unsurprisingly, he will be speaking on COVID and the lessons that have been learned from the UK pandemic response. Preceding the Opening Plenary we have a full morning of 10 parallel lecture programmes that include a second day of education and training plus a new programme of presentations from UKAS to introduce the new revised ISO 15189 standards. As always, we will be running a full free seminar programme in our exhibition hall, which both exhibition visitors and delegates are welcome to attend. Our themes include safety and risk, education and training and a genomics update. Our Closing Plenary lecture on Thursday 17 will be delivered by Dr Suzy Lishman CBE and she will be speaking about the hidden killers in the Victorian home. This fascinating talk was the subject of a BBC documentary of the same title and is a scientific subject with a difference. We are looking forward to seeing you there.
IMAGE: SHUTTERSTOCK
After a reschedule and months of planning, Congress is here. Six months later than originally planned, a March Congress, in the wake of the pandemic, has huge significance and a lot to offer its delegates, writes IBMS Deputy Chief Executive Sarah May.
17/02/2022 09:27
BIOMEDICAL 44 THE SCIENTIST
ADVICE COVID testing
TESTING N WHEELS Chief Biomedical Scientist Bamidele Farinre outlines a Mobile Processing Unit project to take COIVD testing out into the community.
D
ue to the impact of the COVID-19 pandemic, the Department of Health and Social Care expanded the nation’s testing capacity by doubling the capacity of the NHS and Public Health England laboratories, as well as setting up an entirely new nationwide network of testing sites, Lighthouse Laboratories and partner laboratories to process COVID-19 swab samples for the public. The importance of testing, isolation and contact tracing for control of SARS-CoV-2 transmission has been highlighted by the World Health Organization (WHO) as a critical intervention to prevent the spread of infection and ensuing morbidity and mortality from COVID-19. International efforts have largely focused on the detection of infection in symptomatic individuals as well as evolving clinical testing systems to detect those with asymptomatic infection that may still be infectious to others. Mobile Processing Units (MPUs) are mobile laboratories that were designed to deploy to COVID outbreaks. The rationale is to reduce mobility or eliminate the
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transit time for samples to travel to the traditional static lab location and, therefore, reduce test turnaround time. MPU vans (MPUVs) are designed and purpose built for flexibility – they are small laboratories, housed vans and can support a diagnostic workflow, with all required equipment on site. Loopmediated isothermal amplification (LAMP) is a single-tube technique for the amplification of DNA and a low-cost, rapid alternative to RT-qPCR. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) combines LAMP with a reverse transcription step to allow the detection of RNA. Target sequence is amplified at a constant temperature. Typically requiring four different primers to amplify six distinct regions on the target gene, which increases specificity. The amount of amplified product produced in LAMP is considerably higher than PCR-based amplification. LAMP MPUVs are equipped with an OptiGene Genie HT machine and are capable of processing ~400 samples a day. MPUVs have been designed to potentially support other diagnostic capabilities. Their mobile nature makes them ideally suited to support outbreak response,
agilely responding to the location of most need through Test and Trace. The primary target for this service is to deploy MPUs to COVID outbreak regions to conduct testing of COVID swab samples via RNA RT-LAMP. OptiGene’s COVID-19 RT-LAMP assay is a test for the detection of SARS-CoV-2 in clinical specimens (nasopharyngeal swabs/oropharyngeal swabs and saliva). The RT-LAMP assay targets the positive-sense viral genomic RNA within the ORF1ab region. The assay has two formats – an RNA version for use
17/02/2022 09:28
ADVICE COVID testing
THE BIOMEDICAL SCIENTIST
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validation and verification, as well as operation of 14 validated vans. To achieve this, I set up detailed standard operating procedures and processes for the performance of the test. I trained my own biomedical science team and develop a comprehensive “train the trainer” programme, with all staff members receiving the full three weeks of comprehensive molecular training. I established the competency assessment framework for signing off staff, led the implementation of the IT laboratory information management system and established a key performance indicator monitoring programme. These were all key requirements for the achievement of accreditation and validation from the Department of Health and Social Care. I demonstrated diligence and the ability to engage with senior clinicians and executives at the Department of Health and Social Care to submit the required accreditation audit checklist and achieve the verification of all the vans on target and according to schedule.
The challenges
IMAGES: ALAMY/SHUTTERSTOCK
on extracted RNA and its primary use case is in symptomatic testing, and a direct version for use on crude clinical samples, such as saliva, and its primary use case is in asymptomatic testing.
My role I was employed by the Acacium Group as the Chief Biomedical Scientist on the delivery of the MPUVs for the Department of Health and Social Care. This is a project that has been running for nine months with me leading the team for the last
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seven months. I started in the project as a Senior Biomedical Scientist (Training and Developmental Lead). During the initial project set-up and establishment of requirements for the validation and verification of the assay and the vans, I was able to demonstrate my leadership skills and my ability to solve problems, as well as support other members of the team. I was then promoted to Chief Biomedical Scientist (Scientific Lead) for the project with responsibility for the
The project was very challenging from the beginning with numerous changes in requirements that I managed to navigate and solve. Managing teams and projects across multi-sites is very challenging. One of the many challenges include coordinating site inductions that are relevant and cost-effective. This is often a huge strain on resources with added travel time and the time taken to conduct the actual induction on site. Some of the other hurdles I overcame included: effective engagement of the whole team, balancing consistency with local adaptation (working relationship between mobile processing units and mobile testing units), managing staff performance and maintaining open communication. Logistics planning for smooth-running management of resources had to be strategic. The success of this project was
17/02/2022 11:29
BIOMEDICAL 46 THE SCIENTIST
ADVICE COVID testing
achieved thanks to my ability to utilise resources across different hub sites, ensuring the establishment of evidencebased technical standards and processes. I exhibited a good grasp of the science but also of the management of a large cohort of scientists, advanced practitioners and laboratory assistants and helped them take ownership of their own development and performance, including creating a safe working environment and engaging a Health and Safety Officer to lead on this aspect of the project. I built a team of over 100 staff over the seven-month period.
The outcomes and results Each MPUV requires formal audit accreditation through the verification and validation process. The project has been successful in its aim, which was to test the population by identifying symptomatic and asymptomatic individuals with SARS-CoV-2 that present to an MTU (or other relevant testing facility in combination with an MPU in the region of deployment) by ensuring that they self-isolate. All 14 MPUVs were deployed to areas of outbreak, or where there was perceived to be a high risk, and they supported other additional testing capability in order to control infections. This has led to the following milestones: Improved outbreak response by deploying to outbreak areas to provide an onsite laboratory capability to deliver rapid processing of tests, able to deploy to the centre of outbreak areas and process samples within four hours of deployment. Reduction in turnaround time. This capability enables reduced turnaround time for lab processing of tests, meaning the chain of transmission can be broken. Some of the vans deployed to add contingent capacity to meet demand in order to improve test turnaround time in areas where lab processing times need to improve.
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Remote area testing. Mobile processing has been used to access geographically remote areas to provide test processing quickly, guaranteeing all members of the population to have quick ready access to Test and Trace services. Improved capacity for symptomatic testing in an outbreak (300+ tests per day).
Partnership and collaboration The Department of Health and Social Care is the ultimate customer and owner of the MPUVs and is responsible for governance of the unit. Remote Medical International is the lead contractor that owns the MPUV delivery process and is responsible for providing the oversight and governance of the MPUV delivery programme. Acacium Group provides the laboratory staff for the MPUVs and provides site and shift management to oversee the day-to-day running of the labs. Other collaborators include the key provider of vehicles for the MPUV programme; OptiGene, provider of the LAMP machines in the form of the Genie HT and also, a key consumables provider in terms of LAMP reagents; and Promega, provider of Maxwell RNA extraction machines, also, a key consumables provider in terms of RNA extraction reagents. The author would like to thank: the MPUV project team, RMI; Remote Medical, Acacium group (Espirita Workforce Solutions), LML (London Medical Laboratory) and HCA Labs.
TAKEAWAYS Workforce planning for this project was a complex and time-consuming activity, involving a blend of various aspects of the talent acquisition and management processes. It involved recruiting, retention, leadership, and employee development and redeployment. Ensuring there was enough of the best-suited talent adequately trained for the project needs was at the core of workforce planning for the project. The nature of the project is such that we have a high turnover, as such, effective workforce planning resulted in massive savings for all parties involved in the project and helped to prevent negative impact on staff morale.
TANGIBLE PROJECT IMPACT FOR FUTURE Reducing labour costs in favour of workforce deployment and flexibility. Responding to the needs of our service users (Pillar II community testing). Identifying skills gaps and areas of succession risk and formulating relevant strategies for talent management and people development with a great focus on targeting specific and identified inefficiencies in our processes. Implemented employee retention in initiatives, which improved the quality of our outputs. We have been able to improve work–life balance (with a four-days-on, four-daysoff shift system in place).
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BIOMEDICAL 50 THE SCIENTIST
ADVICE How to...
HOW TO... SECURE A PLACEMENT
Biomedical science student Ryan O’Neil talks through his placement experiences and provides advice for anyone considering applying.
I
n September 2021, I began my placement year in the Cellular Pathology Department at University Hospital Southampton. This placement is a year out of my Biomedical Science degree at the University of Portsmouth. During my placement I am working towards completing my IBMS Registration Portfolio to become an HCPC-registered biomedical scientist. The Cellular Pathology Department is situated in the south block of the hospital and is on Floor E, which means running up five flights of stairs when you’re a bit late!
Applying for a placement The opportunity to apply for this placement was well advertised by my university, going as far back as when I was attending open days while on the university hunt. In the run up to the application process, we attended online meetings with representatives from different hospitals who gave us brief overviews of the departments offering placement positions. Also within these meetings, students who had completed
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placements in the previous year shared their experiences, giving further insight into what the placement had to offer. Applications for the year began in March 2021, and involved a written application and interview. The application required a cover letter in which I had to outline why I would be a good fit for the NHS and any relevant previous work experience. I also had to submit a form stating my chosen departments and locations. I applied for microbiology, which was only being offered by Queen Alexandra Hospital in Cosham. For some of us, our applications successfully gained us access to the interview stage of the process. The interviews were conducted virtually and organised in a round-robin style involving rotating through rooms representing different disciplines. Each interview lasted for around five minutes and involved two questions, assessing competency, values or soft skills and one extra question based on the preferred discipline choice. Eagle-eyed readers may have picked up that my chosen option does not match my current placement. I did not receive
an offer for microbiology, likely because I panicked when asked my subject-specific question and did not respond overly competently. Therefore, I was amazed when I received an email stating that I had managed to secure a position elsewhere. Initially, I was of course slightly disappointed that I did not get into microbiology. However, I realised that the few pre-COVID labs I had at university would be beneficial for working in cellular pathology as I had experience using a microscope and performing haemotoxylin and eosin stains.
Starting my placement I was given a tour of the lab and its facilities, along with a timetable in which I would rotate through new areas of the department each month. At the start of my placement a big challenge I faced was feeling out of depth. Despite having two years worth of academic biomedical experience, I was not accustomed to the specific techniques, machines and procedures. However, everyone in the department was extremely supportive as they didn’t expect me to already have
17/02/2022 09:29
ADVICE How to...
THE BIOMEDICAL SCIENTIST
51
As part of my registration, I have to complete 30 pieces of evidence in order to meet the standards of proficiency. these skills. In each section of the lab, I was appointed a trainer with whom I would first observe the techniques, then perform them myself with supervision and finally perform without supervision. This format of learning was especially useful within the more technical parts of the lab, such as embedding and microtomy, which are not immediately easy to perform and require lots of practice. A fair number of those working in the department had also submitted their portfolios to gain their HCPC registration and were able to give lots of guidance. As part of my registration, I have to complete 30 pieces of evidence in order to meet the standards of proficiency. The content of these pieces of evidence ranges from research and writing pieces, to practical in-lab activities, such as performing technical procedures. At the end of the year, all of my competency evidence is compiled into a portfolio and verified by the IBMS. Alongside
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this, I will conduct a tour of the lab for the IBMS verifier to show that I understand the work of the department and my role within it.
Practising and refining My favourite area of the lab so far has definitely been microtomy, purely due to the progress that I have made. On my first day of using a microtome I just could not get the technique right at all and left at the end of the day feeling a bit hopeless. Then on my second day, I was determined to get it perfect to make up for the day before and… the sections I produced were still rubbish. It wasn’t until the fourth or fifth day of practice that I had become more comfortable with the techniques and started to build up a bit of muscle memory that I was able to produce much better sections. It was irrational to think that I could immediately master the technique and that’s what the placement is all about – practising and refining skills in a clinical environment
where there are no expectations for you to have them on arrival.
Advice for others To any students that are unsure, I would recommend applying for a placement year due to the great experiences I have had and the opportunities that becoming HCPC registered will offer. If you do choose to apply, I would recommend that you attempt to make your application the best it can be – include why you want to work for the NHS specifically and why you are the perfect choice. It would also be beneficial to attempt to conduct some work experience before the application, as this will boost your application and help you, even if you do not secure a placement spot. Another piece of advice that I would give is do not be put off if you do not receive your chosen speciality, it may be a bit of a let down initially but the general skills you gain will be a massive benefit for any jobs you go on to apply for in the future and, most importantly, you’ll have a great time with some amazing experiences no matter in which speciality you perform your training.
17/02/2022 09:29
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MY IBMS News
THE BIOMEDICAL SCIENTIST
53
MY IBMS NEWS
VISION CAMPAIGN
IMAGE: WELLCOME COLLECTION
CELEBRATING 100 YEARS OF WOMEN IN THE IBMS On 4 February 1922 a motion was passed to officially admit female members to the IBMS. A hundred years later, the IBMS is celebrating the role of women in the Institute’s history and the incredible women working in biomedical science today. To mark the centenary, the Institute is running the “100 Years of Women in the IBMS” campaign throughout 2022. The campaign started on 11 February – International Day of Women and Girls in Science. It aims to raise the profile of female members, highlight the achievements of women in the biomedical workforce and inspire future generations of female scientists.
Today, 67% of IBMS members are women, as are 10 out of 21 members of IBMS Council. The IBMS is looking to promote the work of women in biomedical science by featuring the stories and voices of female members. Submissions can be as short
as a quote and as long as a blog post. By the end of 2022, the aim is to have featured 100 female biomedical scientists in this campaign. The IBMS has also developed a template where you can easily add your picture to share the #100YearsIBMSWomen campaign on social media. For more information, visit ibms.org/resources/100-yearsof-women-in-the-ibms
IBMS CORPORATE STRATEGY 2022 The bold, new IBMS Corporate Strategy 2022 has been published. It sets out the vision, mission, values, key themes and core aims the IBMS will be focusing on over the next five years. It establishes the continuation of three member-focused pillars – Support, Progress, Promote – and how the IBMS aims to deliver these. IBMS Chief Executive David Wells said: “In a time of enormous change, it is right that the IBMS responds with an ambitious, exciting strategy to keep biomedical science at the heart of healthcare.” The strategy document, which goes into detail around the core aims above, can be downloaded in full below from the IBMS website. Visit ibms.org/ resources/documents/ ibms-strategy-2022
IBMS PRESIDENT
Debra Padgett inaugurated Debra Padgett has been officially inaugurated as IBMS President at a ceremony in London. Debra has become the 35th IBMS President and the third female president. Former IBMS President Allan Wilson delivered a speech focusing on his term as president and endorsing Debra. Debra said: “I am truly humbled to be elected as president, the pinnacle of my career to date, I’m the product of hard work, continual learning, support, drive and determination,
P53 IBMS News_March 2022_Biomedical Scientist.indd 53
but above all, absolute passion for the job I do every day. “I’m eager to make the IBMS the best professional body it can be for our members – we’re better and stronger together. It’s imperative the we build on our reputation as the leading professional body for biomedical science, whilst maintaining our voice with politicians, governments and policymakers across the four nations.”
17/02/2022 09:31
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MY IBMS Regulation
THE BIOMEDICAL SCIENTIST
55
REGULATION: AN IBMS POSITION STATEMENT Alan Wainwright, Executive Head of Education at the IBMS, looks at a consultation on regulation.
T
he Government has launched a consultation that considers how the powers to introduce and remove professions from regulation might be used in the future with respect to decisions on which professions should be regulated, no longer require statutory regulation or whether there are unregulated professions that should be brought into statutory regulation. This is part of a series of consultations as the government seeks additional legislative powers under the Health and Care Bill to ensure this happens through the power to close down an individual health and care professional regulator or remove
P55-56 Regulation_March 2022_Biomedical Scientist.indd 55
restrictions on the delegation of functions by the regulators Statutory regulation refers to health and care professions that must be registered with a professional regulatory body by law. The titles used by regulated professionals are also legally protected. It is an offence for an individual to describe themselves as
“The IBMS is responding and wishes to raise awareness among its members”
a regulated healthcare professional without holding the appropriate registration with the relevant regulator (for example, a biomedical scientist with the Health and Care Professions Council). The IBMS is responding to this consultation and wishes to raise awareness among its members about key aspects about statutory regulation of biomedical scientists that inform the response. The IBMS agrees that a qualitative and quantitative analysis of the risk of harm to patients is one of the most crucial factors to consider when deciding whether to regulate a health or care profession but should not be regarded as the sole determinant for regulation. Qualitative
1
17/02/2022 09:32
BIOMEDICAL 56 THE SCIENTIST
MY IBMS Regulation
and quantitative analysis of the likelihood of risk of harm to patients is crucial to ensuring the best informed and evidence-based outcome for the patients. Qualitative risk analysis is more subjective and mainly focuses on identifying risks to measure the likelihood of a specific risk event occurring. The goal is to determine severity, i.e. quantitative analysis as this is better for managing the risk of harm to patients as it uses verifiable data to analyse the effects of risk involved. The IBMS agrees that proportionality, targeted regulation and consistency should also be considered in deciding whether to regulate a health or care profession. Regulation can often be seen as a bureaucratic barrier, but certainly in the case of biomedical scientists there is a strong desire for regulation from within the profession and professional body as the underpinning science and understanding that underpins the knowledge of laboratory investigation into disease, and training that is required
2
to perform the analyses safely to provide accurate results, creates a culture of professional competence and understanding of the risk to patients that can occur when strict standards of practice are not adhered to. The IBMS agrees that the currently regulated professions should remain subject to statutory regulation as this plays a critical role in setting and implementing the standards of professional behaviour, competence and ethics underpinning the day-to-day interactions that patients and the public have with the NHS and the variety of other health and social care services within the UK. A professional, responsive and flexible workforce is the cornerstone of the healthcare service provision. Professional regulation reassures the public that the people who provide healthcare are qualified, capable and competent. When healthcare professionals do not meet these standards, professional regulators should automatically act to protect the public. The risk of removing regulation is not just about a reduction in standards. For some, such as biomedical scientists, removal would imply that the high standards of quality scientific and clinical work were not required to deliver patient care. Loss of protective title would erode the entity of the profession and with it the specific requirements for education and training and continued professional development.
3
The IBMS disagrees that currently unregulated professions should remain unregulated and not subject to statutory regulation. The alternative of voluntary
4
P55-56 Regulation_March 2022_Biomedical Scientist.indd 56
The currently regulated professions should remain subject to statutory regulation
registration does not have the legislative power to remove someone from a register that permits them to practise based on their confirmed ability to meet standards of practice that protect the public. The advances in healthcare knowledge and technology should require unregulated professions to be reviewed to determine if they can be recommended for statutory regulation based on the assessment of risk to patients and the public.
HAVE YOUR SAY The Department of Health and Social Care is seeking views on the criteria used to make decisions on which health and social care professions should be regulated. To respond to the consultation, visit bit.ly/StatRegCons This consultation closes at 11:45pm on 31 March 2022.
17/02/2022 09:32
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BIOMEDICAL 58 THE SCIENTIST
MY IBMS Continuing professional development
JOURNAL-BASED LEARNING EXERCISES
Please select your choice of correct answers and complete the exercises online at: www.ibms.org/cpd/jbl
DEADLINE: WEDNESDAY 18 MAY 2022 Leukocytosis induced by tigecycline in two patients with severe acute pancreatitis Lia X, Lib L, Liuc T, Haia X, Sun B. Br J Biomed Sci 2021; 78 (4): 225–8. doi: 10.1080/09674845.2021.1885865. Assessment No: 030122
01
Tigecycline is the most sensitive drug used against extensively drug-resistant bacteria.
11
Case 2 describes a 28-year-old male with severe acute pancreatitis.
02
Tigecycline-associated adverse drug reactions are increasing, the most common being nausea, vomiting, diarrhoea and liver dysfunction.
12
Renal function was abnormal, indicating acute kidney injury, an uncommon complication of acute pancreatitis.
03
This article describes two cases in which leukocytosis developed within a month of initiating tigecycline in infected pancreatic necrosis.
13
Acinetobacter baumannii was detected in pus from peritoneal drainage on day 8 of admission.
04
Case 1 describes a 27-year-old female patient admitted to hospital complaining of ongoing abdominal pain for 24 hours.
14
In case 2, C-reactive protein level on admission was 228 mg/L.
05
The patient was diagnosed with hypertriglyceridemiainduced chronic pancreatitis.
15
Despite tigecycline-induced acute pancreatitis being a rare phenomenon, product labelling was updated to include acute pancreatitis as an adverse event in 2016.
06
Broad-spectrum antibiotic therapy, sulperazone cefoperazone and culbactam sodium were given for the first five days.
16
Minocycline can induce neutrophil movement from bone marrow into the circulation and causes leukocytosis.
07
Following open necrosectomy, the abscess culture demonstrated carbapenem-resistant Klebsiella pneumoniae.
17
Tigecycline and minocycline are both tetracycline derivatives and share a similar structural formula.
08
In case 1, C-reactive protein level on admission to hospital was 266 mg/L.
18
In these two patients, complicated intra-abdominal infections were diagnosed with clinical symptoms, imaging features, auxiliary examination, and bacterial culture results.
19
Amylase and lipase concentrations were not screened during the treatment of these patients.
20
Further study is required with emphasis on the potential role of genetic susceptibility.
09 10
Tigecycline was stopped on day 5. The patient was discharged on day 41, and showed no clinical symptoms nor abnormal laboratory investigations at six-month follow-up.
REFLECTIVE LEARNING 01
Discuss the role of antibiotics in the treatment of acute pancreatitis.
02
The problem of antimicrobial resistance requires regulation to reduce unnecessary and inappropriate antibiotic use in humans, animals and the environment. Discuss.
MY IBMS Continuing professional development
THE BIOMEDICAL SCIENTIST
59
DEADLINE: WEDNESDAY 18 MAY 2022 How to report the antinuclear antibodies (anti‑cell antibodies) test on HEp‑2 cells: guidelines from the ICAP initiative. von Mühlen CA, García-de la Torre I, Infantino M et al. Immunol Res 2021; 69 (6): 594–608. doi: 10.1007/s12026-021-09233-0. Assessment No: 030522
01
Forty countries (40/68) informed that there are National Consensuses or Guidelines in place.
11
The majority of respondents screened at 1:80 (87/110=79%), followed by 1:160 (29/110=26%), several using both dilutions in parallel.
02
Fifty centres indicated that they had a distinct screening dilution for children, normally one titre lower for children compared to adults.
12
It is recommended that the HEp-2 IIFA data should be concise and traceable and that the report should include ANA patterns, titre, reference range, and comments or remarks.
03
The use of AC numbers is recommended as it promotes standardisation and may help in finding relevant information while navigating the ICAP website.
13
Many laboratories and some automated instruments screen in parallel dilutions aiming at improved sensitivity, speedier turnaround time, and to avoid misinterpretations.
04
Laboratories are divided when it comes to reporting cytoplasmic patterns, ranging from not reading or not reporting them at all, to considering them as positive or negative.
05
06 07
08
09 10
There is a general understanding in the rheumatology community that higher HEp-2 IIFA titres are better associated with systemic autoimmune rheumatic disease. In the case of a positive ANA test, it is recommended that the pattern and the lowest dilution to demonstrate reactivity be reported. Mitotic patterns (AC-24 to AC-28) should be reported as ANA-negative. It is recognised that HEp-2 IIFA pictures could add value, but it is a feature not observed in any of the reports received indicating that too much time and effort would be required for such addition. Among 108 laboratory respondents, 55 (51%) adopt the practice of reflex testing or follow-up testing. Seven laboratories started screening at 1:40 as the only dilution, while another 10 participants screening at that dilution also do so in parallel at 1:80 or 1:160.
14
15
16 17
18
19 20
No laboratories have considered using likelihood ratios to provide additional specific information on titres.
Multiple anti-cell antibody patterns are common and observed when more than one autoantibody is in the sample, eliciting distinct staining patterns that can be readily attributable to separate cellular targets. Cytoplasmic patterns (AC-15 to AC-23) are, by definition, not ANA. Sixty-three laboratories (55%) reported cytoplasmic staining as ANA-positive, 38 (33%) reported isolated cytoplasmic staining as ANA-negative. ICAP recommends reporting both patterns and associated endpoint titres.
A major goal of the ICAP initiative is to facilitate accurate and harmonised HEp-2 IIFA reading and interpretation through standardised nomenclature. A recent survey found that 26% of laboratories report cytoplasmic patterns as ANA-positive.
REFLECTIVE LEARNING 01
Compare your reporting of antinuclear antibodies and its compliance with the recommendations in this paper.
02
Compare and contrast the relative sensitivities and specificities of different screening dilutions and titrations for antinuclear antibodies.
BIOMEDICAL 60 THE SCIENTIST
MY IBMS Here to help
HERE TO HELP
NON-ACCREDITED BIOMEDICAL SCIENCE DEGREES Alan Wainwright and Richardia Penn from the IBMS give their top tips for submitting documentation.
P60 My IBMS-HTH_March 2022_Biomedical Scientist.indd 60
Additionally, for graduates that have a science honours degree that is not IBMS accredited, the IBMS has a route that employers have identified as suitable for candidates undertaking biomedical scientist training. These degrees are more likely to require supplementary study consisting of specified “top-up” modules from an IBMS-accredited degree, which can be frustrating and costly. There is no escaping the requirement for these individuals to show clear evidence of the depth and breadth of knowledge in biomedical science in order to meet the academic content required by the HCPC standards of proficiency. In terms of academic curriculum, they must demonstrate they have studied subjects commensurate with IBMS-accredited programmes and this includes the key biomedical subjects: cellular pathology, clinical biochemistry, clinical genetics, clinical immunology, haematology and transfusion science, medical microbiology and virology. The IBMS has a process for evaluating non-accredited degrees that are equivalent to BSc (Hons) level or above. All applications are assessed on the basis of the taught academic subject content and level of the qualification award. Shortfalls in education are identified and the individual advised on their supplementary education
requirements for compliance with the HCPC standards of proficiency. These are our top tips for submitting documentation when applying for this assessment: Ensure you read and follow the guidance and frequently asked questions available on our website before starting your application. Part A and Part B of the application process will provide further instruction and information on how to submit your application. Part B includes an electronic attachment of sample module descriptors. Ensure to redact your personal details from any documents submitted in Part B. Avoid submitting supporting documentation as a link to the University website. Ensure to read the outcome letter for the degree assessment in full once received. This will provide guidance on the next steps of the process as well as appealing your outcome. All degree assessment documentation can be accessed via the website ibms.org/degree-assessment
IMAGES: ISTOCK
T
he COVID-19 pandemic has highlighted the role of biomedical scientists in an unprecedented fashion. Crucially this has been down to professional knowledge and adaptability of roles that ensured essential pathology services were maintained. This is possible because of the thorough grounding in biomedical science theory and practice along with standards of proficiency that underpin our profession. In this context, two standards are paramount: HCPC SoP 13.8 Understand the role of the following specialisms in the diagnosis, treatment and management of disease: cellular science, blood science, infection science, molecular and genetic science and reproductive science. HCPC SoP 14.7 Be able to demonstrate proficiency in practical skills in cellular science, blood science, infection science, molecular and genetic science and reproductive science, where appropriate to the discipline. The two main preferred routes to HCPC registration as a biomedical scientist are an IBMS-accredited degree containing the Registration Training Portfolio (integrated degree), or an IBMS-accredited degree with the Registration Training Portfolio completed outside of the degree.
17/02/2022 09:33
RECRUITMENT For recruitment advertising contact our Sales Team +44 (0)20 7880 7621
UK National External Quality Assessment Scheme for Immunocytochemistry and In-Situ Hybridisation has a vacancy for a
Staff Scientist We are looking for someone to join our enthusiastic, hard-working team of scientists based in Farringdon, London. This is a new post, created to accommodate increased demand for our services and to enable us to develop new EQA products. About the Scheme The UK National External Quality Assessment Scheme for Immunocytochemistry and In-Situ Hybridisation (UK NEQAS ICC & ISH): • has been in existence for nearly 40 years • monitors the quality of advanced testing in clinical cellular pathology laboratories across the NHS and private healthcare providers • is a market leader in the provision of external quality assessment (EQA) services, to the UK and worldwide • helps to improve cancer testing and patient outcomes • is accredited by UK Accreditation Service (UKAS) • is a member of the UK NEQAS Consortium (a registered UK charity). About your role In your work with us you will: • participate in the scienti¿c and laboratory work supporting our core EQA activities • be involved in our quarterly EQA assessment runs, working with expert assessors from across the world • be expected to work in a self-directed manner when carrying-out your day-to-day work.
THE BIOMEDICAL SCIENTIST
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Make the move to Island life The States of Guernsey are looking for an Anatomical Pathology Technologist & -JFQYMHFWJ 8HNJSYNܪH &XXNXYFSY to join the team at Pathology. Work on the beautiful Island of Guernsey FSI ܪSI YMJ \TWP QNKJ GFQFSHJ ^TZѣ[J GJJS looking for.
About you If you are the person we are looking for, you will: • have experience of working in a clinical histopathology service laboratory or research facility • be enthusiastic about what you do and meticulous in the way you do it. Your starting salary will be dependent on your previous experience and skill set, it will be between £47,154 and £55,442 per annum (inclusive of high cost area supplement). Your worktime hours will be 37.5 hours, Monday to Friday. Training will be given where needed to help you fully develop into your role. If you want to know more Read the Job Description and Person Speci¿cation, which is available here: https://ukneqasiccish.org/job-vacancy/ If you then need more information, email Andy Dodson (Scheme Director). If you want to apply, email your CV and a covering letter telling us why you want the job and why you are the person we are looking for to: adodson@ukneqasiccish.org
States of Guernsey
Find out more at: \\\ LT[ LL UFYMTQTL^OTGX
We should receive your application by Friday, 11th March, 2022.
Executive Head of Education Institute of Biomedical Science We are looking to recruit a new Executive Head of Education following the retirement of the current post holder. This individual is a key member of the senior leadership team of the IBMS, working closely with the CEO and the other Executive Heads, and is responsible for delivering the work programmes that underpin the Institute’s corporate strategy for education and professional standards of practice. They will provide a high level of specific expertise in assessing the impact and implementation of central initiatives on the Institute and its members. The postholder will provide expert advice to Council and the Chief Executive on education and training initiatives and support the operational performance of the education department as well as working closely with the Chair of the Education and Professional Standards Committee to deliver to the Terms of Reference and the education components of Institute’s strategy. This role will be the lead for the Institute’s HCPC approved programmes and degree accreditations and will the primary contact for key stakeholders, including academic providers of professional degrees in biomedical science, to ensure the IBMS professional learning opportunities are appropriate to the needs of the profession. This is a highly interactive role requiring high-level strategic thinking, exemplary communication and diplomacy skills, self-direction, initiative and a thorough knowledge of HCPC regulatory standards in the widest context. The IBMS offers a flexible salary package plus benefits depending on experience. For further information please contact our recruitment partner Jonathan Wiles at Page Executive Email: jonathanwiles@pageexecutive.com. To apply please send your CV and a covering letter to the same address by 17.00 hrs on Friday 25th March.
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BIOMEDICAL 62 THE SCIENTIST
MY LAB Azuma Kalu
MY LAB
TOXICOLOGY IN SHEFFIELD Azuma Kalu and Dean Tazzyman give a guided tour of the toxicology laboratory at Sheffield Teaching Hospitals NHS Foundation Trust.
S
heffield toxicology is a service unit in specialised clinical chemistry, which is part of Sheffield Laboratory Medicine. Located at the Northern General Hospital campus of Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield toxicology is housed in a standalone building a few hundred metres from the main laboratory medicine facility. Specimens for toxicological analysis are received by pre-analytics staff at both toxicology and laboratory medicine buildings and, at regular times of the day, specimens received at the laboratory medicine building reception are taken over to toxicology. In 2021, we received and processed nearly 4000 clinical and post-mortem cases from coroners, substance misuse services, hospitals and antenatal clinics from around the country. The number and type of specimens for each case request varies from ante-mortem, post-mortem, or a mixture of both, and can be preserved or plain bloods, urines, cerebrospinal fluids, gastric contents, vitreous, bile, tissues and much more. We see many interesting cases and as the samples make their way from the specimen reception through to analysis and reporting every step provides an opportunity for learning something new, which contributes to the overall professional development of staff.
P62 My Lab_March 2022_Biomedical Scientist.indd 62
A dedicated team of medical laboratory assistants book in the samples on to our laboratory informatics system, after which the labelled samples are sorted into the appropriate pre-analysis racking system for storage. On the day of analysis, the batch worklist is created, the samples are retrieved from storage and prepped according to the standard procedure by trained and competent biomedical scientists. Samples are analysed in batches and the method of analysis depends on the requested tests, as well as sample types. Initial screening of urines for drugs of abuse is performed on the Cobas chemistry analyser. Urine samples that test positive for any of the drugs or metabolites are further quantitated. The introduction of the high-resolution mass spectrometers to our line-up of equipment has offered us the robustness to screen and quantify clinical and post-mortem urines and bloods. It has also allowed us to second check the urine screening performed on the Cobas chemistry analyser. The laboratory currently has four ultrahigh performance liquid
chromatography with a variety of detection systems, including fluorescent, electrochemical, photodiode array and variable wavelength. There are three ultra-high performance liquid chromatography mass spectrometers (LCMS), three gas chromatography mass spectrometers (GCMS), two headspace gas chromatography (HSGC) and two high-resolution mass spectrometers (HRMS). For cases from coroners, pathologists and mortuaries, we investigate the toxicological cause of death, so our clinical scientists interpret the results in the context of the medical history and other information provided. Our service has expanded in recent years and this expansion has been matched with investment in the latest technology. This has enabled us to provide a wide range of test repertoires, from the more commonly abused drugs – such as cannabis, cocaine, ketamine and amphetamines – to the new and emerging ones like isotonitazene and derivatives. The laboratory supports training of medical laboratory assistants, biomedical and clinical scientists through academic and professional qualification routes. We are a friendly, hardworking, and forwardlooking team. If this has sparked your interest and you want more info about our services, we would like to hear from you. You can get in touch on 0114 226 7666, or email us on sth.labmed@nhs.net
17/02/2022 09:34
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For further information please call
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launchdiagnostics.com p63_BIO.Mar22.indd 63
15/02/2022 15:56
We've missed you
Roche Diagnostics is proud to be the principal sponsor of the IBMS Congress 2022. We look forward to seeing you in person on stand 209, or in our exclusive Roche Live Lounge. Come and talk to us about what we can do to help make your laboratory the best it can be for you, the services you support, and your patients. diagnostics.roche.com
Biomedical Scientist IBMS p64_BIO.Mar22.indd 64ad 2022.indd 1
26-Jan-22 4:05:46 PM 15/02/2022 15:57
