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The 2022 report of the Lancet countdown on health and climate change: health at the mercy of fossil fuels. One estimate attributed 4.4% of annual carbon dioxide emissions to the health services of 36 major countries; predictably, hospitals were the main sources.[6] At the very least, this should prompt us to focus on our own carbon dioxide emissions. The existence of direct and specific links between climate change and clinical biochemistry is not obvious. [Extracted from the article]

Background: Assessing the pre- and post-test probability of disease in the context of routine health care is challenging. We wished to study how test performance parameters relating to clinical utility vary by clinical indication in a 'real-world' setting. Methods: The diagnostic accuracy of serum total B12 and Active-B12® (holotranscobalamin) was evaluated in a primary care population, using serum methylmalonic acid as the reference standard. We used electronic requesting to establish the clinical indication for each request. Routine requests from primary care for serum total B12 were included if creatinine was also measured and estimated glomerular filtration rate was at least 60 mL/min/1.73 m2. Results: Clinical indications included peripheral neuropathy (n = 168), anaemia (n = 168), cognitive decline (n = 125), suspected dietary deficiency (n = 76), other (n = 362). For peripheral neuropathy, the area under the receiver operator curve ± 95% confidence interval (AUC ± CI) was 0.63 (0.54–0.71) (P = 0.002) for total B12 and 0.68 (0.60–0.77) (P < 0.0001) for Active-B12®. For anaemia, AUC ± CI was 0.56 (0.47–0.66) (P = 0.10) for total B12 and 0.69 (0.59–0.78) (P < 0.0001) for Active-B12®. For cognitive decline, AUC ± CI was 0.54 (0.43–0.65) (P = 0.26) for total B12 and 0.69 (0.58–0.80) (P = 0.0002) for Active-B12®. The pre–post-test change in probability of disease varied by clinical indication. Conclusion: Combining diagnostic accuracy studies and electronic testing in a 'real-world' setting allows clinical utility to be assessed by clinical indication. Wider application of this would permit more personalised laboratory medicine. In this study, diagnostic performance of total B12 and Active-B12® varied across all indications. Active-B12® provided better discrimination, but this may have reflected the cut-offs used. [ABSTRACT FROM AUTHOR]

An editorial is presented on clinical biochemists adding value by participating with other health professionals in the delivery of a high-quality service. Topics include allowing for differences in the nature, size, and staffing of hospital laboratories; and generating the data in reinforcing awareness of the effect of reflex thresholds on the metrics of both reflex and reflective testing.

Background Communicating abnormal results to requesting clinicians is an essential part of clinical authorisation. Guidance from the Royal College of Pathologists on communication of critical/unexpected results is issued as 'advice to pathologists'. The 2017 guidelines advise rapid communication of serum potassium results ≤2.5 mmol/L and ≥6.5 mmol/L. Little is known about what happens after the results have been communicated. We wished to establish answers to the following questions: Are phoned results acted on? If so, when? What is the outcome of any action taken? Methods A prospective study of primary care potassium results authorised out of hours was undertaken. Potassium requests from primary care were retrieved from the laboratory information management system. The potassium result was recorded, along with other data. Data were analysed for potassium results that were validated out of hours (18:00 h-08:00 h). Results Over six months, 220 potassium results <3.1 mmol/L and >5.9 mmol/L from primary care were validated out of hours. A subset of these (27) were phoned to the general practice out of hours 'hub', and 16 patients referred to hospital out of hours, on account of the potassium results. The remaining potassium results phoned out of hours were acted on subsequently. Conclusions Critical potassium results were phoned urgently and are acted on, although not always out of hours. For potassium results phoned out of hours, the most frequent action was to refer to hospital out of hours. Different actions occurred for similar potassium results, reflecting the fact that actions taken and their urgency depend on the patient, the clinician and the practice policy for handling results. [ABSTRACT FROM AUTHOR]

The author discusses prescription of psychiatric medications, with a focus on different dietary needs of patients. Topics discussed include dietary restrictions based on religious grounds, medical grounds and personal preference, National Nutrition and Physical Activity Survey related to avoiding of a food type related to allergy, absence of sufficient information in medical literature on presence of animal products in mental health medications and relevance of increased patients engagement.

This essay analyzes the complicated gendered landscape that academic women’s studies represents for gay male students and instructors. It uses personal experience and contemporary gender theory to explore why women’s studies is perceived to be the natural province of gay males, how gay males are interpellated as ‘‘men’’ in women’s studies, and the choices gay males face between academic feminism and popular discourses of gay rights activism. It argues that Women’s studies represents both a promising and perilous discursive space for gay males, especially those attempting to embody gender constructionist, anti-essentialist, and queer subject positions. [ABSTRACT FROM PUBLISHER]

Background: Laboratory investigations may be added to existing requests either automatically on the basis of algorithms (reflex testing) or by laboratory professionals (reflective testing). The clinical utility of reflex and reflective testing is not fully established. We studied efficiency (number of tests that needs to be added to make a diagnosis) and effectiveness (number of diagnoses) of reflex and reflective testing in selected biochemical scenarios. Methods: Using fixed rules, we prospectively measured efficiency and effectiveness of reflex and reflective testing in the following scenarios (reflex initiators in parentheses): (1) hypovitaminosis D (hypocalcaemia plus elevated alkaline phosphatase activity); (2) hypomagnesaemia (hypokalaemia or hypocalcaemia); (3) hypothyroidism (high thyroid-stimulating hormone [TSH]); (4) hyperthyroidism (low TSH); (5) haemochromatosis (reflex or reflective addition of iron studies, followed by reflective addition of genetic studies). Separately, using a different data-set, we examined the impact of varying TSH thresholds on outcomes in the biochemical diagnosis of hyper- and hypothyroidism. Results: In patients aged over 55 y, 25-hydroxy-vitamin D <50 nmol/L could be predicted with ≥90% certainty when albuminadjusted calcium was ≤2.1 mmol/L plus alkaline phosphatase >150 U/L. Higher numbers of tests were needed to make a diagnosis in other scenarios. In general, more diagnoses were made by reflex testing. Outside the euthyroid TSH range, efficiency of diagnosis of hyper- and hypothyroidism became asymptotic, while effectiveness declined. Conclusions: Near-maximal efficiency of reflex testing can be achieved, depending on the reflex and diagnostic thresholds applied. Reflective and reflex testing are complementary activities, the clinical utility of which depends on the initiators used. [ABSTRACT FROM AUTHOR]

The study analyzes the ''My Strength is Not for Hurting'' rape prevention public media campaign through the lens of feminist visual culture studies, arguing that the campaign sends contradictory and confusing messages to boys and men about rape and sexual assault. It also touches on the implications of the campaign's appropriation of a commercial advertising aesthetic; the tendency to objectify women and silence their voices; and complications resulting from efforts to include racial and sexual diversity. [ABSTRACT FROM AUTHOR]

A 26-year-old female overseas student was admitted to hospital with a fracture of her left humerus following minimal trauma. Biochemical abnormalities included hypercalcaemia, hypophosphataemia, raised alkaline phosphatase, raised parathyroid hormone and undetectable 25-hydroxy-vitamin D. Skeletal X-rays revealed multiple osteolytic lesions in the humerus as well as similar lesions in the femora and pelvis. Magnetic resonance imaging of her left shoulder showed a large soft tissue mass in the proximal humerus. Bone biopsy was reported as consistent with a brown tumour of primary hyperparathyroidism and a sestamibi scan confirmed the presence of a parathyroid adenoma. However, the isotope bone scan was reported as showing features typical of fibrous dysplasia involving multiple sites. The patient subsequently fractured her right femoral shaft, and a femoral nail was inserted. Parathyroidectomy was performed at the same time. Postoperatively she exhibited increased calcium and vitamin D requirements. Coexistence of primary hyperparathyroidism and polyostotic fibrous dysplasia is very rare. [ABSTRACT FROM AUTHOR]

Two studies are reported on the effects of improvement in the physical and social environment upon the problem behaviors (aggressive, hyperactive, and inappropriate behaviors) and self-help behaviors of severely and profoundly retarded institutionalized males. In Study I, self-help and problem behavior ratings were obtained before and after a 10-week baseline period, and after three successive 10-week periods of exposure to an improved ward environment. Results indicated significant and enduring improvements on self-help and problem behavior ratings, although no formal treatment was employed. In Study II, residents were exposed to a behavioral treatment and an improved setting, or an improved setting alone. Residents were assessed at baseline and after 10 and 20 weeks of treatment or control conditions. Results indicated that significant improvement was obtained on self-help ratings for only the residents who received behavioral treatment. However, for all problem behavior ratings except aggressive behaviors, significant reductions were obtained for both groups. The discrepancies in the findings of the two studies for self-help skills are discussed, and directions for future research and methodological issues are considered. [ABSTRACT FROM PUBLISHER]

The author reflects on the impact of reflex thresholds on the effectiveness and efficiency of reflex and reflective testing. He notes that difference between reflex testing and reflective testing. He stresses that reflective and reflex testing are complementary activities and do not overlap each other. The author suggests the generation of analogous data for individual diagnostic scenarios if evidence-based laboratory practice is to extend to the choice of reflex thresholds.

An introduction is presented in which the editor discusses various reports within the issue on topics including challenges faced by gay and straight male students in the Women's Studies class, masculinity in Women's Studies classroom, and queer masculinity.

Background: Modified Light's criteria are widely used to categorize pleural fluids as either exudates or transudates. Similarly, the serum-ascites albumin gradient (SAAG) is used in the differential diagnosis of ascites, particularly with reference to the prediction of portal hypertension. Fluid and serum samples are required for both of these to be applied. The effect of the time interval between fluid and serum samples on the interpretation of results has not been studied. Methods: We examined the effect of sample timing on (a) the application of modified Light's criteria, and (b) the categorization of SAAG as wide (≥11 g/L) or narrow (<11 g/L). Specifically, we compared the use of a 'routine' serum sample, i.e. one that was not formally paired by the requesting clinician with the fluid sample, with serum samples collected within 2 h of the fluid sample. Results: Of 77 pleural fluids included for analysis, 45/47 were categorized as exudates, and 32/30 as transudates, using near-simultaneous/routine serum samples respectively. Discrepant categorization was observed in two cases (P=0.74). Of 109 ascitic fluids, SAAG was ≥11 g/L in 100/95 cases, and <11 g/L in 9/14, using near-simultaneous/routine serum samples respectively. Discrepant categorization was observed in five cases (P=0.27). Conclusions: With reference to categorizing pleural and ascitic fluids as described above under (a) and (b), in most cases the use of routine serum samples does not alter the fluid categorization compared with the use of serum samples collected within 2 h. [ABSTRACT FROM AUTHOR]

Introduction: Reflective testing refers to the practice of adding on tests by laboratory staff. Little is known about what patients think of this practice. Methods: We surveyed patients attending a general practice surgery and patients attending hospital outpatient clinics. We sought their views about the practice of adding on tests and about the information they received from requesting clinicians about their investigations. Results: In both groups of patients, large majorities favoured an approach in which relevant additional tests are performed without consulting the requesting clinician or patient first. Most patients also felt that the requesting clinicians had provided a satisfactory explanation about what tests were to be performed and why. Conclusion: Most patients are content to let NHS professionals add on relevant tests if this is felt to be in their interest. [ABSTRACT FROM AUTHOR]

The article offers information on the contributions and roles of the editorial team of the periodical of laboratory medicine "Annals" including the Editor in Chief Edmund Lamb. It mentions appointment of Maurice O'Kane as Deputy Editor of the journal. It also mentions contributions of Philip Wenham and Stephen Halloran as Associate Editors.

A letter to the editor is presented in response to the article "Hyperamylasaemia and Dual Paraneoplastic Syndromes in Small Cell Lung Cancer" by K. Akinosoglou, D. Siagris, and E. Geropoulou in a 2014 issue.