Laboratory practice is central to earlier myeloma diagnosis: Utilizing a primary care diagnostic tool and laboratory guidelines integrated into haematology services.

Treatment advances have greatly improved survival, but myeloma is among the worst of all cancers for delayed diagnosis, causing serious morbidities and early deaths. This delay is largely because the symptom profile of myeloma has very low specificity, and in primary care, myeloma is rare. However, initiating the journey to diagnosis simply requires considering myeloma and sending blood to test for monoclonal immunoglobulin. Laboratory tests reliably detect monoclonal immunoglobulin, which is present in 99% of myeloma cases, so why do health care systems have such a problem with delayed diagnosis? The Myeloma UK early diagnosis programme has brought together diverse expertise to investigate this problem, and this article was prepared by the programme's working group for laboratory best practice. It reviews evidence for test requesting, analysis and reporting, for which there is large variation in practice across the United Kingdom. It presents a 'GP Myeloma diagnostic tool' and how it can be integrated into laboratory practice alongside a laboratory best practice tool. It proposes improved requesting and integration with haematology services for reporting and interpretation. Here the laboratory has a central role in creating efficient and cost-effective pathways for appropriate and timely bone marrow examination for myeloma diagnosis.

A Medically Supervised Pregnancy Exercise Intervention in Obese Women: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether an intensive, medically supervised exercise intervention improved maternal glycemia and gestational weight gain in obese pregnant women when compared with routine prenatal care. METHODS: This randomized controlled trial compared a medically supervised exercise intervention with routine prenatal care. The primary outcome was a reduction in mean maternal fasting plasma glucose in the intervention group by 6.9 mg/dL at the time of a 75-g oral glucose tolerance test at 24-28 weeks of gestation. Secondary outcomes included excessive gestational weight gain. The intervention consisted of 50-60 minutes of exercise: warm-up, resistance or weights, aerobic exercises, and cool-down. All women received routine prenatal care. Power calculation determined that 24 women were required per group to detect a difference of 6.9 mg/dL in fasting plasma glucose between groups based on an independent-sample t test for statistical power of 80% at a type I error rate of 0.05. A sample size of 44 per group was planned to allow a dropout rate of 33%. RESULTS: From November 2013 through August 2015, 88 women were randomized: 44 each to the exercise and control groups. Eight women in the control group and 11 in the intervention group did not complete the trial at 6 weeks postpartum (P=.61), but 43 in each group attended the 24- to 28-week glucose screen. There were no baseline maternal differences between groups. Classes commenced at a mean of 13 4/7±1 2/7 weeks of gestation. In early pregnancy, 51.1% (n=45/88) had an elevated fasting plasma glucose (92-125 mg/dL). There was no difference in the mean fasting plasma glucose at 24-28 weeks of gestation: 90.0±9.0 mg/dL (n=43) compared with 93.6±7.2 mg/dL (n=43) (P=.13) or in the incidence of gestational diabetes mellitus at 24-28 weeks of gestation: 48.8% (n=21/43) compared with 58.1% (n=25/43) (P=.51) in the control and exercise groups, respectively. At 36 weeks of gestation, excessive gestational weight gain greater than 9.1 kg was lower in the exercise group, 23.5% compared with 45.2% in the control group (P<.05). CONCLUSION: An intensive, medically supervised exercise intervention for obese women from early pregnancy did not improve maternal glycemia. Pregnant women who are obese, however, should be advised to exercise because it attenuates excessive gestational weight gain. CLINICAL TRIAL REGISTRATION: International Standard Randomised Controlled Trials (ISRCTN) registry, ISRCTN 31045925.

Correction: 1.2 million kids and counting-Mobile science laboratories drive student interest in STEM.

[This corrects the article DOI: 10.1371/journal.pbio.2001692.].

1.2 million kids and counting-Mobile science laboratories drive student interest in STEM.

In today's increasingly technological society, a workforce proficient in science, technology, engineering, and mathematics (STEM) skills is essential. Research has shown that active engagement by K-12 students in hands-on science activities that use authentic science tools promotes student learning and retention. Mobile laboratory programs provide this type of learning in schools and communities across the United States and internationally. Many programs are members of the Mobile Lab Coalition (MLC), a nonprofit organization of mobile and other laboratory-based education programs built on scientist and educator collaborations. A recent survey of the member programs revealed that they provide an impressive variety of programming and have collectively served over 1.2 million students across the US.

Time and temperature affect glycolysis in blood samples regardless of fluoride-based preservatives: a potential underestimation of diabetes.

Background The inhibition of glycolysis prior to glucose measurement is an important consideration when interpreting glucose tolerance tests. This is particularly important in gestational diabetes mellitus where prompt diagnosis and treatment is essential. A study was planned to investigate the effect of preservatives and temperature on glycolysis. Methods Blood samples for glucose were obtained from consented females. Lithium heparin and fluoride-EDTA samples transported rapidly in ice slurry to the laboratory were analysed for glucose concentration and then held either in ice slurry or at room temperature for varying time intervals. Paired fluoride-citrate samples were received at room temperature and held at room temperature, with analysis at similar time intervals. Results No significant difference was noted between mean glucose concentrations when comparing different sample types received in ice slurry. The mean glucose concentrations decreased significantly for both sets of samples when held at room temperature (0.4 mmol/L) and in ice slurry (0.2 mmol/L). A review of patient glucose tolerance tests reported in our hospital indicated that 17.8% exceeded the recommended diagnostic criteria for gestational diabetes mellitus. It was predicted that if the results of fasting samples were revised to reflect the effect of glycolysis at room temperature, the adjusted diagnostic rate could increase to 35.3%. Conclusion Preanalytical handling of blood samples for glucose analysis is vital. Fluoride-EDTA is an imperfect antiglycolytic, even when the samples are transported and analysed rapidly provides such optimal conditions. The use of fluoride-citrate tubes may offer a viable alternative in the diagnosis of diabetes mellitus.

Effectiveness of Animal Assisted Therapy after brain injury: A bridge to improved outcomes in CRT.

BACKGROUND: Animal Assisted Therapy (AAT) has been widely used as a complementary therapy in mental health treatment especially to remediate social skill deficits. The goal of AAT is to improve social, emotional, and cognitive functioning. OBJECTIVE: The purpose of this article is to draw upon the literature on AAT and explore specific applications to cognitive rehabilitation therapy (CRT) and social skills training. METHODS: This study provides a systematic review of most of the available literature on ATT and assesses that potential uses of ATT for brain injury rehabilitation. RESULTS: Although the efficacy of AAT is not currently well documented by rigorous research, (Kazin, 2010) anecdotal evidence suggests that brain injury survivors may benefit from the combination of AAT and cognitive rehabilitation techniques. CONCLUSIONS: Acquired Brain Injury (ABI) survivors with cognitive impairments can benefit from AAT as part of a comprehensive and holistic rehabilitation treatment plan.

The role of preanalytical glycolysis in the diagnosis of gestational diabetes mellitus in obese women.

OBJECTIVE: The objective of this prospective observational study was to determine whether the preanalytical management of maternal plasma glucose samples had a significant effect on glucose measurements in obese pregnant women. STUDY DESIGN: Based on the accurate calculation of body mass index in the first trimester, obese women were recruited at their convenience. In 1 cohort, fasting glucose level was measured in early pregnancy; in the other cohort, an oral glucose tolerance test was performed at 24-28 weeks' gestation. Paired samples were taken from all women in both cohorts. The first sample was transferred to the laboratory in iced water for immediate analysis (fast-tracked analysis). The second sample was not placed on ice and transferred according to established hospital practices (hospital-tracked analysis). RESULTS: Of the 24 women who had a fasting glucose test in early pregnancy, the result was abnormal (≥5.1 mmol/L) in 7 women (29%) with hospital-tracked analysis compared with 16 women (67%) with fast-tracked analysis (P < .01). The mean phlebotomy-analysis interval was 119 minutes for the hospital-tracked samples compared with 23 minutes for the fast-tracked samples (P < .001). Of the 24 women who had a glucose tolerance test, the fasting glucose level was abnormal in 4 women (17%) after hospital-tracked analysis compared with 13 women (54%) after fast-tracked analysis (P < .01). The hospital-tracked phlebotomy-analysis interval for the fasting sample of the 24-28 week oral glucose tolerance test cohort was 166 minutes compared with 25 minutes for the fast-tracked samples (P < .001). CONCLUSION: Unless maternal fasting glucose samples are transported on ice and analyzed immediately in the laboratory, gestational diabetes mellitus will be underdiagnosed in obese women.

Establishing trimester-specific maternal thyroid function reference intervals.

BACKGROUND: Thyroid disorders are common in women of childbearing age and are associated with adverse pregnancy outcomes. Physiological changes in pregnancy and the lack of pregnancy-specific reference ranges make managing thyroid disorders in pregnancy challenging. Our aim was to establish trimester-specific thyroid function reference intervals throughout pregnancy, and to examine the prevalence of thyroid autoimmunity in otherwise euthyroid women. METHOD: This was a prospective, cross-sectional study of thyroid function tests (TFTs) in pregnant women attending a large, tertiary referral maternity hospital. Patients with known thyroid disorders, autoimmune disease, recurrent miscarriage, hyperemesis gravidarum and pre-eclampsia were excluded. TFTs were analysed in the CUH biochemistry laboratory using Roche Modular E170 electrochemiluminescent immunoassay. Trimester-specific reference ranges (2.5th, 50th and 97.5th centiles) were calculated. RESULTS: Three-hundred-and-fifty-one women were included into the analysis. Median maternal age was 30. Thyroid-stimulating hormone concentrations showed slightly increasing median centile throughout gestation. Free thyroxine (T4) and T3 decreased throughout gestation. Table 1 demonstrates the calculated percentiles according to gestational weeks. CONCLUSION: We established pregnancy-specific thyroid function reference intervals for our pregnant population, for use in clinical practice.

Repeatability of extra-pair mating in tree swallows.

Models of sexual selection assume that female mating preferences are heritable and, thus, repeatable for individual females across multiple mating episodes. Previous studies of the repeatability of female preference have examined individuals in captivity and focused presumably on social mate choice. However, extra-pair mating is widespread and can also influence sexual selection. We examined the repeatability of extra-pair mating in a wild population of tree swallows (Tachycineta bicolor) by experimentally inducing females to lay two clutches in rapid succession within the same season. We found that the proportion of extra-pair young and the number of extra-pair sires were highly repeatable for individual females. However, the repeatability of specific extra-pair sires was low. We suggest that this unusual pattern of mating may be due to females maximizing the heterozygosity of their offspring.