School Uniform Should Not Be Abolished

Joanna Chong 06. 12. 2011 School Uniforms Should Not Be Abolished Good morning to all my friends. Imagine if you need to choose which clothes to wear to school every morning so that you will look pleasing to everyone in the school, how will you feel? Would you feel very troublesome? Our school plans to abolish school uniforms and allows students to wear any clothes to school. This issue becomes a talking-point in our school. I am totally against the idea as I think uniforms are totally necessary to build proper school culture. Today, I am here to convince you that school uniforms should not be abolished.The reasons why school uniforms should remain are because it brings a lot of advantages to students. First, school uniforms promote a sense of belonging and create good school culture. When all the students wear the same uniform, the spirit of learning in school will be uplifted. It shows that the school expects high standards and students respond with better behavior. Wearing school uniforms also can prevent students especially girls from wearing clothes which harsh to the eye such as miniskirt, sexy dress, short pants and so on.On the other hand, boys can focus on their study if girls wear proper uniforms in school. Besides, equality among students can be maintained in school. No matter what family background are the students having, they will wear the same uniform and the difference between rich and poor is smaller. A student who comes from less fortunate family does not need to worry about being bullied or being disdained in school just because he wears older clothes. Apart from that, students can save their time in the morning to do other things like having breakfast by just simply wearing school uniforms.This is because they do not have to waste time thinking of what to wear to school and how to decorate themselves by putting some decorations on their clothes. Moreover, school uniforms help students to focus on study instead of fashions and trendy clothes. Futhermore, wearing a uniform helps to prepare students for working in the future. This can help students to adapt with the condition of wearing uniforms to work in the future. People like nurses, doctors, the firemen and the policemen wear uniform as part of their job.Other working adults also wear suits to work. In conclusion, school uniforms should not be abolished. Reasons are that school uniforms give a sense of belonging to us, maintain equality among students, help students to focus on study and help them to prepare for working in the future. Therefore I urge all of you, my friends, to sign a petition to the school administration board so that they can take into consideration of the benefits of having us, students to wear school uniform. Thank you. (460 words)

Discussions of race and community relations in all facets of American life are often limited to generalized attitudes that are interracial

Discussions of race and community relations in all facets of American life are often limited to generalized attitudes that are at base, interracial. That is to say, the dominant, or white culture, sets standards for the perceived subordinate culture. The expectation is that all cultures that make up the United States must adhere to what is American in order to benefit from the promises of America and its Constitution, that of liberty and prosperity. To complicate matters, the dominant culture also dictates who reaps the benefits of Americanism, despite behavior. Throughout American history there have been many folks who challenge such notions for the sake of a single cause. Whether it is the abolition of slavery, women's suffrage, or education and housing reform, protest, or the ability of an oppressed group to say â€Å"no† to injustice and lack of choice grounded this nation. While on the surface such protests are commendable and admirable, an undercurrent exists that is usually left unchecked. Freedom to earn money and prosper as well as own land is within ones rights as an American that have been upheld as â€Å"self-evident. What complicates such a simplistic and arguably accessible accomplishment is that one group determines how far another group can go, the extent its members can be successful. This notion of superiority is seen within cultures in this country as well. When discussing the history of Blacks in America, the legacy of slavery must be acknowledged as a constant line feeding into ideas of superiority. Such ideas permeate attitudes of whites towards blacks, yet ironically; it also nourishes beliefs within the black community and causes the drawing of class distinctions. Adopting the attitudes and beliefs of ones oppressors and pinning such expectations –not being open to examining and maintaining ones own culture in the midst of or in spite of a dominant culture contributes to the holding back of progress. It can be construed that uplifting the race, based on white paternalistic notions of respectability serves a very limited purpose. Ignoring or attempting to eradicate free black Americans relatively young past in order to accept and uphold standards designed for another culture, namely the dominant one, only serves to polarize an already fragmented culture. Since before freedom, free blacks in the North established class lines comparable to their white counterparts. There was a clear black aristocracy made up of well-educated, wealthy and professional blacks. Many determined that the closer they were to white culture the more superior, much like the stratification that existed on slave plantations when the slaves who possessed the lighter complexions found themselves working closer to the master and his family. Such slaves often experienced privileges that the darker-skinned slaves could not even imagine. The legacy of slavery is most prevalent as class distinctions are drawn among blacks. Where this is seen even more, ironically at time just a half-century beyond slavery, is during the Great Migration. Many established northern blacks saw themselves as successful, having achieved middle class status. While working on uplifting the race to a level of respectability, that is, a most acceptable group among middle class whites, they adhered to faith, hope, and charity. Faith occurred in the form of the church, hope in the manner in which many experienced prosperity, and charity, that which was offered the less fortunate migrants fresh from the cotton fields, who needed to be groomed for proper behavior. Even with faith, hope, and charity, like their white counterparts, the sense of superiority among the established black community made it clear that only a select few would reap the benefits of the liberty and prosperity promised to all. Eastern cities like Washington, DC had a clear distinction between free blacks and the black aristocracy. The lines were drawn with regard to churches one attended, clubs in which one belonged, and neighborhoods where one could purchase homes. Likewise, whites, too, determined class lines based on what they deemed appropriate behavior of the Negro. For example, in 1916 Mary Church Terrell, daughter of one of America's first black millionaires, was refused service at a drug store soda fountain. She and her husband formally protested to the store manager, who immediately apologized for the clerk and said, â€Å"We do not care to serve people of any race at our fountain who are not genteel, but such objection certainly could not obtain against your wife, yourself and any high class colored person† (Gatewood 67). Clearly for some whites the aristocrat of color warranted different and better treatment than did ordinary blacks. In black communities throughout the US, old established families occupied a position of aristocracy. As a black observer noted, â€Å"almost all communities possess a few thoroughbred families who glory in lineal ancestry and carry wherever they go the tone and flavor of unconscious refinement, pride, that manifest their culture, achievement, behavior, and ancestry. Family trees genealogical charts often included an assortment of European noblemen, white American statesmen, African kings, and Indian Chieftains. Even Chicago where there is nothing old, I found the same spirit† (Higgenbotham 70). In Chicago the black population in 1880 was 6480 and increased seven-fold by 1910. There were groups called the 400, the upper 10's, and the high-toned people. (Higgenbotham 117). Stratification in black society, one Chicago editor noted was â€Å"proceeding along its natural course exactly analogous, or at least similar to, the formation of social groups of the white race in this country† (Gatewood 124). The Great Migration forced the established Black community in Chicago to make major adjustments and accommodations. Historically, black churches and civic groups had, like their counterparts in the South, resisted any involvement in social issues. The arrival of hundreds of thousands of migrants, however, simply could not be ignored; churches, being African- Americans richest and most influential institutions, were quickly called to action in the effort to help migrants properly adjust themselves to life in Chicago. Blacks already living in Chicago, Old Settlers were aware of the implications of the Great Migration. The Old Settlers strove to establish respect from whites and a sense of equality within the city's socio-economics system. With the arrival of southern blacks, most of whom were unfamiliar with urban mores, the Old Settlers feared that the progress they had achieved would be dashed. They feared that all whites would equate all blacks with the rural and uneducated migrants. Moreover, the Old Settlers realized the enormous strains placed on many of the migrants who arrived lacking a place to live or a sense of direction in the achievement of personal stability. This is where the church and civic organizations played a big role in offering shelter, food, and clothes to the migrants until they could do for themselves. These organizations provided services for migrants, such as assisting them in obtaining a job. They did it for charity yet the self-interest; yet capitalism was ever present. Borrowing from ideologies of Booker T. Washington and W. E. B. DuBois, the church and civic groups adopted the lifting as we climb approach. For men it was good for business, for the women, status was most crucial so they were motivated by position in the community to be charitable. This is many ways mimics the white progressives whose Christian-based affect was prevalent in their charitable work. Likewise, a certain sense of hypocrisy and fear of association influenced the intentions and efforts to Americanize, or make the migrants Chicagoans, the people they were assisting, often resulted in a miscarriage of sensitivity to the values of an established culture. Gwendolyn Wright in her text Building the Dream offers that such reformers â€Å"did bring much genuine concern, but they brought moralistic middle-class biases to their crusade† (Wright 129). This attitude had an impact on the housing issue for blacks in Chicago as lines were drawn, gates were built, and people were shut out. For so many, Chicago was the land of promise and potential. The dream of liberty and prosperity seemed very close at hand as hopeful migrants left their homes in the Deep South. They met many established Blacks in Northern urban centers who â€Å"visualized the progress of their race in terms of education, personal economic success, judicious political action, and co-operation with powerful and influential white people† (Drake 51). From 1890 to 1920 economic, political, and social lives of blacks in Chicago underwent tremendous transformation. (Knupfer 30). It was believed that the influx of blacks had â€Å"Negroes rapidly replacing foreigners as Chicago's problem† (Drake 60). Given this information, advancing the race became an issue and many aristocratic and middle-class blacks felt the dichotomy of being black in America much like their foreign counterparts; allegiance to an ethnic group as well as to America. The result of this duality lead to the class divisions reminiscent of the days of slavery. The select few living life much like the whites or aspiring to do so and many left behind eating the scraps, when they could get them.

President of the National Honor Society Essay

As I review the past several years, there are many accomplishments that I can be proud of. I have been able to maintain a 3. 95 grade point average while in high school. At the same time, I have had the good fortune to act as President of the National Honor Society at Keller High School. I have also been able to lead the drum line battery of the school marching band as the Captain. I have also dedicated much of my spare time to working with youth at Gateway Church as a Youth Group Leader. Finally, I was given the chance to be nominated as Keller High School’s Homecoming King in 2008. All of these accomplishments have helped shape the person I have become. However, the most significant experience that has impacted my life was the time I spent at the Dream Center in one of the many slum neighborhoods of Los Angeles. â€Å"No red or blue clothing,† is what caught my attention as I embarked on the journey to Los Angeles. Simply wearing the trademark colors of the famous Bloods and Crips gangs was something to be avoided. This rule stuck with me more than any other rule or guideline that I had been presented with. Suddenly, the task I was about to undertake became real and I was honestly frightened about what I was going to see. I had been given vivid illustrations about the poverty and death that I was about to witness. However, growing up in an upper middle class neighborhood didn’t prepare me for the reality that many people face each day. I asked myself how do I pray for people whose best days are not even comparable to my worst days. Soon I was able to see firsthand where I would be staying for the next two weeks as I tried to find an answer. The building was called the Dream Center. The fact that I grew up in an affluent neighborhood didn’t prepare me for the horrid accommodations I would be living with. Before settling in I was given a nametag that identified me as a member of the Gateway Church. Although needed for identification, my badge was as irrelevant as a Christmas tree on Halloween. For two weeks I would not be known by the affluent suburb of my origin, but I would be known as a fifteen year old, six foot two, African American male who was a temporary guest of a fifteen story homeless shelter. I accepted my nametag and proceeded to my room. I quickly took in my surroundings and came to the conclusion that my temporary living quarters could certainly be compared to a prison. The room was stark and devoid of any emotion or color. The white walls made the room appear harsh and unfriendly. My roommates and I had only three bunk beds, a nightstand, a closet, a toilet, a sink and six towels, which made for uncomfortable conditions. However, this simplicity allowed us to step outside our comfort zone and prepare ourselves for the work ahead. The white-stained walls, questionable mattress stains, unfamiliar smells, and random bed linens left our young imaginations to do their work, but there wasn’t time to dwell on it – there was work to do! This work was rewarding. There were many opportunities to serve, both individually and as part of a larger group. Some of these missions were optional and some were mandatory. However, this didn’t matter. What truly mattered was the work I was able to engage in so that I could make a small attempt to improve the lives of others. I was able to feed the homeless, work with the children’s ministry and work with the food truck ministry. After a very short time, I realized the dedication of the permanent staff at the Dream Center. I only had the night to rest and I was constantly busy with one task or another during the day. I began to look up to the people who did this job each and every day. During my free time, I engaged in Bible study, prayer groups and devotions in order to prepare for the most challenging and demanding event that was to come. It was an event that would change my life forever. On July 19, 2007 at 5:00pm I began to prepare for a journey that would impact the course of my future. The Skid Row Missions leader gave a short thirty minute preparation speech about the mission I was about to embark upon. â€Å"You are about to embark on one of the most rewarding, frightening, and most dangerous events of your life,† are the words that I will never forget. He led a prayer, gave instructions and also gave caution about the danger of the job I was about to do. I looked around at the others in my group and saw similar emotions on their faces – I was excited and I was scared but the most intense emotion I was feeling was eagerness to go out and do something for someone in need. â€Å"Be smart, be alert, be careful, and trust in God†, our church leader warned as we boarded the fifteen-passenger Ford vans that would take us from relative safety to the harsh and dangerous street known as Skid Row. The van weaved in and out of the notorious Los Angeles traffic making me feel as if I were riding a rollercoaster. I took in my surroundings as they turned grim and dark. The skyscrapers were shot into the darkening sky like a bullet fired to start the Kentucky Derby. New technology and infrastructure meshed with old landmarks to create eye candy for everyone who paid any degree of attention. My excitement began to fade as I saw the sign. The massive green sign that said â€Å"SKID ROW-NEXT EXIT†, reminded me that it was time to become alienated in the new world I was venturing into. I immediately began to sense darkness and death even though it was daylight and everyone around me was alive. My fear soon faded and was replaced with an inner peace from God that told me that I was right where I needed to be. One member of our group voiced what we were all thinking, â€Å"Is this safe? † It didn’t matter anymore – what mattered was that we had arrived and we had a job to do. We couldn’t have known that this simple question would come up again and again as we did our ministry work. We began our ministry by passing out Ozarka water and Famous Amos cookies. We were immediately tested by a large African American male in tattered clothing. He asked for two waters but we had been specifically instructed to only give out one water and one snack to each person. After five minutes of listening to escalating expletives as unpredictable as an F-5 tornado in Texas, we finally gave him a second water. We feared enough for our safety that we felt we had no choice. We continued our work under a thinly disguised veil of complete terror. As we proceeded down the dark streets, I had to constantly remind myself that I was not watching a movie. The people I saw were real and were suffering from very real afflictions. I was able to look past this reality by praying for the people I came into contact with. I prayed for healing, strength, jobs, addictions and sickness and many other things that were on the hearts of these poverty-stricken people. As I prayed, I also began to ponder the images I was seeing. The images began to way heavy on my heart and I wondered how people could live this way. The most important question I asked myself was, â€Å"Why isn’t anyone doing something about this? † I received my answer when I realized that I was doing something. It was something small but it was something. As the trip to the Dream Center came to an end, I was left with a heavy heart and a deep passion to help the poverty-stricken people living in Los Angeles. The Gateway Church youth group was able to break apart my arrogant, spoiled mentality so that I could move toward the mentality of someone who is in survival mode. I stepped into someone else’s everyday life, and had to survive based on the little that I knew. I learned that the world is very different than the small corner of the world where I live. It is my job as someone who has experienced the troubled world to tell other people what the real world is like, so that we can work together to be the voice of the people who struggle to simply survive. I will no longer consider perfect grades and being crowned Homecoming King as my most important accomplishments. Instead, I now know that the events of this trip did more to help me develop into the man I am today and they also set the precedent for the man I will be in the future.

Business Law Written Assignment Research Paper Example | Topics and Well Written Essays - 500 words

Business Law Written Assignment - Research Paper Example An offer Is made with respect to the monetary value and a counter offer is made in return to the offer. The present facts of the case pertains to a minor entering into a contract, since any person below the age of 18years is a minor and cannot take part in a contract. Since Ty is below the age of 18 years, Roes are entitled to disaffirm Ty’s â€Å"agreement† to sell the Van-Damm artwork to Rem, obtaining the artwork back from Rem. According to the commercial lease code, every lease document has to be in signing since it is a document of contract and therefore to invoke any legal action such document must be in written format. Rem cannot invoke his rights of lease until and unless his lease is signed with the parties. Without having signed the lease agreement, he has not become party to such contract and therefore it cannot be ascertained whether he considered entering into the contract or not. The clause to terminate the document is not improper and does not curtail the rights of the individual. Every individual is given a right to exit the contract which is mentioned within the terms of the contract and such right is part and parcel of the existing structure of the contract. No, Rem would not win as there is no written agreement which has been signed between the parties. Since there is no written agreement between the parties it would be impossible to ascertain whether such a contract existed, and therefore it is impossible for Rem to prove such a fact before the court of law. If Rem were to sue Ms. Relief to enforce the terms of the Commercial Lease document (Exhibit â€Å"A†, attached) to allow Rem to lease the Beverly Hills space for his Van-Damm exhibition, would Rem

Social Class systems Essay Example | Topics and Well Written Essays - 250 words

Social Class systems - Essay Example Studies conducted show that forty two percent of men born in the bottom five social classes stay that way when they become adults. To add to the figures, just eight percent of Americans born at the bottom, rise to the top. From this figures it is safe to argue that contrary to popular belief, America is in fact a caste social system. There are various reasons for this argument, the first being that the country has a thin safety net to cushion children from poverty, therefore less class mobility. We find that in most poor children are raised by single parents, a factor which increases poverty levels. This is compounded, by racial discrimination which leaves most people of color, especially African Americans vulnerable and poor, compared to the other races. The second reason is that in our society, education is enables one to get a higher salary. This leaves people from poor families at a disadvantage because upper income parents invest more in their children’s education to increase their chances of success in life. The children of the high income earners go to the best schools and are prepared to learn. It is safe to argue that most people at the top are there due to their backgrounds, more than merit. Ours is therefore a system of the poor remaining poor and the other way round. The kind of education you get how the police treat you and even who you get married to, is largely influenced by your social

Financial Checkup Assignment Example | Topics and Well Written Essays - 750 words

Financial Checkup - Assignment Example The figures clearly indicate that I am credit worth as my assets are capable of covering my credit. In addition, it shows that I understand how to manage my debts as I keep the levels of debts below what I really own (Assets).The figures can be helpful when seeking short term credit to handle my short term needs (Eisenberg 69). According to my income and expense statements, the total expense is $2750 while my income is $900.The total loss is $1840.From this figures, my total expense exceed the total income resulting in a loss. This may be attributed to the fact that being a student, there is little time to engage in income generating activities but there is extensive spending due to a number of requirements in the learning institution and my personal needs. However, my income of 900 dollars show that I am capable of managing my time and engage in part time income generating activities , which clearly indicate that I can utilize time as a major resource in making substantive income(Eisenberg 62). My liquidity ratio is 2.92,which is below the recommended ratio of 3.The ratio shows that my liquid assets cannot meet my current expenses by a difference of 0.8.This can be attributed to the fact that as a student, I am bound to spent more than what I hold as liquid assets. However, the figure is comparatively positive compared to other students as it shows that I can meet most of my current expenses using my own cash and cash equivalents. Further, the figure is not alarming as I can still manage to get external source of cash such as pocket money from parents to cover the current expenses that I may be unable to meet on my own (Eisenberg 33).The debt asset ratio is 0.72.This figure is below 1, which clearly indicates that my assets exceed my debts and so I can pay my debts. Further, the figure shows that I am credit worth when borrowing or applying for a loan. My monthly average amount for revolving savings is$417.This average budgeted amount for every moth show

Built environment organisation and Process Essay

Built environment organisation and Process - Essay Example This dissertation is an attempt in the context of a construction project and takes into consideration the individual capabilities of an architect and a Quantity surveyor in order to determine the most suitable among the two for adopting the role of a lead consultant for a project. The next two sections will outline the work areas and individual areas of specialization of these professionals and the subsequent section will provide a requisite analysis of the two professions with a view to determining the most suitable among them. The prime tasks of an architect are to implement the plan and design of a construction project. Additionally, monitoring the progress and the various stages of construction happen to be the other important tasks. The work environment and methods of an architect are aimed at understanding the needs of the resident at all levels and to the slightest detail. This is due to the fact that designing the elevation and the interior details as well as estimating the dimensions of every entity within the construction project are the sole responsibilities of the architect. The importance of an architect within the purview of a construction project arises from the single fact that he/she must possess the ability to be able to visualize all requirements and needs of the customers in absolute totality as there is virtually no room for any adjustments or modifications once the basic framework is in place. Moreover, an successful architect is always known to leave no stone unturned in ensuring that none of the requirements are left open in an unclear or ambiguous way. As such, an architect sits at the top of the construction hierarchy when it comes to the extent of contact with the customer. There are many cases where the architect is also supposed to be well informed with the legal construction norms of the land (need to elaborate on this) as any kind of plan or design is likely to be influenced either directly or indirectly as a result of which it is extremely necessary to grasp all the norms and constraints beforehand. An able architect always knows the right technology to use for the purpose of construction and as such is entrusted with the responsibility of suggesting the best available methods for construction both to the customer as well as the developer. The usefulness and importance of these suggestions has direct implications on the cost, effort and schedule that goes into the project. Thus, in a way, an architect functions as an interface between the client and the developer. CAPABILITIES OF THE QUANTITY SURVEYOR In any construction project, the management of the finances involved is a major task. This requirement grows both in magnitude, complexity and importance especially when the construction project is huge, spans a long period of time and involves the exchange of money between several hands. As such, keeping track of all the transactions and making the requisite decisions becomes an individual and concentrated task that needs to be handled by a trained qualified and experienced professional. Therefore, in the

David Foster Wallace is on YouTube giving the commencement address at Essay

David Foster Wallace is on YouTube giving the commencement address at Kenyon College, a speech that when published, is called T - Essay Example As a function of seeking to understand this particular speech and a more effective manner, the following analysis will take a nuanced approach, incorporating criticism, review, and analysis of Wallace is pronouncements in the hopes that the reader will gain a more informed understanding with respect to the approach that he champions and the relevance of the information that he presents. Wallace starts by discussing the experience of life; exhorting the listener to â€Å"construct meaning and create relevance† from the otherwise mundane and seemingly pointless activities that all human beings, regardless of their socioeconomic status, race, or ethnic origin, must engage as a function of living. From there, the author delves into the issue of what a liberal arts education actually means; denoting that the education itself means nothing. Rather, the ultimate meaning that is derived from a liberal arts education is solely contingent upon what the individual has the potential to do with it. However, the author strongly encourages the listener to avoid a type of arrogance; maintaining critical awareness in its stead. Whereas it is true, as a Wallace states, that reality is ultimately designed with the individual experience as the only measurement through which understanding can be accomplished, seeking to define the world through such a selfish viewpoint necessarily decreases the degree of empathy and understanding that an individual might otherwise exhibit (Boswell 368). As a function of this, Wallace encourages the individual with regards to what they should pay attention to; defining the debate within oneself and utilizing the liberal arts education as a means of affecting this. As such, not becoming detached, not refusing reality because it is painful, sad, monotonous, or mundane, and continually exercising a right and will towards thinking come to be the prime mechanisms through which Wallace point of view can most reasonably be affected (Veggian 99). In effect, what Wallace is promoting is an understanding of the fact that thinking is a choice and should not be an automatic setting; albeit a choice that a liberal arts education necessarily encourages. Finally, hammering this point home further, Wallace discusses the necessity of not being lulled into a complacent routine. Rather, seeking out â€Å"thinking† and utilizing the experiences and knowledge that are gained from a liberal arts education is not only an opportunity but in fact something of a calling that each and every individual that experiences such an education and can draw upon it must necessarily engage. The irony of all of this has to do with the fact that even though each of these points is effectively expounded upon by Wallace, the author and speaker himself ultimately committed suicide in 2008 (Fest 127). Although the events surrounding his suicide remained largely misunderstood, it is the view of this particular author that Wallace was unable to ascribe to t he high standard of open-mindedness, compassion, and a sense of selflessness that he promoted to the audience within the commencement address. However, this inability upon Wallace part should not be understood as an effective dismissal of the

ROLE OF VIRTUAL ORGANIZATIONS Research Paper Example | Topics and Well Written Essays - 1750 words

ROLE OF VIRTUAL ORGANIZATIONS - Research Paper Example Results were as expected and the findings implied that virtual organizations offer a fashionable way of carrying out virtual businesses guaranteeing proper communication between the employees and e-consumers, ensuring low cost management, promising time-saving transactions and assuring a well collaborative environment with safe conduction of e-commerce, all based on some pixels on the computer screen. Current theories focus on the virtual world which is an online imaginary world or cyberspace world where people live imaginary lives, also called the Second Life, in which they establish and maintain businesses and make real money. The business in a virtual world is referred to as virtual business, the product produced is called virtual product, but the money made is real. In a virtual organization (VO), nothing really exists, or exists â€Å"as pixels dancing on the computer screens of people who inhabit the online virtual world† (Hof). Businesses are carried out on personal computers. Businessmen log into their accounts, interact with their employees, get updated about their performances, carry out commerce online, pay salaries using online payment websites, shop online and make sales online. A VO is a complete world in itself, having virtual products, goods and services. It has its own virtual economy which can even let one own a piece of land. The virtual currency can eve n be converted in to real dollars. VOs have made business possible that only exists in somebody’s brains without the need of tables, desks, chairs, offices, buildings, and cups of tea over meetings. Research has shown that VOs also play a major role in carrying out e-commerce, very much similar to real world. There are auction sites where one can place bids or sell something that one owns. One makes payments and gets paid online. There are shopping websites that let you shop whatever you want while sitting in the comfort of

The things needed by a woman fleeing from domestic abuse Essay Example for Free

The things needed by a woman fleeing from domestic abuse Essay There are many things that one can do to support a woman who is attempting to flee from domestic violence. According to the Domestic Violence Victims Bill of Rights (Andrew Cuomo, 2008). The first critical thing that a survivor of domestic violence needs is assistance to get both her and any children to safety. Safety means to a shelter, or location where one’s partner will not look. Safety also means that the survivor of domestic violence will need legal assistance. Second, they will need legal and law enforcement assistance in obtaining Temporary Restraining Orders, and personal belongings. According to Strong DeVault and Sayad (2001), one fo the most critical things that can be provided for women fleeing from domestic abuse would be emotional and psychological support. This can be provided in any number of ways including, counseling, support groups, and family support networks. 4. 2. Discuss some of the general recommendations that family violence experts make for preventing family violence. Strong, DeVault and Sayad (2001) make several suggestions that can be seen as effective in preventing situations in which family violence might occur. The first solution that is suggested by the experts is that society seeks to reduce societal problems such as, poverty, unemployment, low wages and other factors that contribute to situations of extreme stress within the family. The second suggestion made by Strong, DeVault and Sayad (2001) is that both husbands and wives in a family need equal opportunities to achieve educational and career goals. The third key aspect of preventing family violence according to the experts is to educate men and women about family planning and birth control in order to avoid unplanned or unwanted pregnancy. The final method suggested by Strong, DeVault and Sayad (2001) is to ensure that parents, specifically young parents are educated about parenting as well as about disciplinary methods that are non-violent in nature in order to break the multi-generational cycle of violence that is common to many families. Strong, DeVault, Sayad (2001) suggest that the daycare system be reformed and that preventative programs be developed to stop family violence before it becomes a problem for families. Finally, it is suggest that families receive assistance in developing social support networks in order to end social isolation that may be common in violent family situations. These suggests from the experts are only general however they can guide agencies and therapists who deal with family violence in creating policies and programs to deal with family violence. 4. 3. What is Divorce Mediation and what is its primary goal? Divorce mediation is primarily a means of resolving marital disputes resulting form divorce such as, property division and child custody, without involving the courts, or lawyers. This reduces the stress on the divorcing couple and allows them to settle without the hostility and arguing over these issues that is typically seen in divorce pursued through the court systems. Strong, DeVault, and Sayad (2001) argue that, this is critical for ensuring that the best possible results are obtained for the family in terms of child custody, visitation and child support. Strong, DeVault and Sayad (2001) suggest that divorce medication can have a powerful influence on how well parents get along after a divorce and therefore how well children adjust to a situation of divorce. This means that family members are less likely to have problems if mediation rather than courts and lawyers are utilized in order to avoid hostilities. In fact, avoidance of hostility between divorcing family members is the primary goal of divorce mediation. 4. 4 Based on the work of Visher and Visher, discuss three structural characteristics that make the stepfamily different from the traditional first-marriage family? There are three main ways in which stepfamilies differ structurally from traditional nuclear families. According to Strong, DeVault and Sayad (2001), one major way lies in the fact that one for both parents in a stepfamily may have differing custody arrangements for their children including, sole custody, joint custody, legal custody, physical custody or no custody of their children. Thus children that are brought into the marriage may spend differing amounts of time within the stepfamily and have differing rates of adjustment to living within a stepfamily. Second, the number of parents in the family differs from the traditional two parent family because a child may have a biological mother and father and anywhere from 1-4 stepmothers and stepfathers. This can create conflicts, as the child will have to face different rules and expectations with each family. Finally, Strong, DeVault and Sayad (2001) state that, stepfamilies are larger, and often have more complicated family system than traditional families. References James, Paula (1997) The Divorce Mediation Handbook: Everything You Need To Know. Jossey-Bass, New York, 240 Office of the New York State Attorney General (2008) Domestic Violence Victims Bill Of Rights Retrieved, August 11, 2008, from, http://www. oag. state. ny. us/family/domestic_violence. html Strong, Bryan, DeVault, Christine, and Sayad, Barbara, W (2001) The Marriage and Family Experience 9thEd, Wadsworth/Thomson Publishing, New York,

Handling, Storage and Disposal of Samples

Handling, Storage and Disposal of Samples Expectations of a Health Care Professional In the histology laboratory all specimens arrive fixed in 10% buffered formalin. In the laboratory, the specimen and the request form are labeled with the same lab number. The specimens are left in the same order the lab number is given and processed. Safety gloves and an apron are worn when processing the specimen. Unfixed specimens received in a plane container are fixed in 10% formalin which is commercially prepared and left for one day to process. This is done if the specimen requires fixation. Certain specimens are an exception to this rule. Lymph nodes are wrapped in gauze when lymphoma is suspected, skin sections for Immunofluorescence due to Pemphigus vulgaris are suspended in saline solution, and frozen sections are not fixed since fresh tissue is sectioned for microscopic examination. Whether the result has been reported or not determines which samples are disposed and stored if the result has been reported or not: After the samples are processed the pieces of the sample that were not inserted in the cassette are placed back inside the respective container. The fixed specimen in the container is refrigerated until the result is reported (figure1). 3 weeks after reporting the result a disposal list is created and the specimens to be disposed are packed inside boxes, labeled and then sent for incineration. Samples such as fetus are kept for burial. Empty containers are left for a week and a half as a quality control and for human errors. In many cases the label on the container shows the type of specimen so the empty containers are left in case verification of type of specimen is required. Blocks and slides are stored permanently inside a storage room. All blocks and slides are carefully and methodically filed so they are available for records or for future reference. As years pass blocks remain unchanged but stains on the slide tend to fade so there is sample deterioration. After cutting, the blocks are placed in numerical order according to the year and placed inside boxes. The first and the last number of the blocks in each box are written on the boxes. All sides and top box are labeled and sealed with tape. Slides are filed in numerical order after the report is issued. Slides are placed in a slide box and the lab number of the first and last slide are written on the box. Effective self-management of time and workload The opening hours for the histology are from 6.00 am till 5.00 pm. The lab is open from Monday till Sunday and time shifts are available so the laboratory remains more open and more service is given to the public. The laboratory does not open during night shift because results in the histology laboratory are not considered urgent. Results must first be seen by the pathologist so no immediate results are required so processing is done during the day. Samples that are considered urgent In histology, specimens are not considered urgent because they have to be viewed by the pathologist results are issued. Frozen sections are considered urgent since the sample must be quickly processed so an intra-operative decision can be taken by the surgeon. Samples can also be considered urgent when a pathologist needs the results in a quick time, due to surgery scheduled on that day or the following day. Career-Long Self Directed Learning What is CPD? CPD stands for Continuing Professional Development, an ongoing free training programme in histopathology including histology and cytology (Institute of biomedical Science, 2011). It is defined as â€Å"The systematic maintenance, improvement and broadening of knowledge and skills, and the development of personal qualities, necessary for the execution of professional and technical duties throughout the practitioner’s working life† (The Chartered Institution of Highways Transportation, 2011). This means that CPD allows the employer to improve and to widen knowledge, quality, competence and skills in his/her profession. What constitutes CPD activity? A CPD is constituted by meetings, short courses, conferences or workshops that are created to inform other members of stuff or even the public. Organization and participation are essential for a successful CPD. It must be transparent, accountable and visible (Fox Fox, 2004, p.182). CPD can be done: To present one’s own research report With the aid of websites, journals, posters, books and other printed media To show something encountered during work, that can be of interest to rest of the workers To make and encourage new procedures and changes Introduce a new course that will be of interesting to the public or workers How does the CPD scheme benefit Pathology employers? A CPD scheme enables the biomedical scientist to develop the necessary knowledge, attitudes, personal effectiveness and skills for his/her professional practice. The employer must identify his/her and their employer’s learning needs. In order to improve patient care the employer must be up to date on facts, new concepts and most importantly on opinion and consensus (The Royal College of Pathologists, 2010). The employer can record activity and document all learning achieved (Academy of Medical Royal Colleges, 2010). All this is done not for only the present but also for future progression (Institute of biomedical Science, 2011). What are the benefits to a biomedical scientist (the employee) participating in the CPD scheme? Keep up to date with current rapid and expanding knowledge (The Royal College of Pathologists, 2010). Increases job satisfaction, productivity and quality of working life (Chen, Chang Yeh, 2006) Acquire new skills for safe and effective practice. This builds up confidence in the employee (Institute of biomedical Science, 2011). Promote professional ideas and new initiatives, increasing job satisfaction (Institute of biomedical Science, 2011). Documentation of all that is learned from the scheme is encouraged (The Royal College of Pathologists, 2010). Benefit from quality control measures (Academy of Medical Royal Colleges, 2010). Encourage reflective practice (Academy of Medical Royal Colleges, 2010). Reduce risk of clinical isolation (The Royal College of Pathologists, 2010). Prepare for new roles example managerial. Employers value employees that undergo continuous CPD since such employees show learning agility (Chen et al., 2006; Royal College of Pathologists, 2010). Maintain a reputation of the biomedical possession and public assurance (The Royal College of Pathologists, 2010). Where is the information relating to CPD displayed in Pathology? When a CPD meeting is going to be held all biomedical scientists are informed through an email. The email is sent to the principle to make sure that all the histology staff knows about the meeting. Vertical Audit Site of origin The trucut samples were taken from the right breast upper outer quadrant (Figure 2) Sample Taking and Description of sample The trucut biopsy is taken after a mammography showed a suspicious result. To diagnose, a trucut biopsy was performed. A trucut (core) biopsy is mostly done to sample tissues from a solid mass or calcium deposits, increasing sensitivity (Youk, Kim, Kim, Lee Oh, 2007). Very small masses or masses that are too deep are sampled using a guiding imaging technique. No scars are left after sampling. It has the advantage of being highly sensitive and specific (Sadler et al., 1994). The biopsy was performed at Mater Dei’s surgical operating theater (SOP) (in the Breast Clinic). The patient was given local anesthetic and left for a few minutes. A 16mm gauge core needle (figure 3) was then used to obtain the tissue samples. The tissues sampled contain tissues from the mass and normal healthy tissues from the breast. The sections sampled contain also provide more diagnostic information than mammography and fine needle aspiration. The samples are larger than FNA therefore results are more accurate (Kasraeian, Allison, Ahlmann, Fedenko Menendez, 2010). The clinician or nurse localised the mass and its boundaries and the mass was then immobilised. The needle was inserted through the skin into the lump and the tissue section was taken. To increase the chances of diagnosis 6 trucut specimens were taken. Their length varied from 9mm to 14 mm. The needle was then detached. The trucut specimens were then introduced into a container contain 10% buffered formalin. The container and the request form where received in the histology laboratory the following day. Specimen reception/numbering A courier brought the trucut specimen for histology processing into the histology laboratory. In the laboratory, the request form which comes together with the specimen was left for a day where registration and processing began. The following day, the receptionist used the HOE system to input data so they can be available only in the laboratory. The ID number of the patient was inputted followed by location the specimen was sampled example BOFFA, the name of the medical lab scientist, and the name of the pathologist/consultant. If available, the macro examination results were also included. A label containing the lab number, the letter on the cassette, the last two digits of the year, and the patient’ name and surname was prepared and printed. The label was prepared to label the slide after staining (in this case only one label was required). Specimen Registration The sample and its respective request form were both labeled with a barcode containing a specific laboratory number. The barcode was stuck on the top of the request form and at the back of the container (without covering any patient’s details). The laboratory number was also written with the aid of marker on top of the tap of the container. The request form was stamped at the top and at the bottom with the date in which it was received in the laboratory. The trucut specimen and the other histological specimens were left one after the other, according to the laboratory number. Specimen processing proceeded in this order. Specimen Processing 1. Cut-Up The trucut specimen was first processed in the laboratory at the cut-up laboratory. The name and surname of the patient and the lab number on the request form and on the specimen container were checked. The trucut biopsies in 10% buffered formalin were taken out from the container, using forceps, on the working bench. A macroscopic examination was performed on the 6 trucut biopsies obtained. Their length ranged in length from 9mm to 14mm. They were all embedded in one printed cassette labeled A1. Blue foam was also placed and the cassette was covered with a medal lid. It was then was placed in eosin with the other specimens. The trucut biopsies were then ready for further laboratory processing. After all specimens were cut, a histopathology worksheet was filled in. This included the case number of the patient, the number of tissues taken (6) , the tissue type (breast trucut), the number of blocks (A1), any comments such as left to fix (not applicable), the name of the pathologist who will examine the slides, and the name of the medical laboratory scientist (in this case who performed the cut up). 2. Tissue Processing (Impregnation) The biopsies were processed in an automated processing machine. This was performed in a closed system for trucut specimens using program A. It is important that the specimen is not larger than 3mm since it will not fit and cannot be cut afterwards. The closed system has 14 baths and it provides pressure, waving, bubbling and rotation to the tissues so the reagent can penetrate better. This is performed overnight, therefore the processor is programmed. When time for embedding is prolonged, the fixation time is prolonged to compensate. The tissues were first fixed in 10% buffered formalin so that the fixation was continued They were then dehydrated in 2 baths of 70% alcohol, in 1 bath 95% alcohol and then in 2 baths of absolute alcohol. The dehydrated sections were then moved into the chloroform and xylene. This step was done for clearing. Chloroform is a carcinogen and it affects the nervous system. The tissues were automatically moved in wax for tissue impregnation. This caused the tissues to harden. A temperature of less than 60oC was necessary because a higher temperature would have affected elasticity of the wax. Fumes go in a waste bottle and charcoal filter is present to filter leak. The tissues were now ready for embedding. 3. Embedding During embedding, the formalin fixed processed tissues are surrounded by wax so a solid paraffin block is obtained. This will enable the medical lab scientist to obtain thin sections from the block so that they can be stained and later viewed by the pathologist. The procedure involved was as follows: The cassette was taken from the processor to the warm compartment of the histocentre. The histocentre is an embedding center that facilitates paraffin embedding. It is equipped with a dispenser, specimen handling tank, warmed embedding moulds, warmed forceps wells and warm plate for orientation of the specimen in the melted paraffin. After checking the wax tank was properly filled, the cold plate and light were switched on. The cold plate helps in transferring of the melted paraffin. The tissue cassette was opened and the number on the labeled cassettes was checked with that on the worksheet entry. A suitable mould compartment corresponding to the size of the tissues in the cassette was chosen. The mould was filled with paraffin wax The tissue was placed at the bottom of the mould, correctly orientated. Incorrect orientation ruins the first section taken The trucuts were placed centrally aligned across long axis of the mould, and not placed at random. Adequate border of embedding medium must surround all sides of the tissue to give maximum cutting support. The mould placed in its cassette was placed on a cold plate and allowed to solidify. The block was scraped along a para trimmer to trim excess wax on surface. Tissues embedded must be perfectly flat to ensure that a complete section will be obtained. 4. Microtomy After the block was trimmed, thin sections were now cut using a microtome. The block was first trimmed to expose the area to be sectioned. A sharp non-rusted blade was used not to cause damage to the tissue by scoring. The microtome was cleaned from staples and sutures that remained to avoid damage of the blade. Microtomy was then started. The tightly screwed blade was checked and adjusted in the correct position. The micrometer gauge was set at a thickness of 18-22 µm. The block was placed inside the block holder of the microtome and secured. The block holder was in parallel to the edge of the blade so a straight ribbon of sections was obtained. The block holder was moved using the couae trimming device until the wax block was almost touching the edge of the blade. The fine trimming rotator device was when the block touched the edge of the blade and trimming of the block was started. Excess wax from the surface of the block was removed until the surface of the tissue was exposed. Debris due to coarse cutting was removed using a Camel hairbrush. The block was then placed on ice to cool giving the tissue and the wax similar consistency. Water absorbed by the tissue, slightly swelling it, so cutting is easier later on. If this does not occur sections tend to crease. The block was reattached to the microtome, leaving the left-hand rotator device. The micrometer gauge was then set at 3 µm. A series of sections forming a ribbon were cut and the first one was not used since it is usually thicker than 3 µm. 4 layers were taken. This means that the after the first section was achieved, the next few layers were ignored and then a second section was taken. The same was done for the third and fourth. This is done so that the pathologist can study many layers from the site taken so that diagnosis is more accurate. The appropriate ribbon section (for all the four sections obtained) was gently transferred into a water bath using forceps. The water bath is set a few degrees below the melting point of the wax. The sections were floated onto a glass slide containing 20% alcohol. The ribbon section was then released on the surface of a water bath (at a temperature less than that of melting point of wax i.e. 60oC. The sections were collected on an APES-coated glass slide. They were placed on near the other. Coated APES facilitates adhesion of the sections onto the glass slide. 4 slides were obtained (a slide for each layer taken). The number of the block was written on the glass slide using a diamond pen and placed on a slide rack. It was dried in an oven at about 60oC for 10 minute. 5. Staining Together with the other blocks from the other specimens the slides were dried and now ready for staining. The routine gold standard stain in histology is Haematoxylin and Eosin stain. This was done in an automated staining machine which followed the regressive method. This allowed overstaining of the tissues and removal excess dye by differentiation. The staining procedure was programmed as followed: The slides were left in the heating station so that all water is removed. The slides were dewaxed in a xylene for 4 minutes. This removed the surrounding wax from the tissues. They were then placed in xylene alcohol for 15 seconds. This started the gradual hydration process and prepared the tissues to be stained by haematoxylin dissolved in an aqueous solvent. The hydration process is followed by 2 baths of absolute alcohol (15 seconds each). The slides were then passed into four baths: 95% alcohol, 70% alcohol, 50% alcohol, and 30% alcohol (15 seconds each). They were then passed for 15 seconds in distilled water since haematoxylin stain is water based. The slides were then passed for 10 minutes in haematoxylin stain. The time inside the haematoxylin bath varies according to the properties of the stain. The prolonged use of the stain increases the time the slides pass in the bath. The slides were rinsed in two baths of distilled water, the first bath for 30 seconds and the second bath for 10 seconds. Differentiation then occurred in acid alcohol for 1 second. This allowed the nucleus to retain the stain and to decrease the pH (acidic) so colour changes to light purple. The slides were rinsed in distilled water for 15 seconds. Bluing occurred in tap water for 5 minutes. This raised the pH so sections became light blue. The slides were then passed into a bath containing distilled water for 15 seconds. The slides were passed in absolute alcohol for 15 minutes for dehydration and because this favours alcoholic eosin staining since it is alcohol based. Counterstaining was performed in a bath containing alcoholic eosin for 3.15 minutes. The time in alcoholic eosin varies according to the properties of the stain. The prolonged use of the stain increases the time the slides pass in the bath. Prolonging time allows the cytoplasm to take up the pink eosin stain. The slides were then dehydrated in four baths of acid alcohol, 15 seconds each. The slides were cleared in xylene alcohol for 15 seconds followed in 2 baths of xylene for 5 minutes each. This helps during mounting since DPX mountant is xylene based. The slides were left in the heating station so that all water is removed. The slides were taken out from the rack and mounted with DPX mountant. Quality Control: Two slides are stained with H E stain using the automated machine in the morning before starting routine staining. Errors in staining such as weak stains and contamination (example of eosin) can be detected so they can be solved. The 4 slides of the patient were therefore well stained since the machine passed QC on that day. Results: Nucleus: Blue Cytoplasm and other eosinophilic structures: Pale pink After processing, the number on the slides was checked with that of the cassette and the block. The slides were then labelled with their respective label. The cassette was placed on top of the slide to see if all the stained sections present on the block were sectioned. All the stained sections agreed with those on the block. Role of the Biomedical Scientist The role of the biomedical scientist is to perform all the above procedures. The medical lab scientists are divided into different sections throughout the histology laboratory: in the cut-up room and in the embedding and staining section of the laboratory (excluding immunohistochemistry laboratory). In addition, the biomedical scientist must also fill several worksheets. The initials of the biomedical lab scientists performing the cutup, macro-examination, LID and embedding are written in the histopathology worksheet. The MLS must monitor any changes example in reagents. Any injuries or misshapen occurring in the laboratory must be recorded. Pathologist Role/Result Reporting After staining, the pathologist viewed the slides under the microscope and performed a microscopic examination. The observed results were noted. The microscopic examination results were sent to the secretary who typed the result in the results form. The pathologist then read the results form for any errors and once the result was verified the pathologist authorised the result. Result Entering and Authorisation After the pathologist viewed the slides under the microscope he took the fully written request form to the secretary. The secretary separated the forms into different piles, according to the pathologist. The form was typed in a result form and printed as a result sheet. The written and the print result form were separated into 2 different racks. The report sheet was taken to the respective consultant/pathologist who reviewed the printed result sheet for any mistakes. This includes patient details, clinical details, and examination results. Once the pathologist verified the data written, he used the software to authorise the result. Once the pathologist authorised the result, this was available in the LIS of the cytology and histology laboratories. The CMI system allowed the results to be available to the wards. The result sheet was taken to the secretary where the result form was piled with other results forms according to the pathologist/consultant. Copies were made and sent to ward and patient. Result Issuing (Describe the results form) The results form contains the details of the patient, including the name and surname, address, date of birth, sex and the hospital number. The name of the clinician and the site from where trucut biopsy was taken (SOP) are included. The date the specimen was taken and the date and time it was received are also included. The lab number associated to the specimen is important to be included because besides identifying the patient it can be used for future reference. If the slides or block containing the sections are required they are labelled (including lab number) and stored and easily retrievable. The specimen type and site from where the biopsy was taken, the macroscopic examination and the microscopic examination are all included. The included, in this case â€Å"Benign breast parenchyma of the right breast†. The pathologist and the date and time the result was reported and authorised (by pathologist) and the date and time the result form was printed are also included. Benign Breast Parenchyma: The breast parenchyma forms part of the normal breast tissue. It was reported as benign during microscopy because of few scattered (not clustered) lobules seen in breast sections. Since no atypical features were observed, no special stains or immunohistochemistry staining (example ER or Her-2 stains) were required. It is ideal the patient undergoes regular breast screening. Sample Collection and Specialist Preparation The containers to process routine surgical specimens vary from small to large received in 10% buffered formalin. Very large containers are rare. The container used depends on the size of the specimens. Small specimens such as polyps, prostate scrapings, appendix, trucuts, and trephines are received in small containers containing 10% buffered formalin. Some specimens such as fetus vary in size such as fetus and colon so they received in larger specimens (medium when compared to small containers). Large specimens such as lung, breast, and colon are received in large containers containing 10% buffered formalin. Large specimens require more than one day to be cut. First the specimen is opened and left for an additional day or more for further fixation. The following are types of specimen the laboratory receives that require specialist preparation techniques and the actions taken: Trephine and Bone specimens: – Decalcification with EDTA or formic acid. EDTA is used example for bone marrow trephine and formic acid is used example on bone sternum for one day Figure 4 showing a femur bone undergoing decalcification in EDTA. Infective specimen example with HIV – Over fixation in formalin to kill infective cells* Lymph node –The time of fixation depends on the thickness of the specimen. More time the more the fixative is allowed to penetrate the lymph node.* It is left for two or three days depending on the thickness of the specimen. Over fixation will destroy the surface antigens causing artifacts and a false negative result during immunohistochemistry. Sural nerve: Sent from operation inside a gauze soaked with saline. The request from and case summary are required. The cut up laboratory gives the lab number and send the specimen to the immunohistochemistry laboratory. The tubular sural nerve is wet, and the two ends of the nerve are cut. One end is sent to a pathologist to get an idea of diagnosis and the centre part of the nerve and the other cut end are sent abroad. Muscle: This is received in saline and a lab number is given in the cut up laboratory and then sent to immunohistochemistry laboratory. It is frozen at -70oC and cut by a cryostat at -20oC. The thin sections are then stained with a series of special stains example Oil Red O and with immunohistochemistry stains example myosin. APES coated glass slides are used to prevent the tissue section from sliding off. Imprints: Example lymph node: A slide is pressed on the lymph node and the imprint is sent abroad. The lymph node is then worked normally in formalin. Imprints are used for genetic studies. Liver with no tumour: A series of special stains are performed: PAS – useful if there is a high glycogen content upon staining Reticulin Stain – useful in liver cirrhosis and liver fibrosis Masson’s Trichome Stain – Useful in liver fibrosis Iron Stain – useful for haemosiderosis, haemochromatosis Title: Frozen Sections Aim Performing a macroscopic examination by the pathologist Cut up of the specimen Obtaining sections at -17oC using a micrometer, inside a cryostat Staining the section/s by haematoxylin and eosin stain Performing microscopic examination of the stained section/s by the pathologist Introduction A frozen section is a specific type of biopsy performed during surgery so that a rapid diagnosis of the tissue extracted is made (Brender, Burke Glass, 2011). The tissue can be sectioned and stained in the laboratory for microscopic examination by the pathologist. The surgeon is given flexible intra-operative decision making according to the result given by the pathologist after the rapid processing (KarcioÄÅ ¸lu, 2005, p.121). Principle A surgery is booked and a biopsy is taken and sent to the laboratory. As soon as the fresh specimen arrives in the histology laboratory the pathologist and the selected biomedical scientists start processing the specimen. The pathologist performs a macroscopic examination on the specimen and the observed features are written down by the pathologist. The MLS then start cutting thin sections according to the specimen, using a microtome inside a cryostat at -17oC. The sections are then quickly stained with haematoxylin and eosin stain. In contrary to routine H E, the sections are not passed through xylene and dehydrated down to water. This is because the frozen sections are not embedded in paraffin wax prior staining. Since the stain is very fast there differentiation with acid alcohol is also not performed. After mounting the pathologist checks if the stained slide is satisfactory and after performs a microscopic examination. This lets the surgeon decide what to do next. Materials and Equipment required Cryostat, OCT medium, cryospray, Glass slides, cover slips, disposable pipettes, Procedure 1. Macro-examination The pathologist opens the container/s containing the specimen/s. A macro examination is performed on the specimen/s and the pathologist starts a description so that the medical lab scientist writes on the request form. The description includes the size dimension (length x width x height) in centimeters, the shape of the specimen and if it is soft or hard. The consultant suspects carcinoma and sampling is them performed. 2. Cutting the specimen The consultant cuts piece of the specimen that covers the whole area of the specimen. It is important the most suspicious is included in the segmented section so that the consultant can find and detect the tumour during microscopy. If required, multiple sections can be taken to make a diagnosis. The size cut depends on the size of the sample and tumour. More than one pieces of the specimen can be cut example: two sections from a liver (due to liver transplantation), and from a lymph node attached to the liver. 3. Cryostat The cut specimen/s is/are placed, with the aid of tweezers, in the center of a cryostat object disk containing OCT medium. The cryostat object disk with the tissue is placed on the cryobar (holder) inside the -17oC set cryostat. The tissue is left to settle so it gets cold and this is enhanced by using a cryospray. When the tissue solidifies it is placed onto an object disk holder. The machine is set at 5 µ on the control panel and the block is moved towards the edge of the blade. After making sure it is properly clamped trimming is started. The rotator on the right of the cryostat is turned. The section begins to curl as the block comes in contact with the blade. The section is held down slowly and gently with tweezers and cut until the surface of the tissue is visible. The cryostat is now quickly set at 30 µ (this is the thickness used for most of the specimens in histology). A good section is detached and taken onto a glass slide placed opposite of the block. As the tissue comes in contact with the glass slide it sticks onto it since it melts and adheres to it. The glass slide is immediately in the staining station found adjacent to the cryostat. Haematoxylin and eosin staining is performed. 4. Haematoxylin and Eosin Staining The glass slide with tissue section is f Handling, Storage and Disposal of Samples Handling, Storage and Disposal of Samples Expectations of a Health Care Professional In the histology laboratory all specimens arrive fixed in 10% buffered formalin. In the laboratory, the specimen and the request form are labeled with the same lab number. The specimens are left in the same order the lab number is given and processed. Safety gloves and an apron are worn when processing the specimen. Unfixed specimens received in a plane container are fixed in 10% formalin which is commercially prepared and left for one day to process. This is done if the specimen requires fixation. Certain specimens are an exception to this rule. Lymph nodes are wrapped in gauze when lymphoma is suspected, skin sections for Immunofluorescence due to Pemphigus vulgaris are suspended in saline solution, and frozen sections are not fixed since fresh tissue is sectioned for microscopic examination. Whether the result has been reported or not determines which samples are disposed and stored if the result has been reported or not: After the samples are processed the pieces of the sample that were not inserted in the cassette are placed back inside the respective container. The fixed specimen in the container is refrigerated until the result is reported (figure1). 3 weeks after reporting the result a disposal list is created and the specimens to be disposed are packed inside boxes, labeled and then sent for incineration. Samples such as fetus are kept for burial. Empty containers are left for a week and a half as a quality control and for human errors. In many cases the label on the container shows the type of specimen so the empty containers are left in case verification of type of specimen is required. Blocks and slides are stored permanently inside a storage room. All blocks and slides are carefully and methodically filed so they are available for records or for future reference. As years pass blocks remain unchanged but stains on the slide tend to fade so there is sample deterioration. After cutting, the blocks are placed in numerical order according to the year and placed inside boxes. The first and the last number of the blocks in each box are written on the boxes. All sides and top box are labeled and sealed with tape. Slides are filed in numerical order after the report is issued. Slides are placed in a slide box and the lab number of the first and last slide are written on the box. Effective self-management of time and workload The opening hours for the histology are from 6.00 am till 5.00 pm. The lab is open from Monday till Sunday and time shifts are available so the laboratory remains more open and more service is given to the public. The laboratory does not open during night shift because results in the histology laboratory are not considered urgent. Results must first be seen by the pathologist so no immediate results are required so processing is done during the day. Samples that are considered urgent In histology, specimens are not considered urgent because they have to be viewed by the pathologist results are issued. Frozen sections are considered urgent since the sample must be quickly processed so an intra-operative decision can be taken by the surgeon. Samples can also be considered urgent when a pathologist needs the results in a quick time, due to surgery scheduled on that day or the following day. Career-Long Self Directed Learning What is CPD? CPD stands for Continuing Professional Development, an ongoing free training programme in histopathology including histology and cytology (Institute of biomedical Science, 2011). It is defined as â€Å"The systematic maintenance, improvement and broadening of knowledge and skills, and the development of personal qualities, necessary for the execution of professional and technical duties throughout the practitioner’s working life† (The Chartered Institution of Highways Transportation, 2011). This means that CPD allows the employer to improve and to widen knowledge, quality, competence and skills in his/her profession. What constitutes CPD activity? A CPD is constituted by meetings, short courses, conferences or workshops that are created to inform other members of stuff or even the public. Organization and participation are essential for a successful CPD. It must be transparent, accountable and visible (Fox Fox, 2004, p.182). CPD can be done: To present one’s own research report With the aid of websites, journals, posters, books and other printed media To show something encountered during work, that can be of interest to rest of the workers To make and encourage new procedures and changes Introduce a new course that will be of interesting to the public or workers How does the CPD scheme benefit Pathology employers? A CPD scheme enables the biomedical scientist to develop the necessary knowledge, attitudes, personal effectiveness and skills for his/her professional practice. The employer must identify his/her and their employer’s learning needs. In order to improve patient care the employer must be up to date on facts, new concepts and most importantly on opinion and consensus (The Royal College of Pathologists, 2010). The employer can record activity and document all learning achieved (Academy of Medical Royal Colleges, 2010). All this is done not for only the present but also for future progression (Institute of biomedical Science, 2011). What are the benefits to a biomedical scientist (the employee) participating in the CPD scheme? Keep up to date with current rapid and expanding knowledge (The Royal College of Pathologists, 2010). Increases job satisfaction, productivity and quality of working life (Chen, Chang Yeh, 2006) Acquire new skills for safe and effective practice. This builds up confidence in the employee (Institute of biomedical Science, 2011). Promote professional ideas and new initiatives, increasing job satisfaction (Institute of biomedical Science, 2011). Documentation of all that is learned from the scheme is encouraged (The Royal College of Pathologists, 2010). Benefit from quality control measures (Academy of Medical Royal Colleges, 2010). Encourage reflective practice (Academy of Medical Royal Colleges, 2010). Reduce risk of clinical isolation (The Royal College of Pathologists, 2010). Prepare for new roles example managerial. Employers value employees that undergo continuous CPD since such employees show learning agility (Chen et al., 2006; Royal College of Pathologists, 2010). Maintain a reputation of the biomedical possession and public assurance (The Royal College of Pathologists, 2010). Where is the information relating to CPD displayed in Pathology? When a CPD meeting is going to be held all biomedical scientists are informed through an email. The email is sent to the principle to make sure that all the histology staff knows about the meeting. Vertical Audit Site of origin The trucut samples were taken from the right breast upper outer quadrant (Figure 2) Sample Taking and Description of sample The trucut biopsy is taken after a mammography showed a suspicious result. To diagnose, a trucut biopsy was performed. A trucut (core) biopsy is mostly done to sample tissues from a solid mass or calcium deposits, increasing sensitivity (Youk, Kim, Kim, Lee Oh, 2007). Very small masses or masses that are too deep are sampled using a guiding imaging technique. No scars are left after sampling. It has the advantage of being highly sensitive and specific (Sadler et al., 1994). The biopsy was performed at Mater Dei’s surgical operating theater (SOP) (in the Breast Clinic). The patient was given local anesthetic and left for a few minutes. A 16mm gauge core needle (figure 3) was then used to obtain the tissue samples. The tissues sampled contain tissues from the mass and normal healthy tissues from the breast. The sections sampled contain also provide more diagnostic information than mammography and fine needle aspiration. The samples are larger than FNA therefore results are more accurate (Kasraeian, Allison, Ahlmann, Fedenko Menendez, 2010). The clinician or nurse localised the mass and its boundaries and the mass was then immobilised. The needle was inserted through the skin into the lump and the tissue section was taken. To increase the chances of diagnosis 6 trucut specimens were taken. Their length varied from 9mm to 14 mm. The needle was then detached. The trucut specimens were then introduced into a container contain 10% buffered formalin. The container and the request form where received in the histology laboratory the following day. Specimen reception/numbering A courier brought the trucut specimen for histology processing into the histology laboratory. In the laboratory, the request form which comes together with the specimen was left for a day where registration and processing began. The following day, the receptionist used the HOE system to input data so they can be available only in the laboratory. The ID number of the patient was inputted followed by location the specimen was sampled example BOFFA, the name of the medical lab scientist, and the name of the pathologist/consultant. If available, the macro examination results were also included. A label containing the lab number, the letter on the cassette, the last two digits of the year, and the patient’ name and surname was prepared and printed. The label was prepared to label the slide after staining (in this case only one label was required). Specimen Registration The sample and its respective request form were both labeled with a barcode containing a specific laboratory number. The barcode was stuck on the top of the request form and at the back of the container (without covering any patient’s details). The laboratory number was also written with the aid of marker on top of the tap of the container. The request form was stamped at the top and at the bottom with the date in which it was received in the laboratory. The trucut specimen and the other histological specimens were left one after the other, according to the laboratory number. Specimen processing proceeded in this order. Specimen Processing 1. Cut-Up The trucut specimen was first processed in the laboratory at the cut-up laboratory. The name and surname of the patient and the lab number on the request form and on the specimen container were checked. The trucut biopsies in 10% buffered formalin were taken out from the container, using forceps, on the working bench. A macroscopic examination was performed on the 6 trucut biopsies obtained. Their length ranged in length from 9mm to 14mm. They were all embedded in one printed cassette labeled A1. Blue foam was also placed and the cassette was covered with a medal lid. It was then was placed in eosin with the other specimens. The trucut biopsies were then ready for further laboratory processing. After all specimens were cut, a histopathology worksheet was filled in. This included the case number of the patient, the number of tissues taken (6) , the tissue type (breast trucut), the number of blocks (A1), any comments such as left to fix (not applicable), the name of the pathologist who will examine the slides, and the name of the medical laboratory scientist (in this case who performed the cut up). 2. Tissue Processing (Impregnation) The biopsies were processed in an automated processing machine. This was performed in a closed system for trucut specimens using program A. It is important that the specimen is not larger than 3mm since it will not fit and cannot be cut afterwards. The closed system has 14 baths and it provides pressure, waving, bubbling and rotation to the tissues so the reagent can penetrate better. This is performed overnight, therefore the processor is programmed. When time for embedding is prolonged, the fixation time is prolonged to compensate. The tissues were first fixed in 10% buffered formalin so that the fixation was continued They were then dehydrated in 2 baths of 70% alcohol, in 1 bath 95% alcohol and then in 2 baths of absolute alcohol. The dehydrated sections were then moved into the chloroform and xylene. This step was done for clearing. Chloroform is a carcinogen and it affects the nervous system. The tissues were automatically moved in wax for tissue impregnation. This caused the tissues to harden. A temperature of less than 60oC was necessary because a higher temperature would have affected elasticity of the wax. Fumes go in a waste bottle and charcoal filter is present to filter leak. The tissues were now ready for embedding. 3. Embedding During embedding, the formalin fixed processed tissues are surrounded by wax so a solid paraffin block is obtained. This will enable the medical lab scientist to obtain thin sections from the block so that they can be stained and later viewed by the pathologist. The procedure involved was as follows: The cassette was taken from the processor to the warm compartment of the histocentre. The histocentre is an embedding center that facilitates paraffin embedding. It is equipped with a dispenser, specimen handling tank, warmed embedding moulds, warmed forceps wells and warm plate for orientation of the specimen in the melted paraffin. After checking the wax tank was properly filled, the cold plate and light were switched on. The cold plate helps in transferring of the melted paraffin. The tissue cassette was opened and the number on the labeled cassettes was checked with that on the worksheet entry. A suitable mould compartment corresponding to the size of the tissues in the cassette was chosen. The mould was filled with paraffin wax The tissue was placed at the bottom of the mould, correctly orientated. Incorrect orientation ruins the first section taken The trucuts were placed centrally aligned across long axis of the mould, and not placed at random. Adequate border of embedding medium must surround all sides of the tissue to give maximum cutting support. The mould placed in its cassette was placed on a cold plate and allowed to solidify. The block was scraped along a para trimmer to trim excess wax on surface. Tissues embedded must be perfectly flat to ensure that a complete section will be obtained. 4. Microtomy After the block was trimmed, thin sections were now cut using a microtome. The block was first trimmed to expose the area to be sectioned. A sharp non-rusted blade was used not to cause damage to the tissue by scoring. The microtome was cleaned from staples and sutures that remained to avoid damage of the blade. Microtomy was then started. The tightly screwed blade was checked and adjusted in the correct position. The micrometer gauge was set at a thickness of 18-22 µm. The block was placed inside the block holder of the microtome and secured. The block holder was in parallel to the edge of the blade so a straight ribbon of sections was obtained. The block holder was moved using the couae trimming device until the wax block was almost touching the edge of the blade. The fine trimming rotator device was when the block touched the edge of the blade and trimming of the block was started. Excess wax from the surface of the block was removed until the surface of the tissue was exposed. Debris due to coarse cutting was removed using a Camel hairbrush. The block was then placed on ice to cool giving the tissue and the wax similar consistency. Water absorbed by the tissue, slightly swelling it, so cutting is easier later on. If this does not occur sections tend to crease. The block was reattached to the microtome, leaving the left-hand rotator device. The micrometer gauge was then set at 3 µm. A series of sections forming a ribbon were cut and the first one was not used since it is usually thicker than 3 µm. 4 layers were taken. This means that the after the first section was achieved, the next few layers were ignored and then a second section was taken. The same was done for the third and fourth. This is done so that the pathologist can study many layers from the site taken so that diagnosis is more accurate. The appropriate ribbon section (for all the four sections obtained) was gently transferred into a water bath using forceps. The water bath is set a few degrees below the melting point of the wax. The sections were floated onto a glass slide containing 20% alcohol. The ribbon section was then released on the surface of a water bath (at a temperature less than that of melting point of wax i.e. 60oC. The sections were collected on an APES-coated glass slide. They were placed on near the other. Coated APES facilitates adhesion of the sections onto the glass slide. 4 slides were obtained (a slide for each layer taken). The number of the block was written on the glass slide using a diamond pen and placed on a slide rack. It was dried in an oven at about 60oC for 10 minute. 5. Staining Together with the other blocks from the other specimens the slides were dried and now ready for staining. The routine gold standard stain in histology is Haematoxylin and Eosin stain. This was done in an automated staining machine which followed the regressive method. This allowed overstaining of the tissues and removal excess dye by differentiation. The staining procedure was programmed as followed: The slides were left in the heating station so that all water is removed. The slides were dewaxed in a xylene for 4 minutes. This removed the surrounding wax from the tissues. They were then placed in xylene alcohol for 15 seconds. This started the gradual hydration process and prepared the tissues to be stained by haematoxylin dissolved in an aqueous solvent. The hydration process is followed by 2 baths of absolute alcohol (15 seconds each). The slides were then passed into four baths: 95% alcohol, 70% alcohol, 50% alcohol, and 30% alcohol (15 seconds each). They were then passed for 15 seconds in distilled water since haematoxylin stain is water based. The slides were then passed for 10 minutes in haematoxylin stain. The time inside the haematoxylin bath varies according to the properties of the stain. The prolonged use of the stain increases the time the slides pass in the bath. The slides were rinsed in two baths of distilled water, the first bath for 30 seconds and the second bath for 10 seconds. Differentiation then occurred in acid alcohol for 1 second. This allowed the nucleus to retain the stain and to decrease the pH (acidic) so colour changes to light purple. The slides were rinsed in distilled water for 15 seconds. Bluing occurred in tap water for 5 minutes. This raised the pH so sections became light blue. The slides were then passed into a bath containing distilled water for 15 seconds. The slides were passed in absolute alcohol for 15 minutes for dehydration and because this favours alcoholic eosin staining since it is alcohol based. Counterstaining was performed in a bath containing alcoholic eosin for 3.15 minutes. The time in alcoholic eosin varies according to the properties of the stain. The prolonged use of the stain increases the time the slides pass in the bath. Prolonging time allows the cytoplasm to take up the pink eosin stain. The slides were then dehydrated in four baths of acid alcohol, 15 seconds each. The slides were cleared in xylene alcohol for 15 seconds followed in 2 baths of xylene for 5 minutes each. This helps during mounting since DPX mountant is xylene based. The slides were left in the heating station so that all water is removed. The slides were taken out from the rack and mounted with DPX mountant. Quality Control: Two slides are stained with H E stain using the automated machine in the morning before starting routine staining. Errors in staining such as weak stains and contamination (example of eosin) can be detected so they can be solved. The 4 slides of the patient were therefore well stained since the machine passed QC on that day. Results: Nucleus: Blue Cytoplasm and other eosinophilic structures: Pale pink After processing, the number on the slides was checked with that of the cassette and the block. The slides were then labelled with their respective label. The cassette was placed on top of the slide to see if all the stained sections present on the block were sectioned. All the stained sections agreed with those on the block. Role of the Biomedical Scientist The role of the biomedical scientist is to perform all the above procedures. The medical lab scientists are divided into different sections throughout the histology laboratory: in the cut-up room and in the embedding and staining section of the laboratory (excluding immunohistochemistry laboratory). In addition, the biomedical scientist must also fill several worksheets. The initials of the biomedical lab scientists performing the cutup, macro-examination, LID and embedding are written in the histopathology worksheet. The MLS must monitor any changes example in reagents. Any injuries or misshapen occurring in the laboratory must be recorded. Pathologist Role/Result Reporting After staining, the pathologist viewed the slides under the microscope and performed a microscopic examination. The observed results were noted. The microscopic examination results were sent to the secretary who typed the result in the results form. The pathologist then read the results form for any errors and once the result was verified the pathologist authorised the result. Result Entering and Authorisation After the pathologist viewed the slides under the microscope he took the fully written request form to the secretary. The secretary separated the forms into different piles, according to the pathologist. The form was typed in a result form and printed as a result sheet. The written and the print result form were separated into 2 different racks. The report sheet was taken to the respective consultant/pathologist who reviewed the printed result sheet for any mistakes. This includes patient details, clinical details, and examination results. Once the pathologist verified the data written, he used the software to authorise the result. Once the pathologist authorised the result, this was available in the LIS of the cytology and histology laboratories. The CMI system allowed the results to be available to the wards. The result sheet was taken to the secretary where the result form was piled with other results forms according to the pathologist/consultant. Copies were made and sent to ward and patient. Result Issuing (Describe the results form) The results form contains the details of the patient, including the name and surname, address, date of birth, sex and the hospital number. The name of the clinician and the site from where trucut biopsy was taken (SOP) are included. The date the specimen was taken and the date and time it was received are also included. The lab number associated to the specimen is important to be included because besides identifying the patient it can be used for future reference. If the slides or block containing the sections are required they are labelled (including lab number) and stored and easily retrievable. The specimen type and site from where the biopsy was taken, the macroscopic examination and the microscopic examination are all included. The included, in this case â€Å"Benign breast parenchyma of the right breast†. The pathologist and the date and time the result was reported and authorised (by pathologist) and the date and time the result form was printed are also included. Benign Breast Parenchyma: The breast parenchyma forms part of the normal breast tissue. It was reported as benign during microscopy because of few scattered (not clustered) lobules seen in breast sections. Since no atypical features were observed, no special stains or immunohistochemistry staining (example ER or Her-2 stains) were required. It is ideal the patient undergoes regular breast screening. Sample Collection and Specialist Preparation The containers to process routine surgical specimens vary from small to large received in 10% buffered formalin. Very large containers are rare. The container used depends on the size of the specimens. Small specimens such as polyps, prostate scrapings, appendix, trucuts, and trephines are received in small containers containing 10% buffered formalin. Some specimens such as fetus vary in size such as fetus and colon so they received in larger specimens (medium when compared to small containers). Large specimens such as lung, breast, and colon are received in large containers containing 10% buffered formalin. Large specimens require more than one day to be cut. First the specimen is opened and left for an additional day or more for further fixation. The following are types of specimen the laboratory receives that require specialist preparation techniques and the actions taken: Trephine and Bone specimens: – Decalcification with EDTA or formic acid. EDTA is used example for bone marrow trephine and formic acid is used example on bone sternum for one day Figure 4 showing a femur bone undergoing decalcification in EDTA. Infective specimen example with HIV – Over fixation in formalin to kill infective cells* Lymph node –The time of fixation depends on the thickness of the specimen. More time the more the fixative is allowed to penetrate the lymph node.* It is left for two or three days depending on the thickness of the specimen. Over fixation will destroy the surface antigens causing artifacts and a false negative result during immunohistochemistry. Sural nerve: Sent from operation inside a gauze soaked with saline. The request from and case summary are required. The cut up laboratory gives the lab number and send the specimen to the immunohistochemistry laboratory. The tubular sural nerve is wet, and the two ends of the nerve are cut. One end is sent to a pathologist to get an idea of diagnosis and the centre part of the nerve and the other cut end are sent abroad. Muscle: This is received in saline and a lab number is given in the cut up laboratory and then sent to immunohistochemistry laboratory. It is frozen at -70oC and cut by a cryostat at -20oC. The thin sections are then stained with a series of special stains example Oil Red O and with immunohistochemistry stains example myosin. APES coated glass slides are used to prevent the tissue section from sliding off. Imprints: Example lymph node: A slide is pressed on the lymph node and the imprint is sent abroad. The lymph node is then worked normally in formalin. Imprints are used for genetic studies. Liver with no tumour: A series of special stains are performed: PAS – useful if there is a high glycogen content upon staining Reticulin Stain – useful in liver cirrhosis and liver fibrosis Masson’s Trichome Stain – Useful in liver fibrosis Iron Stain – useful for haemosiderosis, haemochromatosis Title: Frozen Sections Aim Performing a macroscopic examination by the pathologist Cut up of the specimen Obtaining sections at -17oC using a micrometer, inside a cryostat Staining the section/s by haematoxylin and eosin stain Performing microscopic examination of the stained section/s by the pathologist Introduction A frozen section is a specific type of biopsy performed during surgery so that a rapid diagnosis of the tissue extracted is made (Brender, Burke Glass, 2011). The tissue can be sectioned and stained in the laboratory for microscopic examination by the pathologist. The surgeon is given flexible intra-operative decision making according to the result given by the pathologist after the rapid processing (KarcioÄÅ ¸lu, 2005, p.121). Principle A surgery is booked and a biopsy is taken and sent to the laboratory. As soon as the fresh specimen arrives in the histology laboratory the pathologist and the selected biomedical scientists start processing the specimen. The pathologist performs a macroscopic examination on the specimen and the observed features are written down by the pathologist. The MLS then start cutting thin sections according to the specimen, using a microtome inside a cryostat at -17oC. The sections are then quickly stained with haematoxylin and eosin stain. In contrary to routine H E, the sections are not passed through xylene and dehydrated down to water. This is because the frozen sections are not embedded in paraffin wax prior staining. Since the stain is very fast there differentiation with acid alcohol is also not performed. After mounting the pathologist checks if the stained slide is satisfactory and after performs a microscopic examination. This lets the surgeon decide what to do next. Materials and Equipment required Cryostat, OCT medium, cryospray, Glass slides, cover slips, disposable pipettes, Procedure 1. Macro-examination The pathologist opens the container/s containing the specimen/s. A macro examination is performed on the specimen/s and the pathologist starts a description so that the medical lab scientist writes on the request form. The description includes the size dimension (length x width x height) in centimeters, the shape of the specimen and if it is soft or hard. The consultant suspects carcinoma and sampling is them performed. 2. Cutting the specimen The consultant cuts piece of the specimen that covers the whole area of the specimen. It is important the most suspicious is included in the segmented section so that the consultant can find and detect the tumour during microscopy. If required, multiple sections can be taken to make a diagnosis. The size cut depends on the size of the sample and tumour. More than one pieces of the specimen can be cut example: two sections from a liver (due to liver transplantation), and from a lymph node attached to the liver. 3. Cryostat The cut specimen/s is/are placed, with the aid of tweezers, in the center of a cryostat object disk containing OCT medium. The cryostat object disk with the tissue is placed on the cryobar (holder) inside the -17oC set cryostat. The tissue is left to settle so it gets cold and this is enhanced by using a cryospray. When the tissue solidifies it is placed onto an object disk holder. The machine is set at 5 µ on the control panel and the block is moved towards the edge of the blade. After making sure it is properly clamped trimming is started. The rotator on the right of the cryostat is turned. The section begins to curl as the block comes in contact with the blade. The section is held down slowly and gently with tweezers and cut until the surface of the tissue is visible. The cryostat is now quickly set at 30 µ (this is the thickness used for most of the specimens in histology). A good section is detached and taken onto a glass slide placed opposite of the block. As the tissue comes in contact with the glass slide it sticks onto it since it melts and adheres to it. The glass slide is immediately in the staining station found adjacent to the cryostat. Haematoxylin and eosin staining is performed. 4. Haematoxylin and Eosin Staining The glass slide with tissue section is f