Achilles' Rejection of Agamemnon's Offer Essay Example | Topics and Well Written Essays - 250 words

Achilles' Rejection of Agamemnon's Offer - Essay Example Greeks heroes were known to perform heroic deeds, and Achilles is an opposite of this. He could have used the opportunity to accept the offer and show his heroism. His action of refusing to participate in the battle stained his heroic code of honor as both his friends, and the Greeks questioned whether he was a patriot to his country (Homer & John, 345). Known by the public as a great fighter, Achilles act of refusing to participate in the battle is an irony. Therefore, all the happenings that took place in the war were blamed on him because, as a warrior, he had refused an honorable settlement and allowed his pride to destroy his nation (Homer & John, 350). In conclusion, the act of Achilles in refusing reconciliation was a wrong act since the result was the fall of Greek and death of other talented fighters. Pride is a healthy aspect for self-image, but when in-excess, it becomes a tool of

Definition Nature And The Humanities

Definition Nature And The Humanities Nature is the vague and elusive subject of millennia of thought. It is the tangible self evident life found in both backyards and expansive forests. Nature is a container for and of life, created but uncreatable. It is thought by some to be the creation of deliberate intention but which is unable to be created by human efforts. Of all the elusive traits attributable to this vague object of thought, an important concept may be found behind all of the endless contradictions Nature so fervently thrusts upon its observers: Nature itself may actually be a symbol for something greater which poets and authors have alluded to. The nature of Nature is living. Many descriptions can be attached but dead, lifeless, empty, exanimate are not among them. Often those words are readily employed to describe a place where Nature once was found but no longer resides. Reflecting the ever apparent principle of duality Nature exhibits its closeness to Divinity by being both the most accepting and the most rejecting of forces. Nature will accept any outcast and might very well be so rejecting as to kill anything that dares step into the expansive realm it dominates. Many inhabitants live in the home Nature creates but those creatures only reflect what Nature has given them: life. Yet the recipients are not Nature. Nothing in it can be taken and said to be Nature itself but without the creatures which inhabit it, Nature ceases to live. The closer an object tends to be to the source of life of all that is living, the more it is subject to symbolic attribution. It becomes an archetype. In addition Nature is nebulous, which compounds the capacity for symbolic usage. And the authors who grasp this concept are only able to describe it in a nebulous manner, as they see it. The preceding three cardinal examples lead up to the concluding example of why Nature is so conducive to symbolic attributions. There is a cornerstone reason, more important than all the others as to why Nature holds so much meaning to humans, without which nothing else would matter in our understanding. It is a truth everyone knows but few truly know. This apparent self contradiction so characteristic of Nature gives another hint at what it is. If a person looking for red on a rainbow has found yellow then orange, red is not far off. This leads to the conclusion Nature is an objectively real, living entity given life by its observers. Nature is living but apparently not conscious. Nature is objectively real but cannot maintain its separate existence without the life given to it by both its observers and inhabitants. Nature gives life to everything without which nothing would have life. These truths lead to understanding Nature is alive but might only have a collective unconscious for a mind. Depending on the readers beliefs this may be due to the Creator of life not giving a single physical holding place for consciousness to function. Or it may be because Nature has not evolved enough to have developed an unconscious, let alone a conscious mind. But there may be a more sublime possibility, one which helps explain its symbolic and powerful nature. Nature might be cognisant at the self conscious level of awareness but at a scale unobservable by humans, similar to how cells in a brain exhibit many characteristics of Nature but at a much smaller scale. This is a practical reason, as opposed to the more nebulous reasoning it might at first seem to be. Nature might be too big to be within the human realm of comprehension. And humans might be so small they are outside of Natures ability to grasp. Cells live and die, form into individual types and perform individual functions, attack and defend themselves from other cells, eat and breathe. If the cells veer too far into the expanse of the body they might die from conditions harsh compared to where it was formed. At this time so much space is allotted to the universe as to render numbers hardly meaningful in relation to it, allowing instead only the ruthless application of an equally incomprehensible symbol: the infinite. Beyond the realm of both human comprehension and mathematics, N atures awareness might be found in the infinite. With archaic properties as powerful as these it is no surprise Nature is a strong a hook for symbolism. Still, Nature might only be a symbol for something greater than itself, something that holds the true properties which Nature can only symbolize. Authors who write on the subject seem to allude to not only Nature itself but the power behind it. This seems to refer to a God or Creator. Or it may be a divinity from the complete composition of everything. Authors do not write in consensus of a single Creator but do seem to agree that there is something behind Nature. Not so much religious as spiritual, these writers lead the reader to the conclusion there is a force there. It is a force that Nature is both symbolic and reflective of. Similar attributions can be derived from both this Great Spirit and Nature: living, powerful, dangerous, accepting, and rejecting. Nature may also at the same time, independent of spiritual symbolism, be a symbol of the self. People may go into Nature to reconnect to themselves. We might go to Nature to recharge and get away from artificial lifestyles. To project characteristics of the self onto a hook in psychology is called projecting. This allows for us to hook our own characteristics onto something that is outside us. So Nature could be either a powerful subjective hook which is similar to us in many ways or it might actually posses those traits. Either could be true or both at the same time and still lead people to seek out themselves in Nature as they have always done. Nature dominates. It is a force to challenge the self, allowing for outside experiences representative of internal workings. It waits to dominate or be dominated. Ironically and again consistent in its self contradictory nature, the dominator is waiting for domination. Either created or evolved, Nature remains a battleground to test the self against. It is a force to give meaning to the ability of anyone who puts themselves in its way. To survive a tornado, earthquake or even a night in a tent after roasting marshmallows at a cozy campfire with friends is a symbolic victory of the self over Nature. Nature fulfills a part of the soul which needs to dominate. By accepting this challenge and leaving a much safer civilized city, even for a short period, can give renewed vitality and meaning to life, if you survive. The symbolism of Nature is too expansive to be reduced to a definition any paper is able to give but applied and reasonable thought leads to both some comprehension of Nature and of the divinity it may be a symbol of. People who go to Nature to find themselves will. And people who turn to Nature as a place to recharge their lives with meaning and power will succeed. As long as life exists so will Nature. Although Nature may be damaged by human pollution or other non human events, Nature will live as long as life itself exists. A symbol for life, God and each every individual, it remains a powerful subject for authors, poets and others who have always and will rightfully continue to attribute those symbolic characteristics to Nature.

Verbal Image Translation Analysis Based Upon Ian Flemings From Russia With Love :: essays research papers

This paper deals with the problem of verbal image translation from SL ( English ) into TL ( Ukrainian ). The research is based on comparison of the original [ 1; 337p. ] and Ukrainian translation [ 2; 190p. ] of Ian Fleming’s â€Å" James Bond : From Russia With Love† A few words should be mentioned about the author and his book . Ian Fleming ( 1908 – 1964 ) was a great journalist and detective stories writer . In 1931 he joined Reuters news agency, and during the World War 2 he was a personal assistant to the Director of Naval Intelligence at the admiralty, rising to the rank of commander . At this time he acquired the first-hand knowledge of secret operations . He started his first James Bond novel â€Å" Casino Royale† at the age of 44 , by which time he became the foreign manager of Kemsley Newspapers . He wrote it in the Golden Eye , the house he had built in Jamaica . James Bond has won Ian Fleming the world fame , being the greatest British fictional icon of the late 20-th c. The book is about a British secret agent James Bond , on whom every major foreign government has a file, and whom the Russia’s deadly SMERSH organisation has targeted for elimination – they have the perfect bait in the irresistible Tatiana Romanova . Her mission is to lure Bond to Istanbul and seduce him, while her superiors handle the rest . Bond walks into the trap – but he is always the one to win . The language of this detective story is mostly unexpressive, unemotional, and the stylistic devices ( SD ) that the author uses are typical of the genre : the lyrical images are absent, most of the SDs are used as the means serving to create the picture of the cold, ruthless world of constantly alternating death and fight for survival . Artistic images mostly are stylistically neutral , as no or little expressiveness or emotional colouring is present in them . The same concerns the idioms and phraseologisms ( of which the verbal image is the basic constituting element [ 3 ; 28 ] ) occuring infrequently . The translated work of art is percepted as the artistic one only provided that it corresponds to artistic and stylistic tradition of the TL [ 3; 28 ] .

Whats Medicaid And Medicare Reimbursement Health And Social Care Essay

What is Medicaid and Medicare reimbursement. In this paper you will see a glance of funding issues each province has when working with reimbursement issues. The Medicaid plan administered by single provinces but besides involves federal support and is the beginning of medical coverage for low income patients. In Georgia the population wellness direction plan was implemented to measure growing in wellness attention outgos. A non-experimental attack was used to analyse claims informations from Georgia Medicaid for all plan eligible individuals for each relevant clip period ( purpose to handle footing ) . The economic impact of reimbursement is outstanding in mention to existent cost and Medicaid cost tendencies.Introduction:Medicaid disbursement represents 15 per centum of all US wellness attention disbursement. In financial twelvemonth 2007, national Medicaid plan outgos were $ 332.2 billion, with 43 per centum ( $ 142.6 billion ) borne by provinces. Entire Medicaid plan outgos are projected to increase $ 673.7 billion by 2017 at the rate of 7.9 per centum Pr twelvemonth ( Truffer, CJ, 2010 ) . Medicaid disbursement ranks 2nd among all costs in many province budgets, accounting for 17 per centum of province budgets on norm ( Wildason DE. 2010 ) . Since the state is confronting terrible budget shortages and the growing of Medicaid disbursement is increasing many provinces have adopted cost salvaging such as decreases in supplier payments, coverage and has increased cost sharing with the enrollees. Some provinces have get downing carry oning analyzes to foretell outsourcing Medicaid reimbursement to managed attention organisations ( MCOs ) , negot8iating a planetary rate per member per month ( PMPM ) . One scheme used which is increasing is the aiming of high-cost chronically ailment or handicapped subset of the Medicaid population as execution of a disease direction ( DM ) plan to better wellness results while incorporating cost ( Flowers, L, 2010 ) . The public presentation indexs of the DM plans typically include: ( 1 ) Overall cost nest eggs ( normally based on the sum spent PMPM as compared to some baseline tendency ) ( 2 ) Component cost nest eggs ( decreases in exigency room visits or hospital admittances, as compared to the baseline and ( 3 ) Tax return to investing ( which accounts for plan costs every bit good as medical nest eggs ) . However, grounds of the effectivity of these plans within either Medicare or Medicaid populations is assorted ( Gillespie JL, 2003and Bott, DM, 2009 ) . Although DM plans target persons with specific diseases, surveies of more planetary population wellness direction ( PHM ) plans aiming clinically and socially complex disabled section of Medicaid populations are thin.MethodThe Georgia Department of Community Health contracts with 2 private sector DM sellers to organize and present population wellness outcomes direction services, the plans service the aged, blind, and handicapped population in different parts of the province. This survey focuses on the plan covering Atlanta and North Georgia. Sevenn diseases were targeted for direction ( asthma, chronic clogging pneumonic disease, congestive bosom failure, coronary arteria arteria disease, diabetes, haemophilia, and schizophrenic disorder ) , the plan result and fiscal inducements are tied to overall cost and quality results for all eligible enrollees, irrespective of disease or comorbidity. Georgia paid the North Georgia vendor a $ 13.94 PMPM capitation payment. Medicaid members enrolled in the plans received a wide array of attention services, a 24/7 nurse advice line, educational services, and member/provider analysis utilizing use and claims informations. The nucleus of the intercession squad is the registered nurse â€Å" wellness manager, † but the squad besides includes societal workers, druggists, mental wellness professions, and supplier engagement staff. Georgia ‘s proposed Balancing Incentives Program will be used to further spread out the usage of community-based long term attention services through the followers: aˆ? Expand the figure of slots in Georgia ‘s five 1915 ( degree Celsius ) Medicaid Waiver Programs aˆ? Provide an addition in reimbursement for paediatric place wellness services, thereby increasing entree to home-based, station ague services and cut down yearss spent in the infirmary aˆ? Fund three new community-based services for Medicaid receivers with serious and relentless behavioural wellness demands. The services have been proposed through State Plan Amendment. aˆ? Expand intensive community-based services to youth with serious emotional perturbations and their households. aˆ? Expand the Georgia Pediatric Program ‘s Medically-fragile Day Care service through slot enlargement and age enlargement. aˆ? Adopt Georgia ‘s 12 Aging and Disability Resource Centers as the primary point of entry for place and community services aˆ? Provide web-based preparation on community-based long term attention services available to targeted referral beginnings. The proposed budget for Georgia ‘s Balancing Incentives Program is $ 19,086,355 per twelvemonth, or a sum of $ 57,259,065 over a three-year period. Activities will get down instantly upon presentment of an award with development of statewide developing toward a no-wrong-door point of entry attack, with a focal point of entry through the Aging and Disability Resource Centers. The first five slug points above are designed to significantly spread out the usage of place and community services, cut downing the hazard of institutional attention for several diverse populations necessitating long term attention.Georgia ‘s Balancing Incentive ProgramUnderstanding of Balancing Incentives Program Aims: Since 2008 Georgia has participated in the Money Follows the Person Demonstration Grant, set uping a statewide system of passage coordination to help occupants of establishments in safely returning to their places and communities. In 2007 the State ‘s Medicaid expenditures for place and community based services ( HCBS ) comprised 30.7 per centum of entire long term attention dollars spent yearly. Georgia ‘s Money Follows the Person ( MFP ) Program has successfully transitioned 737 persons from skilled nursing and intermediate attention installations into community abodes and helped spread out the usage of community services, rebalancing the long term attention expenditures for HCBS to 40.9 % by 2010. One facet of the long term support and service system that Georgia has non yet been able to accomplish is a individual point of entry for all community-based services and plans. Entry into Georgia ‘s long term attention plans remains slightly disconnected with many poin ts of entry, some easier to happen than others. Progress toward a no-wrong-door attack was achieved in 2011 when Georgia funded a service, options guidance, provided through an interagency understanding with the State Unit on Aging. Today options guidance is provided through the Aging and Disabilities Resource Centers in all twelve regional Area Agency on Aging in Georgia, supplying direct face-to-face aid to any nursing place or ICF occupant to find available resources and services necessary to ease a successful, sustainable passage. Options Counselors provide the first contact with persons identified for inclusion in the Money Follows the Person Program and serve as a referral point for nursing installation staff as nursing place occupants self-identify for community passage through usage of the Minimum Data Set ‘s Section Q. Further, Options Counselors provide passage aid regardless of purpose to take part in the MFP Program, type of service demand, age or income degree. Despite this work, Georgia still operates several p oints of entry into LTSS, typically determined by population, disablement or type of service required.Current System ‘s Strengths and Challenges:As described above, Georgia ‘s Aging and Disability Resource Centers are more widely recognized by the populace, supplier community and the medical attention system than they were merely a few old ages ago because of outreach attempts by the AAAs, the State Unit on Aging, the State Medicaid Agency and the State ‘s Developmental Disability Agency. Part of the community acknowledgment stems from a big resource database maintained by the ADRCs that presently houses over 24,000 service resources for older grownups, grownups with disablements and persons with developmental disablements. This electronically-maintained resource database relies on parts that are regionally added and maintained by the AAAs. Each part employs information system staff who develop, update and keep the database. Therefore, all information is continually checked for contact truth and any needful alterations to the services offered. One challenge of the system is its labour-intensive theoretical account, utilizing information staff to look into and update resources. BIP Program support is exp ected to supply extra resources for the enlargement of the bing Resource Database targeted toward services specific to populations non antecedently targeted. Another strength of Georgia ‘s LTSS is its traditional usage of conflict-free instance direction. In three of the five release plans a demand of instance direction registration is the absence of association with a service bureau, an association that could function as a focussed referral point for LTSS. Georgia plans to develop construction for struggle free instance direction for the other two release plans and the other plans included in the Undertaking: community mental wellness services provided through the rehabilitation option and the Georgia Pediatric Program in-home nursing service. Since neither has included a conflict-free instance direction service in the yesteryear, this is expected to show a development challenge.Outreach and Ad:Outreach to populations in demand of long term attention has been a long clip chal lenge in Georgia. Georgia ‘s Money Follows the Person Program uses the undermentioned attacks to make out to persons in demand: aˆ? Printed stuffs such as circulars and booklets aˆ? Outreach to aim audiences: referral beginnings such as infirmaries and doctors, nursing installation staff ; older grownup groups, and protagonism organisations aˆ? Education through web sites Funding Plan: Georgia will go on to bespeak province support to fit federal Medicaid financess in order to spread out place and community services through the Balancing Incentive Plan. For more specific information on support, delight refer to the Budget Narrative contained in a separate papers.Challenges:One important challenge in Georgia will be the multiple electronic information systems built to suit points of entry. Over clip organisations in Georgia have independently developed population-specific or program-specific points of entry every bit good as electronic clinical record systems. These systems have evolved over decennaries affecting important province, non-profit-making and private resources. In some plans, there are no bing electronic record-keeping systems. To extenuate this challenge, the ADRCs began working with assorted entry points for developmental disablement services and over clip have expanded the ADRC staff expertness and resource database to include this population. Through its MFP Program Georgia has begun researching engineering options that could supply a platform for transportation of information from multiple electronic recordkeeping systems.Other Balancing Enterprises:As noted antecedently, Georgia was one of the first provinces to be awarded a Money Follows the Person Grant by CMS. Additionally, Georgia is runing one of the presentation releases for kids with terrible emotional upsets to avoid the usage of psychiatric residential intervention installations whenever possible. Technical Aid: Expectations for petitions for proficient aid autumn in the countries of: 1 ) Adopting a standardised, validated paediatric appraisal tool for kids at hazard of hospitalization or institutional long term attention because of delicate medical conditions 2 ) Researching an information engineering platform to ease the transportation of informations electronically for intents of functional and fiscal eligibility for long term attention. Long Term Supports and Services Expansion/Access to Service The followers is a description of the countries of Georgia ‘s Medicaid HCBS plans that will be expanded in assorted ways to supply extra services, serve extra Georgians, or heighten entree to services. aˆ? Expand the figure of slots in Georgia ‘s five 1915 ( degree Celsius ) Medicaid Waiver Programs. The enhanced federal lucifer available through the Balancing Incentive Program will increase admittances to the Elderly and Disabled Waiver Program, the Georgia Pediatric Waiver Program for medically delicate kids, the two Waiver Programs for people with developmental disablements, and the Waiver Program for immature grownups with terrible physical disablements. aˆ? Provide an addition in reimbursement for paediatric place wellness services, thereby increasing entree to home-based, station ague services and cut downing yearss spent in the infirmary. Georgia ‘s place wellness attention rates for station ague skilled services presently offer no derived function in rates for grownup attention and the attention of kids. Home wellness suppliers report a deficit of paediatric nurses, physical and occupational healers available to supply the attention ; therefore, worker deficit consequences in higher costs. In add-on to the higher cost of attention related to the labour market, paediatric place wellness attention is non provided every bit often as that for grownups with greater geographic distances involved in attention proviso. aˆ? Fund three new community-based services for Medicaid receivers with serious and relentless behavioural wellness demands. The services are being reviewed at this clip through State Plan Amendment. If approved by CMS, the new services will offer instance direction, rehabilitation-targeted employment services, and community life supports to persons with serious and relentless mental unwellness. BIP financess will besides be used to spread out Assertive Community Treatment and a rural theoretical account of Assertive Community Treatment for non-urban countries of Georgia. aˆ? Expand the Georgia Pediatric Program ‘s Medically-fragile Day Care service through slot enlargement and age enlargement. Georgia ‘s Pediatric Waiver plan offers medically-fragile twenty-four hours attention to kids who qualify through medical necessity finding. At this clip, Program eligibility is limited to kids age five or younger. There is a demand to spread out the age eligibility limitations, supplying after school attention for medically delicate kids who attend school but need after school attention. Budget Items to Support Balancing Incentive Program Requirements: The followers is a description of the programs for conformity with the demands of the Balancing Incentive Program and the budget deductions with budget projections if known. aˆ? Adopt Georgia ‘s 12 Aging and Disability Resource Centers as the primary point of entry for place and community services: Facilitate the add-on of services and resources specific to populations non presently included in the 24,000-service database. This enlargement of the ADRC resource database is expected to necessitate an increased figure of ADRC staff or may necessitate contracts with other points of entry for cross referral and coordination of resources. aˆ? Provide web-based preparation on community-based long term attention services available to targeted referral beginnings: Will necessitate that the Medicaid Agency purchase or subscribe to a web-based preparation bundle to suit 150 – 200 participants in on-line preparation Sessionss for the intent of cross-referral and communicating between points of entree. aˆ? Develop an outreach program and stuffs in order to raise consciousness of Georgians about the handiness of options to institutional attention. A preliminary Communication Plan includes media releases and articles, booklet and posting printing, societal media posters, and website hosting. The budget for communications is projected to be $ 150,000. aˆ? Development or purchase of an information engineering system designed to ease communicating between assorted province bureaus and other points of participant entree and eligibility finding. The State Medicaid Agency is researching the usage of the eligibility system scheduled for execution in 2014 as the platform through which approved spouses will portion demographic, fiscal and functional information for the intent of eligibility finding. An extra map of the system is that of informations sharing during cross-referral to avoid applicant confusion and facilitate admittance to service without duplicate of informations aggregation.

Méliès’s Trip to the Moon Essay

The film opens with a gathering of academics in a lecture hall. They have robes, beards and pointed hats. They are standing at first in ranks in the room, five more men join them and are given telescopes by female servants. The leader enters and assumes a position at a blackboard on the left where he draws an image of the Earth and the Moon and a bullet-shaped craft landing on the Moon. They all being discussing or arguing about the project. The technique used for acting is based on what one might see acted out in the theater with no modern cinematography such as close-ups or zooms are used to focus the attention on a particular character. All the characters appear onstage and if there is any focus on a certain action is done through theatrical technique such as the females marching out and handing out telescopes and leaving. When the main character, seeming like a professor comes in the group sort of comes to attention and stand still at first while the professor speaks and draws on the board. One’s attention’s shifts to the group again as they discuss and argue with over-large gesticulations in this silent film without written inter-titles. It is a silent stage drama recorded on film, else it would be mime theatre. The film’s scene changes almost like a shift of scene in the theatre. There is a very fake-looking space capsule that is being worked on and some of the astronauts try out the interior. There is a moment when someone falls into a shallow barrel. Possibly, this was meant to be a comic touch which would be at home later in vaudeville. There is no camera movement. It is as if one had a good seat at the theatre and watching a series of tableaux vivantes. The film owes much more to the stage and picture books than to any already-developed film technique. The subsequent boarding of the space-bullet on the left with the cannon on the right looks especially fake and hand-drawn. There is little aim at a believable set and much over-acting: doffing their hats and so on to an imaginary group of spectators, actually us who are watching the living theater more than a film by today’s standards. After the firing of the cannon, there occurs the use of something like special effects where the Man in the Moon, framed by clouds comes closer to the viewer and has human like expressions which show the space vehicle hitting him in the eye. It is a real human looking like he has whipped cream on his face.

Unique Ways to Celebrate Graduation

Unique Ways to Celebrate Graduation Graduating from an online university or college can be surprisingly depressing. You’ve worked hard, done well in your classes, and have truly earned your degree. But, without the traditional cap-throwing, gown-wearing, sappy music-playing graduation ceremony, finishing coursework can sometimes feel anticlimactic. Don’t let that get you down. Many online graduates find their own way to celebrate. Viewing some unique graduation celebration ideas may inspire you to mark the occasion in a special way. Throw Your Own Ceremony or Party Even if you can’t attend a traditional graduation ceremony, host your own. Choose a theme, send out invitations, and celebrate your accomplishments with your best friends. Display your diploma on the wall to mark this important milestone and show interested guests. Spend the evening with upbeat music, good food, and interesting conversation, letting those closest to you know that you did, indeed, graduate, and you are in the mood to celebrate. Take a Trip Chances are that you’ve put off some of your vacationing desires to finish your educational commitments. Now that youve completed your online studies, youre not bound by a scheduled graduation ceremony. Since you’re finished with school, take some time to do what you’ve always wanted. Whether it’s a cruise of the world, a vacation to Maui, Hawaii, or a weekend at a local bed and breakfast, you deserve it. Theres no better way to celebrate your graduation than lying on a beautiful beach or enjoying breakfast in bed in a cottage nestled in the woods. Splurge on a Career-Related Activity While you were busy studying, you may have passed up going to an amazing business conference, skipped becoming a member of an elite art museum, or forgone subscribing to a career journal because you needed to spend your money and devote your time to your schooling. If so, now is your chance to celebrate by ordering tickets, planning your trip, or signing up. Not only will you enjoy it, but it may provide unexpected opportunities to progress in your field of work. Renovate Your Study Since you’ve finished with the late nights on the computer and removed the â€Å"Stay Out† signs from your door, take the opportunity to redecorate the room (or corner) you’ve used to study. If you have a large space, consider turning it into a parlor for entertaining, home theater, game room, or home spa. Or, if you made your homework habitat in a little corner of the house, redecorate it with artwork, famous quotes, or posters to inspire you in your career. Give Back   You’ve had amazing opportunities, and your new degree promises to bring even more chances for exciting experiences. Find a way to give back to your community. Think about volunteering at a local school, dishing out at a soup kitchen, tutoring students at the library, or reading at a neighborhood senior center. Sponsor an orphan in the U.S. or in a foreign country or become a member of a civil rights group. Whatever you choose, giving back is sure to offer real personal satisfaction to add to your hard-earned degree.

Earnings Management Essays

Earnings Management Essays Earnings Management Paper Earnings Management Paper At a basic level, it involves allocating the right inventory to the right customer at the right price. This is also known as yield management. In the Indian context application of revenue management can be seen In many fields: Travel and Tourism: * Advance purchase of tickets offered by airlines * Weekend discount by hotels Attack service by Indian Railways * Different tariffs charged by power generation and distribution companies * Software companies Revenue management has been named as the number one emerging business strategy by the Wall Street Journal. Application of management science models based on linear programming has Improved the contribution to profit for a major steel company (Data Steel) in India by $73 million in 1986-87 and given a cumulative Earnings Management It covers a wide variety of legitimate and illegitimate actions by management that affects the earnings of a company. It is strategy used by the management to deliberately manipulate the companys earnings in order to smooth earnings over two or more interim or accrual accounting periods or to achieve a designated earnings level to meet security analysts forecasts. Companies prefer to smooth earnings in contrast to having years of exceptionally good or bad earnings. It includes legitimate discretionary choices of when to enter into transactions that require accounting recognition, adding a product line, selling a division, decreasing expenditures. For example, implementation of a decision to enhance the entitys reedit and collection activities may legitimately support reducing the estimate of bad debt expense. Abusive earnings management is deemed by the Securities ; Exchange Commission to be a material and intentional misrepresentation of results. This is the case when the management circumvents GAP in an effort to influence reported earnings. Accounting records may be falsified, all the legal liabilities may not be reported, and fictitious transactions may be entered. In many cases, leadership is responsible for employing techniques to manage and smooth earnings. It should however, be noted that earnings management that constitutes read is distinctly different from earnings management perceived to reduce the quality of earnings. While the pure-fraud cases are to be dealt with through criminal law, issues such as earnings management are also to be dealt with through stringent provisions securities regulation and corporate governance norms. The current evidence indicates a greater incidence of the former type of cases rather than the latter, but beyond a point the distinction between the two gets somewhat blurred (as in Satyrs case) and hence caution must be exercised to prevent both types of occurrences. A major area of concern regarding practice of earnings management is the effect it has on destabilize the stock markets. Motives The major drivers which motivate the management to resort to techniques of earnings management may be discussed as follows: * Achieve targeted results * Emphasis on quarterly reporting * Analyst recommendations * High expectation of shareholders * Performance based pay and stock options * Pressure on Board of Directors and top management to showcase their leadership Instruments Some common techniques of revenue management are described below: * Vendor Financing Vendor financing occurs when a company loans money to a company to a customer to purchase goods from the company. The result is increase in sales revenue on the income statement and an increase in notes receivables on the Balance Sheet. The increase in revenues improves earnings and the related ratios that have operating Income Ana net Income In ten computation. I nee technique Is common to some industries such as telecommunications. For example, in early 2000, Motorola loaned more than $ 2 billion via vendor financing to Titles, a Turkish telecommunication company. Subsequent to the financing, Titles defaulted on the principal and interest payments, forcing Motorola to write off the receivable and recognize a loss. The concern here is that financial analysis and subsequent decisions made about a company based on the current period revenues and earnings are immediately distorted. * Booking a Sale before its time Another way of increasing revenues is to record sales in the accounting records before they are earned. One technique is stuffing the sales channel. Managers ship inventory to customers and recorded the corresponding revenues in spite of clauses f returning the goods without cause beyond year end. Another commonly used technique is to record the sale and leave the delivery date open for the customer. Not reducing sales for promised rebates is yet another instrument of revenue management. Revenue can also be increase by shipping and recording as a sale goods delivered on consignment. Companies in the service industry frequently resort to revenue management. Software support and maintenance contracts, engineering updates, equipment maintenance contracts, and other may call for a long term agreement between the service provider and customer. In order to increase revenues a service provider may record as revenue the entire or a substantial portion of the contract in the first year. Many internet retailers and advertising agencies use the gross method of recording revenues. Under the gross approach, revenues collected and the cost of the ticket are recorded separately, thus creating an appearance of high revenue business. Earnings are generally managed by selecting the amount and time period an expense is recorded on the income statement. Commonly used techniques may be describes as follows: * Cookie Jars This is a technique where managers selectively record or fail to record certain expenses on the income statement, using an offsetting Balance Sheet account (cookie jar) to absorb the impact on earnings. This technique is employed on one or more expense categories. Such as bad debt expense, inventory write downs, warranty expenses, sales return, depreciation and others. For example in periods of low earnings, the amount recorded as bad debt expense may be reduced and in periods of high earnings this amount may be increased. The cookie Jar, the allowance for doubtful accounts, simply floats up and down to accommodate the desired expense accrual. The company will rarely report the Justification for changes to the allowance account. This leaves open the allowance for a doubtful accounts cookie Jar for the executives to manage earnings. Non Recurring Charges and the Big Bath The use of non recurring charges is an extension of the cookie Jar concept. It is common for businesses to close plants, reposition operating units, reduce labor counts, outsource non core business functions, and more. The entire amount is recorded as an expense in the current period as a no recurring charge (also kn own as restructuring charge). A restructuring reserve account is established as a liability on the Balance Sheet to offset the actual cash payments for restructuring the business, which may occur over one or more subsequent accounting periods. Executives practicing earnings management underestimate these restructuring reserves to enhance current pergola earnings. A Log Damn occurs when overstated restructuring charges hit the income statement in the current year. Management uses the restructuring charge to establish a restructuring reserve cookie Jar on the Balance Sheet by overstating the current period restructuring expense, thus reducing earnings in excess for the current period. Off Balance Sheet Financing Off Balance Sheet financing is defined as debt obligations that are not recorded on the Balance Sheet. Although technically, they do not alter the earnings, they do affect they do affect the ratios that use debt in the numerator or denominator. Examples of off Balance Sheet financing include: * Operating Leases * Limited Partnerships Coin Ventures) * Pension Obligations * Receivables that have been factored (sold) Project Methodology Objective To identify the various factors affecting Revenue Earnings Management in the Indian IT Industry. Scope The scope of our study was the 85 listed Indian IT companies with data in the public domain for the last 5 years. Methodology The Discretionary accruals have been taken as a proxy of earnings management by a number of researchers. Discretionary accruals are calculated as the difference between total accruals and non discretionary accruals. Firms having high investments tend to report more discretionary accruals in their earnings. The nondiscriminatory component reflects business conditions (such as growth and the length of the operating cycle) that naturally create and destroy accruals, while the correctional component identifies management choices.

Scientific Method Lesson Plan

Scientific Method Lesson Plan This lesson plan gives students hands-on experience with the scientific method. The scientific method lesson plan is appropriate for any science course and can be customized to suit a wide range of educational levels. Scientific Method Plan Introduction The steps of the scientific method generally are to make observations, formulate a hypothesis, design an experiment to test the hypothesis, conduct the experiment and determine whether or not the hypothesis was accepted or rejected. Although students often can state the steps of the scientific method, they may have difficulty actually performing the steps. This exercise provides an opportunity for students to gain hands-on experience with the scientific method. Weve chosen goldfish as the experimental subjects because students find them interesting and engaging. Of course, you can use any subject or topic. Time Required The time required for this exercise is up to you. We recommend using a 3-hour lab period, but the project may be conducted in an hour or spread out over several days, depending on how involved you plan to get. Materials A tank of goldfish. Optimally, you want a bowl of fish for each lab group. Scientific Method Lesson You can work with the entire class, if it is small or feel free to ask students to break up into smaller groups. Explain the steps of the scientific method.Show the students a bowl of goldfish. Make a few observations about the goldfish. Ask the students to name characteristics of the goldfish and to make observations. They might notice the color of the fish, their size, where they swim in the container, how they interact with other fish, etc.Ask the students to list which observations involve something which could be measured or qualified. Explain how scientists need to be able to take data to perform an experiment and that some types of data are easier to record and analyze than others. Help students identify types of data that could be recorded as part of an experiment, as opposed to qualitative data that is harder to measure or data that they simply dont have the tools to measure.Have the students pose questions that they wonder about, based on the observations they have made. Make a list of the types of data they might record during an investigation of each topic.Ask the students to formul ate a hypothesis for each question. Learning how to pose a hypothesis takes practice, so its likely the students will learn from brainstorming as a lab group or class. Put up all of the suggestions on a board and help students distinguish between a hypothesis that they can test versus one they cannot test. Ask students if they can improve any of the hypotheses that are submitted. Select one hypothesis and work with the class to devise a simple experiment to test the hypothesis. Gather data or create fictional data and explain how to test the hypothesis and draw a conclusion based on the results.Ask lab groups to choose a hypothesis and design an experiment to test it.If time permits, have the students conduct the experiment, record and analyze the data and prepare a lab report. Assessment Ideas Ask students to present their results to the class. Be sure they state the hypothesis and whether or not it was supported and cite the evidence for this determination.Have students critique each others lab reports, with their grade determined by how well they identify the strong and weak points of the reports.Ask students to hand in a hypothesis and the proposed experiment for a follow-up project, based on the results of the in-class lesson.

How do the Renaissance, the Protestant Reformation and the Scientific Essay

How do the Renaissance, the Protestant Reformation and the Scientific Revolution connect with the history of the Greeks and Roma - Essay Example The texts were written in Latin and the books that were published were only those that had been approved or written by the church. Since the church declared and controlled literary movement, there were no voices thrown upon them. However, upon the period of Renaissance, Europe’s literature revolution began. People started to write books in vernacular language. Through this, common people found the books more accessible even without knowing Latin and criticisms and criticisms on the church and politics began to rise. People begin to argue upon what is true and what is written in the Bible, from which the texts are written and published by the church itself for which, by reason, were thought by the people to be politically biased and thus, not true. One clear example is tackled by Niccolo Machiavelli. In his â€Å"The Prince†, he rejected the common Christian view that the state is an entity under the control of divine power. These brought changes as to exemplifying the v anishing of the control of the church upon literature. Along with the Renaissance, the movement of the Protestant Reformation brought extreme behavioral changes on the Greek and on the Roman cultures and traditions and shaped the whole of Europe’s history. These changes were triggered upon Europe’s views and religion.

Highway engineering 1 (civil) Assignment Example | Topics and Well Written Essays - 1500 words

Highway engineering 1 (civil) - Assignment Example The street linked Clark Street (New Lynn) with the Windsor road (New Windsor). Due to the increase of Auckland population, an upgrade for the arterial road was needed. The upgrade has several merits, benefitting the commuters and residential properties. The Tiverton/Wolverton route is an important district arterial route linking the town centre development with SH20 and the airport route. The project route carries 25000 Annual Average Daily Traffic at Wolverton and with the SH20 connected to SH1, the route experiences severe traffic congestion during the day and peak hours. The congestion was raised in the national papers in September 2010. The Tiverton/Wolverton route is identified in the National Land Transport Programme 2009-2012 as a high priority project committed for the 2010 construction period. The NZTA identified the route to Auckland Council as one of the route to be upgraded before the Waterview Connection Highway 20. The project will improve east west linkage for the city. The 2012-15 National Land Transport Programme (NLTP) in collaboration with Auckland Transport and other partners aimed to increase commutation for commuters around Auckland and improve efficiency in movement of freights. The programme aimed at investing in constructing the Western Ring Route, Auckland Manukau Eastern Transport Initiative (AMETI), improve road network to enable accessibility to motor vehicles, and upgrade of public transport modes such as rail, bus, and ferry services. NLTP has contributed to the safety, efficiency and resilience of Auckland Transport network through construction of Tiverton/Wolverton Road upgrade project. Safety investments create a transport system that eradicates human error which costs life through the four parts of a Safe System; safe roads and road sides, safe speeds, safe vehicles, and safe road use. The Tiverton/Wolverton Upgrade has delivered long-term benefits to the residents living and

An investigation into the impact of training on the staff Performance Dissertation

An investigation into the impact of training on the staff Performance in Saudi Arabian Airlines - Dissertation Example Saudi Arabian Airlines recognizes the importance of training their staff and has several staff training programs like- -Crew Leadership training. -Training Technical Services staff. - Training program for Finance. -Passenger Sales and Services training. -Training of new recruits. Aim: To understand the impact of training and development on the efficiency of the employees in Saudi Arabian Airlines. Objectives: 1. To investigate the current efficiency level of the employees in Saudi Arabian Airlines. 2. To investigate the roadblocks faced by the employees in performing their jobs in Saudi Arabian Airlines. 3. To investigate the nature of training and development required by the employees of Saudi Arabian Airlines to perform efficiently in Global scale. 4. To investigate the procedure and schedule required to be implemented to train the employees. Literature Review: Training and development of staff requires proper planning by human resource management. There are three methods of traini ng that are basically followed by most organisations. The basic three types of training followed are Cognitive, behavioural methods and management development. In cognitive method the employees are mostly trained regarding the theoretical concepts applicable at work (Hall & Hughes, 1989, p.209). This type of training places more importance on theoretical knowledge required by the employees in order to function properly in their jobs. Knowledge about the company policies, laws related to the functioning of the organization (Martin, 2006, p.15). Knowledge regarding procedures followed by the organisations. Technical knowledge required for carrying out work in the... The aim of this paper is to understand the impact of training and development on the efficiency of the employees in Saudi Arabian Airlines. This research will throw sufficient light on the methods that can be implied by the Saudi Arabian Airlines to achieve better performance from their employees. This research will help the Saudi Arabian Airlines to curtail training and development according to the need of their employees. The result of this research will throw insight on the nature of training that is required by the employees to perform better in their job. The Human resource department will become better equipped in understanding the difficulties faced by the employees. Employees will also feel comfortable in informing the HR department regarding their problems. The trainers will also understand the kind of approach they should have to maximise the benefits reaped by the employees from the training and development.

Issues concerning the rights of minority members in Australia and the Essay

Issues concerning the rights of minority members in Australia and the manner in which shareholder rights may be protected - Essay Example Australia is a nation with strong legal system with a higher level of legal protection for shareholders and creditors2 compared to other nations (La Porta et al, 1998, 1999).In this essay, the various issues concerning the minority shareholder rights in Australia and the different ways by which the shareholder rights may be protected are discussed in detail. This is organized as follows. In the second section, the theoretical perspectives of corporate governance and the problems between directors and shareholders are discussed. In the third section, the directors and shareholders; rights and obligations are discussed. In the fourth section, various issues regarding the minority shareholder rights are discussed. In the fifth section, various remedies for protecting minority shareholder rights are discussed in detail. The fifth section concludes the essay. Starting from classical economists like Smith (1776), Berle, and Means (1932), many studies have been done on the conflicts of interests between the principal or investors and the agent or managers. The idea of separating the concepts of ownership and control has been developed based on these studies. The role of corporate governance comes in this context. According to Shleifer and Vishny (1997), corporate governance is given a broad definition.Corporate governance â€Å" deals with the ways in which suppliers of finance to corporations assure themselves of getting a return on their investment†. OECD(1999) defines corporate governance as â€Å"the system by which business corporations are directed and controlled. The corporate governance structure specifies the distribution of rights and responsibilities among different participants in the corporation, such as the board, managers, shareholders and other stakeholders, and spells out the rules and procedures for making decisions on corporate affairs. By doing this, it also provides the structure through which the company objectives are

What Part Did Religious Ideals Play In The Renaissance Voyages Of Essay

What Part Did Religious Ideals Play In The Renaissance Voyages Of Columbus - Essay Example European monarchs broke away from feudalism to form powerful alliances with the new and wealthy merchant class, whose members were eager for new trading routes, for access to spice markets and for the fabled wealth of the East. Each of these elements was significant for the voyages of discovery, but they were heightened by the missionary character of Christianity and the ideals urged upon its followers by the New Testament. To conquer lands, not just for their riches but also in search of converts, proved to be powerfully motivating.1 So alluring in fact that concerns over navigational knowledge paled into insignificance and ‘faith’ was substituted for sound maritime practices. Without the powerful lure of Christianizing the New World, their Catholic Majesties may perhaps never have sponsored the voyages. And without the conversion zeal exhibited by Christopher Columbus, there may not have been four voyages. Thus the religious ideals of the Renaissance world, of the Span ish Monarchs of Columbus the man played a major role in bringing about the voyages. There can be no doubt about the religious commitment of Isabella of Castile. She ascended to the Spanish throne in 1474 and in the following years contributed greatly to strengthening the dominance of Catholicism in Europe. She was a woman who would be famed throughout history for her great political foresight but who would also plunge all of Christendom into a frenzy of religious ‘cleansing’, through her ‘devotional fanaticism’.2 Isabella was determined to reclaim ‘Christendom’ from the Moors, to which purpose she had committed Spain to quasi-religious wars in the Middle East and on Spanish soil for nearly two decades. She finally completed her Reconquista of Spain with Granada, which was retaken in 14923 and the mood of victory heightened into an atmosphere of pious euphoria throughout the Mediterranean.  

Leadership Models Essay Example | Topics and Well Written Essays - 1250 words

Leadership Models - Essay Example Situational contingency theories have are organizational development application that are effective at applying leadership concepts that are adaptive to the situation at hand. There are three major situation contingency models. The three models are Fielder’s leadership model, House’s path – goal theory of leadership, and Hersey and Blanchard’s situational leadership model. The Hersey – Blanchard leadership model framework implies that there is no one single best way to approach a problem or situation. According to Hersey and Blanchard situational leadership requires adjusting the leader’s emphasis on task behaviors such as giving guidance and direction, relationship behaviors, and providing socio-emotional support (Schermerhorn, J., Hunt, J., Osborn, R., 2003). The leadership style application has become very popular in the 21st century due to the fact that business changes are occurring faster than ever and manager have to be adapt the busin ess strategy of the company and the vision of its human resources to meet the market demands and requirements. The Blanchard and Hersey model can be characterized in terms of the amount of direction and support that the leader gives to his or her followers (12manage, 2009). Appendix A illustrates a matrix that explains the functionality of the model. The four factors illustrated in each quadrant of the matrix are S1, S2, S3, S4. The S1 variable which is located in the bottom left quadrant represents the telling style. In this style the manager provides a high task low relationship work output. This means that manager provides specific instructions and closely supervises the performance of the subordinate. This style is most effective when the leader is dealing with employees that are unable to take responsibility for themselves. An example of an employee that needs his supervisor to apply a telling style is a new employee in a firm. This person needs more

What Part Did Religious Ideals Play In The Renaissance Voyages Of Essay

What Part Did Religious Ideals Play In The Renaissance Voyages Of Columbus - Essay Example European monarchs broke away from feudalism to form powerful alliances with the new and wealthy merchant class, whose members were eager for new trading routes, for access to spice markets and for the fabled wealth of the East. Each of these elements was significant for the voyages of discovery, but they were heightened by the missionary character of Christianity and the ideals urged upon its followers by the New Testament. To conquer lands, not just for their riches but also in search of converts, proved to be powerfully motivating.1 So alluring in fact that concerns over navigational knowledge paled into insignificance and ‘faith’ was substituted for sound maritime practices. Without the powerful lure of Christianizing the New World, their Catholic Majesties may perhaps never have sponsored the voyages. And without the conversion zeal exhibited by Christopher Columbus, there may not have been four voyages. Thus the religious ideals of the Renaissance world, of the Span ish Monarchs of Columbus the man played a major role in bringing about the voyages. There can be no doubt about the religious commitment of Isabella of Castile. She ascended to the Spanish throne in 1474 and in the following years contributed greatly to strengthening the dominance of Catholicism in Europe. She was a woman who would be famed throughout history for her great political foresight but who would also plunge all of Christendom into a frenzy of religious ‘cleansing’, through her ‘devotional fanaticism’.2 Isabella was determined to reclaim ‘Christendom’ from the Moors, to which purpose she had committed Spain to quasi-religious wars in the Middle East and on Spanish soil for nearly two decades. She finally completed her Reconquista of Spain with Granada, which was retaken in 14923 and the mood of victory heightened into an atmosphere of pious euphoria throughout the Mediterranean.  

Hiroshima, a Tragedy That Could Have Been Averted Essay Example for Free

Hiroshima, a Tragedy That Could Have Been Averted Essay The nuclear bombings of Japan are a very controversial topic, and is highly discussed and researched by scholars and the general public. The nuclear bombings are not just a small part in military history, but a lesson in reality and the destruction possible of man to achieve their goals; these bombings have raised a whole host of ethical issues and concerns, which must be taken into consideration. There are many reasons why the actions taken by the United States and specifically President Truman to drop the A-Bomb on Hiroshima were absolutely unnecessary. On the other hand there is an abundant amount of weak justification as to why it was so imperative for the U. S. to distinguish the lives of sixty-six thousand civilians in the blink of an eye, and cause catastrophic destruction and disparity that would have a lasting effect for decades to come. The atomic bomb should have never been dropped on Japan because the atomic bomb is not a strategic weapon. It could be compared to Pheasant hunting using a Sherman Tank. According to writer Mary Bellis, â€Å"the bomb was dropped from the Enola Gay. It missed by only 800 feet. At 0816 hours, in an instant, 66,000 people were killed and 69,000 injured by a 10-kiloton atomic explosion† (Bellis). We can begin by looking at the reasons that ultimately led to the decision to bomb Hiroshima, and the heart of it, with President Truman. On Dec 7, 1941 the Japanese conducted an unprovoked air assault on the U. S. naval base in Pearl Harbor; by doing this the Japanese caused the U. S. to be brought into WWI. Bill Gordon, in his Essay reminds us that, as a result, for four long years, severe loathing of the Japanese people grew immensely in the U.  S. , and many U. S citizens and members of the government viewed the Japanese as a very barbaric race of people, which gave the impression that the bombing would be justified. (Gordon). The fear of them in the U. S. was so present that they were rounded up and confined in containment camps including naturalized Japanese Americans. To add to their unpopularity was their mistreatment of U. S. prisoners of war which to say the least was horrifying, and their attempts to cover them up were proof that they knew they were committing war crimes. But ask yourself, does this justify killing civilians? Although these acts by the Japanese are extremely savage; they were committed on military personnel in the context of war, not on unsuspecting civilians in the course of their everyday activities. Truman’s reason for the bombing was that he believed that the alternative to this was to wage war on the Japanese mainland, but this would mean the death of many U. S. troops and could end in failure. He claimed this was his way to end the war and spare the loss of U. S. military personnel. In doing so, he did achieve just that, but is this not the classic example of a Pyrrhic victory? Doug Longs article states how there were concrete proof that Japan was ready to surrender and Truman had knowledge of this, weeks before his decision. It was understood by both, the Allies and Japan, that surrender was the only way out for the Japanese. Japan was ready to surrender by mid July 1945, and had sought diplomatic help through the still-neutral Russians. In July1945, the U. S. ad intercepted and successfully decoded messages sent between Foreign Minister Togo and Japan’s Ambassador to Moscow, Sato. These messages clearly stated Japans, and specifically the Emperors great desire to end the war. As I stated earlier Truman was well aware of these transmissions, but insisted the bomb was necessary to terminate the war and save the lives of thousands of U. S. soldiers (Long). When in theory it was not. The US government refused to state in the Potsdam Declaration that upon the surrender of Japan the position of the emperor in Japan would remain. This statement along with the Soviet declaration of war on Japan should bring one to believe that this would have been enough to convince Japan to surrender. It is very conceivable that the US Government didn’t include the statement that the position of the emperor of Japan would be allowed to remain if Japan surrendered because the US government didn’t want to appear soft on Japan. If this was all that was needed, would it not have been worth exploring? Again, mass murder to save face in the eyes of the enemy is not a justifiable argument. Long states in his paper â€Å"Hiroshima Was it Necessary? † President Truman had advisors who influenced him to remove the statement against the advice of other advisors who had more knowledge of Japan and their culture, which held a great love and loyalty for their Emperor Hirohito. Was it the ignorance of certain U. S. officials about Japanese culture that led to this invaluable detail being left out of the Declaration? , or was it omitted purposely? , knowing the outcome, thereby creating an excuse to bomb them. , Drobny in his article quotes Herbert Hoover as stating to Truman, I am onvinced that if you, as President, will make a shortwave broadcast to the people of Japan tell them they can have their Emperor if they surrender, that it will not mean unconditional surrender except for the militarists youll get a peace in Japan youll have both wars over (Drobny). This was a full two months before the bomb was dropped, plenty of time to make a simple Broadcast, yet it wa s ignored. . The U. S. decision to drop leaflets from planes in the days before the attack warning the people of their impending doom is also very suspect. Why if the intended bombing of a heavily populated civilian area was planned why would anyone give such a warning? If the intentions were not to kill civilians, then was it even necessary to target these areas? Would detonation of the bomb on an unpopulated Island or at sea off the coast of Japan been enough to show the immense destructive power and in essence have the same effect without all the death? This creates speculation that the bomb was used to impress upon the USSR the capabilities of the U. S. military, this again could have been achieved at a different site without death involved. Another was Hiroshima and Nagasaki being 2 cities that were surprisingly not affected by the war as far as destruction would be a great place to study the effects of the bomb, if any of these were the underlying effects of the decision, there is no concrete proof, but it is quite proven that these were two effects that did take place intentional or not. The thought of using the deaths of civilians, to prove a point to the USSR or to Experiment on civilians is appalling. Jeff Kingston, A history teacher at Temple University in Japan, confirms that During the Yalta conference Stalin had promised the U.  S. to invade Japan â€Å"three months† after the defeat of Germany, and the agreement between the U. S. and the USSR was signed to that effect (Kingston). The Red Army declared the war against Japan exactly three months later; it entered Manchuria on August 8. The same day the Red Army invaded Korea from the north, while the US troops were invading it from the south. The USSR Red Army captured the entire Kwantung Army of the Japanese and began preparing itself for the amphibious landing to the islands of Japan. Indeed, Stalin was fulfilling his obligations to their U. S. ally. Long explains how Truman did not want the Red Army to land on the islands of Japan, even though this move could have saved many lives of the American soldiers ( long). Truman could not afford the thought of victorious Stalin exporting socialism to their Pacific neighbor. That fear probably was one of many motives behind the Truman’s decision to drop nuclear bombs on Japan. Should he not have considered this before making a deal with Stalin? Had he just ignored the fact that this would leave Japan vulnerable for the USSR to occupy? If so, those were not the acts of a responsible leader. An argument could be made that Stalin was hoping to advance the causes of socialism into Asia but there is no proof, only assumptions, now, and then, that he considered the territorial occupation of Asia to achieve that goal. In making Stalin an ally, Truman created a situation that he would not be able to control without the show of massive military force, essentially making the use of the bomb quite probable. There is undeniable proof that Japan wanted to give up, as President Truman had in his possession, and he should have explored every option to negotiate with Japan to surrender, and did not. In my opinion, the United States took a few steps back on the evolution ladder when they decided to kill innocent people. It is widely known the US State Department and President Truman wanted payback for the astonishing attack on Pearl Harbor in 1941, but lowering the U. S. to their level was not the answer. While the Japanese may have been seeking peace deals through the USSR diplomats, it was ultimately pointless. The sheer size, scope and savagery of World War II seemed to leave only room for total victory. It is doubtful the Russians would have accepted a peace treaty instead of surrender regarding Germany any more than the United States would have accepted peace instead of surrender after Pearl Harbor and years of bitter fighting. World War II was in all aspects, a war aimed at nothing less than total victory. This country was not built on the concept of an eye for an eye so this is a weak argument not to accept or at least explore every option to achieve the most humane end to the war. It is widely believed in the U. S. that these decisions were decided to seize the opportunity of any chance at a quick victory. The population was tired of war, huge sacrifices were born by the allies, and a hope to defeat Japan without direct military invasion was believed to be a huge gamble. The main justification for using the Atomic bomb however it worked was that Japan surrendered. While the end did not justify the means, the goal was reached. In the months preceding the bombing, the Japanese were becoming weaker and weaker. They were surrounded by the Navy; many areas were destroyed by air raids, and they couldnt receive any imports and also could not export anything. Naturally, as time went on and the war developed in our favor and it was quite logical to that with the proper kind of a warning the Japanese would then be in a position to make peace, which would have made it unnecessary for us to drop the bomb, or to have had to bring Russia in to the war. Many it seemed wanted to issue a warning for various reasons moral and tactical. The tactical argument was the Allied Forces had already won, the Japanese would have surrendered, and the US would not have exposed its nuclear capabilities to the Soviets thus delaying the arms race. Many military minds were convinced the Japanese were already blockaded and knew they were dependent on the rail transportation and inter coastal shipping. Conventional bombing, submarines and mines would have eliminated any movement of supplies throughout the country. Even with these strangle holds in place, it is still very conceivable that Japan would still not have surrendered if it meant losing their Emperor, but we will never have the answer to this question, because it was not allowed to play out to see the outcome. As with any decisions made in the past, hindsight is 20/20, but these were very different times, and the threat of Communism was so great, even a U. S. president would make a decision this reckless to stop it from spreading. We will never know the outcomes of the many alternatives that were proposed after the fact, but we do know there were alternatives that could have been perused before these cities and their inhabitants were bombed. One would like to believe that it was not all in vain, and the world learned a valuable lesson from this destruction, as we have not had an event like this in the world since. This is only a summary of the events that took place, in an attempt at trying to understand why Truman did what he did, and if it was necessary. You will have to come to your own decision on the moral and ethical issues involved, but hopefully this sheds some light on the subject so your decision can be made in an informed manner.

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