Intrastate semitruck transportation in Michigan Research Paper

Intrastate semitruck transportation in Michigan - Research Paper Example For instance, the construction data for the last semester of year 2009 showed Michigan to have experienced declines in the double-digits (-16.8%) which was reflected in the -6.4% decline of combined trade, transportation and utilities sector (www.bls.gov. 5 February 2010). A related industry to transportation and quarrying is mining and logging which also declined but this decelerated somewhat to only -6.3% over a 12-month period. All the above economic data pertain to number of jobs (in thousands, seasonally adjusted). What is more worrisome is the unemployment rate in state of Michigan which hovers around 15% (actually 14.6%) which is way above the national average of only 10%. But this is only the local picture for the state itself but there are many other issues to look at such as labor conditions, hiring patterns, economic competitiveness, safety, security, congestion, overall mobility, environmental impact and energy efficiency. Other than the economic factors that impinge on the industry, the one factor that has the greatest impact is deregulation. This is one factor more than interest rates or overall state of the economy that affects the industry. The entire US trucking industry is a $200 billion business and is highly fragmented. It means the 50 largest companies account for less than 30% of total industry revenues, unlike in other industries where there is an oligopoly or a high concentration of big players such as in the accounting industry (only 4 big players that can dictate prices). Economists call this as C4 or an industry where only 4 big players control more than 60% like US auto manufacturing or the oil industry. In short, the US trucking industry is over-saturated and lacks the necessary bargaining power with regards to customers and pricing. If we use Porters Five Forces Model then the trucking industry has very weak market power indeed. Of the five

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

Franklin Roosevelt (FDR) :: History Leader Franklin Roosevelt Essays

Franklin Roosevelt (FDR) The world has known many great leaders, especially in the post-Civil War era. Winston Churchill, Martin Luther King, Jr., and Harry Truman all rank with the most prominent leaders of all time. However, in my opinion President Franklin Roosevelt made the most difference out of anybody in this century. He began a new era in American history by ending the Great Depression that the country had succumbed to in 1929. Without him ending the Depression, who knows where this country could have gone? His social reforms gave most people a new perspective on government. Government was not only expected to protect the people from foreign invaders and affairs, but to protect against poverty and joblessness in one’s own country as well. He not only changed the country for the better of everyone, he also made substantial gains on what a president could do for his country. His accomplishments as president will never be duplicated. Public opinion was so overwhelmingly for him that he was elect ed to office four times, which most likely will never be duplicated again. His reign in office came at, by the far and away, the most difficult time in American history. Not only did he accept the challenges at hand, he rose to the occasion and took this country to another level. Roosevelt was born on January 30 near New York City. He graduated from Harvard in 1904 and attended Law School. Although he didn't get his law degree, he was admitted to the New York bar in 1907. He was elected to the New York senate in 1910 and was appointed by Woodrow Wilson as assistant secretary of the navy, a post he held during World War I. Roosevelt ran for vice-president in 1920 and lost. In 1921, he was stricken with polio, which left his legs paralyzed. Twice he was elected Governor of New York and in 1932, he defeated Herbert Hoover for President. After taking office, Roosevelt immediately took drastic action to respond to the Great Depression. He promoted labor laws the benefited unions and Soci al Security. Re-elected for unprecedented third and fourth terms in 1940 and 1944, Roosevelt was the American leader through almost all of World War II. He died of a cerebral hemorrhage in Georgia on April 12, 1945, shortly before the end of the war. Roosevelt went all out in 1931 in order to prepare for the election of 1932. Franklin Roosevelt (FDR) :: History Leader Franklin Roosevelt Essays Franklin Roosevelt (FDR) The world has known many great leaders, especially in the post-Civil War era. Winston Churchill, Martin Luther King, Jr., and Harry Truman all rank with the most prominent leaders of all time. However, in my opinion President Franklin Roosevelt made the most difference out of anybody in this century. He began a new era in American history by ending the Great Depression that the country had succumbed to in 1929. Without him ending the Depression, who knows where this country could have gone? His social reforms gave most people a new perspective on government. Government was not only expected to protect the people from foreign invaders and affairs, but to protect against poverty and joblessness in one’s own country as well. He not only changed the country for the better of everyone, he also made substantial gains on what a president could do for his country. His accomplishments as president will never be duplicated. Public opinion was so overwhelmingly for him that he was elect ed to office four times, which most likely will never be duplicated again. His reign in office came at, by the far and away, the most difficult time in American history. Not only did he accept the challenges at hand, he rose to the occasion and took this country to another level. Roosevelt was born on January 30 near New York City. He graduated from Harvard in 1904 and attended Law School. Although he didn't get his law degree, he was admitted to the New York bar in 1907. He was elected to the New York senate in 1910 and was appointed by Woodrow Wilson as assistant secretary of the navy, a post he held during World War I. Roosevelt ran for vice-president in 1920 and lost. In 1921, he was stricken with polio, which left his legs paralyzed. Twice he was elected Governor of New York and in 1932, he defeated Herbert Hoover for President. After taking office, Roosevelt immediately took drastic action to respond to the Great Depression. He promoted labor laws the benefited unions and Soci al Security. Re-elected for unprecedented third and fourth terms in 1940 and 1944, Roosevelt was the American leader through almost all of World War II. He died of a cerebral hemorrhage in Georgia on April 12, 1945, shortly before the end of the war. Roosevelt went all out in 1931 in order to prepare for the election of 1932.

Hop-in Food Stores Inc Essay

Hop-In Foods Stores has historically been able to rely on internal financing and long term debt in order to continue its growth. The continued growth is attributed to acquisitions of already established stores. Hop-In management has predominantly stayed away from starting up new stores from scratch due to high start up costs. They had found out that it was easier and more cost effective to buy up smaller stores in good locations. As of 1976 all of Hop-In’s expansion was financed by long term debt or equity shed out by upper management. Prior to 1976, Hop-In had had common shares outstanding, but was primarily traded only in Virginia. In order to continue the growth and expansion that management wanted they had to come up with additional funds. Equity financing was the answer to the Hop-In Food Stores need for the additional monies needed to cover growth costs. One of the main risks of IPO offerings is the risk of underpricing. This can be costly to both Hop-In and the investment bank. If the market decides that Hop-In’s value is worth more than initially offered stock prices with rise, leaving additional money that could have been raised by the company. This money â€Å"left on the table† could have been used to finance other investments or pay down any outstanding debts. The investment bank takes on the risk from the standpoint that they did not properly value the stock price. The underpricing of stock means that they did not maximize the money Hop-In could have raised. The reputation of not properly valuing IPO prices can lead to lost future business. In order to determine Hop-In’s new issue price, Mr. Merriman must first forecast the next five years of free cash flows. He should first create pro forma balance sheets and income statements. Once the financial have been forecasted the next step is to figure out what free cash flows are. This can be by multiplying EBIT*(1-tax), adding back depreciation, subtracting the change in capital expenditures, and also subtracting the change in net working capital. This will give you free cash flows for the year. These numbers need to be determined on a yearly basis of at least 5 years into the future. The next step is then to find out the WACC, aka r, of the company. This can be found by the equation, rd(1-tax)(D/V)+re(E/V). Once WACC is found all of the free cash flows need to be discounted back to present values. Another factor that must be found is growth. This can be discovered by doing a industry analysis to determine what the growth rate is expected to be. The growth rate is used to find the terminal value of Hop-In at its horizon date (5 years out). This terminal value is then discounted back to present value. The summation of all PV cash flows plus PV of the terminal value give you the value of the firm. The last step is to subtract the debt of the firm to land at the current equity value of the company. This equity value can then be divided by the number of shares outstanding or planning on being offered to come up with the IPO share price. Mr. Merriman has a difficult decision deciding what the final offering price will be. He has guaranteed a low value of $10 per share. He obviously wants it to close at a price higher than this because his firm will take a substantial loss since they will purchase all the shares from Hop-In Foods. Investment banks usually give a range of possible prices instead of a single definite stock price. This range will consist of the low value of $10, plus 6% in fees, giving a final low value of $10. 60. The high value is calculated by redoing the firm value analysis; taking away all debt and making it an entirely equity financing company. Doing the same before mentioned process will give you a high value. In the end Mr. Merriman should pick a final offering price right in the middle of the low and high value.

Satisfaction of Students Towards the Academic Library Facilities

1. 0 INTRODUCTION This section will discuss the background of the study, the statement of the problem, research question, research objective, methods used and the limitations of the research. 2. 1 Background Academic library is an important asset at Higher Level Institution because the library complements the need of students at Higher Level Institution. Malaysia nowadays encourages the citizen to pursue reading culture to gain more knowledge and information. University Technology Mara of Segamat, Johor have a high technology of library known as PERPUSTAKKAN TUN DR ISMAIL (PTDI).As at PTDI, there are many facilities provided by the management in order to support students to get easier to get information. According to Longman Dictionary Contemporary English third edition, library refers to a room or building containing books that can be looked at or borrowed. A library is a collection of sources, resources, and services, and the structure in which it is housed; it is organized for use and maintained by a public body, an institution, or a private individual. In the more traditional sense, a library is a collection of books.In Malaysia, library already been implemented since years 1956 which first be established of Perpustakaan Negara Malaysia. This library has been getting the permission by Public Library Services for the Federation of Malaya. This library has been getting the permission by Public Library Services for the Federation of Malaya. The significance of library is depends on the usage by the uses which is for education or just for entertainment to fill up the free time. The people are really like to spends time for reading will be request that the library is the most of peaceful place on earth and with the full of knowledge.Here are some points to highlight the important of library. Firstly it is inculcating the reading habits among children, teenagers and also adult. This is because library is the place for getting the new information otherwise to incr ease the knowledge not only for external usage but also internal understanding. Library is a place for learning experience especially for the children. By having a lots of type of book its can attract the children to continuing reading and the extensive genre of children’s literature is an essential part of the growing up process. Library is not only for students, users and lecturers only.Library also essential for community to be the mechanism to gain more information and resources of knowledge to be the knowledgeable citizen. Three main types of library described by The Indexer (2008) are public libraries, academic libraries and special libraries. In this report, we would like to ascertain the satisfaction of library usage in UiTM Segamat towards the academic library facilities. We can measure based on the satisfaction of the user based on the different perspective and dimension. 2. 2 Problem Statement PERPUSTAKKAN TUN DR ISMAIL tends to be the leader of source of any infor mation.In achieving their target to they have to improve their customer satisfaction on facilities provided. Refer to the Mohammad A. Hassanain and Ali A. Mudhei (2006) the main purpose of conducting the assessment was to determine whether or not design decisions made by design professionals are providing the performance needed by users who use the facility. In UiTM Segamat, there are problems where space for students to reading is insufficient, lack of control for photocopier and printing machines, no twenty four hours room for staying up, no safety place for bags storage, and inadequate of toilets provided.The necessity on library to provide quality services is critical, based on their role to support university core business that is to produce great graduate which is needed by industry. The question is; did student obtain the quality that they must get? Other than that, what is their perception on library quality services provides as an important academic facility based on types of services? Is it low or more than their perception? Another thing, what is their satisfaction level on services quality at PTDI? 2. 3 Research Question 1. 3. 1How to determine the level of effectiveness facility in library? . 3. 2What are the stages of the students perception on services facility provided? 1. 3. 3What are needed to improve in term of element facility in library? 2. 4 Research Objective 1. 4. 1To determine the level of effectiveness facility in library 1. 4. 2To identify the student perception on services facility provided 1. 4. 3To measure what are need to improve in term of element facility in library 1. 5 Methodology In order to gather all the information, we are only distributing questionnaire and making interview in completing our research. . 5. 1 Questionnaires We had distributed around 60 sheets of questionnaire which were given to the UiTM Segamat students especially from Degree students. By using this method we can get all the information. 1. 5. 2 Discussi on Apart from that, we were also using the discussion method to seek for the information about this matter. 1. 5 Limitation of Study In order to proceed with this research, we will face with some of limitations : 1. 6. 3 Questionnaires We distribute 60 copies of questionnaires but somehow we just get 50 copies in return.Students do not have enough time to give cooperation to us to answer the questionnaires. Students also do not give a full of concentration during answer the questionnaires. 1. 6. 4 Data Analysis It is hard for us construct the data analysis such as the pie chart and the bar chart. 2. 0DATA ANALYSIS AND FINDINGS In this section, we analyzing all the data and the finding will be report and will commence with level of effectiveness facility in library and we are using one of the types of data analysis which is descriptive analysis. This section will present the findings from the various resources that were used.The findings are divided into five section, which are demog raphic, level of satisfaction on library facilities, details of dissatisfaction towards library facilities provided, the elements that need to be improved and suggestion. In this research paper, we found the result of this research regarding satisfaction of students towards the academic library facilities in PERPUSTAKKAN TUN DR ISMAIL. The dimension is only focusing on facilities only instead of services provided. Student’s perception is different each other and we conclude all the data analysis data using SPSS. 2. 1Data analysis using SPSS 2. 1. Section 1 : Demographic Figure 1 : Pie chart for gender Gender| Frequency| Male| 21| Female| 29| TOTAL| 50| Table 1 : Table for frequency of gender Data show that 42 percent of total number of students replied the questionnaire is male students and the rest about 58 percent is female. Female student responds more rather than male student for this survey Figure 2 : Pie chart for Age Age| Frequency| 21-25| 44| 26-30| 6| TOTAL| 50| Tabl e 2 : Table for frequency of age From the pie chart above, we can conclude that 88 percent of students who respond on this survey were at the range of age between 21 until 20 years old.Where the 12 percent left are for those respondents are that range of age between 26 until 30 years old. Figure 3 : Pie chart for status Status| Frequency| Single| 50| Married| 0| TOTAL| 50| Table 3 : Table for frequency of status Total 100 percent of the respondents are still single and not married yet. This is because there is only a little number of students that already. That is why the status of respondent is mainly single. Figure 4 : Pie chart for course Course| Frequency| Marketing| 10| Finance| 20| Islamic Banking| 10| Accounting| 10| TOTAL| 50| Table 4 : Table for frequency of courseFrom the pie chart and frequency table, we can describe that 20 percent are those for students from Marketing, 40 percent from Finance, 20 percent from Islamic Banking and other 20 percent of respondent is from Ac counting students. Figure 5 : Pie chart for part of students Part| Frequency| 1| 6| 3| 5| 4| 26| 5| 13| TOTAL| 50| Table 5 : Table for frequency of part Respondent are 12 percent come from the part 1, 10 percent part 3, 52 percent part 4 and other 26 percent from part 5. 2. 1. 2Section 2 : Level of satisfaction on library facilities Figure 6 : Bar chart for satisfaction of students Level| Frequency| Percent %|Very satisfied| 10| 20| Somewhat Satisfied| 25| 50| Dissatisfied| 15| 30| Very Dissatisfied| 0| 0| TOTAL| 50| 100| Table 6 : Table for frequency of satisfaction of students 20% of the respondents are very satisfied with the facilities in library. 50% of respondent are somewhat satisfied with the facilities and 30% of the respondents are neutral. There is no number of students not satisfied with facilities in library in UiTM Segamat. Figure 7 : Bar chart for reference book Level| Frequency| Percent %| Very satisfied| 10| 20| Somewhat Satisfied| 28| 56| Dissatisfied| 12| 24| Very Dissatisfied| 0| 0| TOTAL| 50| 100|Table 7 : Table for frequency of reference book 20 percent of the respondents are very satisfied with the book provided by the library. 56 percent are somewhat satisfied and dissatisfied is about 24 percent. There is no very dissatisfaction of responding regarding the book. Figure 8 : Bar chart for library space Level| Frequency| Percent %| Very satisfied| 5| 10| Somewhat Satisfied| 25| 50| Dissatisfied| 20| 40| Very Dissatisfied| 0| 0| TOTAL| 50| 100| Table 8 : Table for frequency of library space Based on data above, there are 10 percent of respondents are very satisfied with the space of library environment provided.They think the space can make the comfortable to study and reading. 50 percent of respondent are somewhat satisfied and 40 percent of respondents are dissatisfied. There is no very dissatisfaction regarding the space of library. Figure 9 : Bar chart for discussion room Level| Frequency| Percent %| Very satisfied| 5| 10| Somewhat Sat isfied| 30| 60| Dissatisfied| 14| 28| Very Dissatisfied| 1| 2| TOTAL| 50| 100| Table 9 : Table for frequency of discussion room 10 percent of the respondents are very satisfied with the discussion room availability. They think that the room are really suitable for manage group discussion. 0 percent of respondents are somewhat satisfied and 28 percent are dissatisfied. There is 2 percent of respondents are very dissatisfied with the discussion room. Figure 10 : Bar chart for the time period of 12 hours room Level| Frequency| Percent %| Very satisfied| 8| 16| Somewhat Satisfied| 23| 46| Dissatisfied| 13| 26| Very Dissatisfied| 6| 12| TOTAL| 50| 100| Table 10 : Table for frequency of the time period of 12 hours room Statistic shown that 16 percent are very satisfied with the time period of 12 hours room are really convenience. 46 percent of respondent are somewhat satisfied, 26 percent are dissatisfied.Unfortunately, there is 12 percent of respondent are very dissatisfied with the time . Figure 11 : Bar chart for printing and photocopy services Level| Frequency| Percent %| Very satisfied| 8| 16| Somewhat Satisfied| 23| 46| Dissatisfied| 13| 26| Very Dissatisfied| 6| 12| TOTAL| 50| 100| Table 11 : Table for frequency of printing and photocopy services 16 percent of respondents are very satisfied with the services of printing and photocopy that provided by library. 46 percent are somewhat satisfied, 26 percent are dissatisfied and 12 percent of respondents are very dissatisfied about the services.Figure 12 : Bar chart for satisfaction of toilet condition Level| Frequency| Percent %| Very satisfied| 8| 16| Somewhat Satisfied| 25| 50| Dissatisfied| 12| 24| Very Dissatisfied| 5| 10| TOTAL| 50| 100| Table 12 : Table for frequency of satisfaction towards toilets condition 16 percent of the respondents are very satisfied with the condition of toilet. They think the condition is on the good manner. 50 percent are somewhat satisfied, 24 percent are dissatisfied and other 10 percent are very dissatisfied. Figure 13 : Bar chart for the function of CCTV Level| Frequency| Percent %|Very satisfied| 8| 16| Somewhat Satisfied| 25| 50| Dissatisfied| 17| 34| Very Dissatisfied| 0| 0| TOTAL| 50| 100| Table 13 : Table for frequency the function of CCTV 16 percent of the respondents are very satisfied with the function of CCTV in the library, 50 percent are somewhat satisfied and 34 percent are dissatisfied. There is no very dissatisfaction for CCTV usage. Figure 14 : Bar chart for safety of the bag shelf Level| Frequency| Percent %| Very satisfied| 0| 0| Somewhat Satisfied| 10| 20| Dissatisfied| 25| 50| Very Dissatisfied| 15| 30| TOTAL| 50| 100|Table 14 : Table for frequency satisfaction safety of bang shelf There is no respondents are very satisfied with the safety of bag shelf that provided by library, 20 percent are somewhat satisfied, 50 percent dissatisfied and other 30 percent are very dissatisfied. 2. 1. 3Section 3 : Details of Dissatisfaction Towards Libr ary Facilities Provided Figure 15 : Bar chart for satisfaction of reference books Level| Frequency| Percent %| Strongly Agree| 3| 6| Agree| 30| 60| Slightly Disagree| 15| 30| Disagree| 12| 24| TOTAL| 50| 100| Table 15 : Table for frequency of satisfaction sources of reference books percent of the respondents are strongly agree with the reference books are not suitable with the requirement of the study. 60 percent are agreed, 30 percent are slightly disagreeing and other 24 percent disagree. Figure 16 : Bar chart for the satisfaction of arrangement of single table Level| Frequency| Percent %| Strongly Agree| 0| 0| Agree| 8| 16| Slightly Disagree| 32| 64| Disagree| 10| 20| TOTAL| 50| 100| Table 16 : Table for frequency of satisfaction of arrangement of single table 16 percent of the students are agreeing that the arrangements of the single tables in the library are not suitable for revision. 4 percent slightly disagree and other 20 percent are disagreeing. Figure 17 : Bar chart for th e time period for usage of study rooms Level| Frequency| Percent %| Strongly Agree| 9| 18| Agree| 18| 36| Slightly Disagree| 20| 40| Disagree| 3| 6| TOTAL| 50| 100| Table 17 : Table for frequency of the time period for usage of study rooms 18 percent of the respondents are strongly agree with the 12 hours time period for usage of study room is insufficient, 36 percent are agree, 40 percent slightly disagree and other 6 percent are disagree. Figure 18 : Bar chart for the toilet satisfaction Level| Frequency| Percent %|Strongly Agree| 2| 4| Agree| 32| 64| Slightly Disagree| 8| 16| Disagree| 8| 16| TOTAL| 50| 100| Table 18 : Table for the frequency of the satisfaction of toilets 4 percent of the student strongly agree with toilet are always under maintenances services, 64 percent agree and 16 percent respondent slightly disagree and disagree with the maintenance of the toilets. Figure 19 : Bar Chart for the printing and photocopy Level| Frequency| Percent %| Strongly Agree| 10| 20| Agr ee| 15| 30| Slightly Disagree| 6| 12| Disagree| 19| 38| TOTAL| 50| 100| Table 19 : Table for the frequency of printing and photocopy 0 percent of the respondent are strongly agree that the number printing and photocopy machine are insufficient, 30 percent agree, 12 percent slightly disagree and other 38 percent disagree. Figure 20 : bar chart for place of the bag shelves Level| Frequency| Percent %| Strongly Agree| 21| 42| Agree| 20| 40| Slightly Disagree| 9| 18| Disagree| 0| 0| TOTAL| 50| 100| Table 20 : Table for the frequency of the bag shelves 42 percent of the respondents are strongly agree with the safety shelves lack in security and safety, 40 percent agree and other 18 percent slightly disagree.Figure 21 : Bar chart for the electricity points Level| Frequency| Percent %| Strongly Agree| 12| 24| Agree| 25| 50| Slightly Disagree| 5| 10| Disagree| 8| 16| TOTAL| 50| 100| Table 21 : Table for the frequency of the electricity points 24 percent of the respondents are strongly agree that the number of electricity points in the library are not enough based on the usage of students towards it. 50 percent agree, 10 percent slightly disagree and other 16 percent are disagree. 2. 1. 4Section 4 : The Elements That Need to be Improved Figure 22 : Pie Chart for upgrading chairs Gender| Frequency|Yes| 20| No| 30| TOTAL| 50| Table 22 : Table for frequency of upgrading chairs 60 percent of the respondents are agreeing that the library should add more chairs and table availability, 40 percent of respondents are not agreeing. Figure 23 : Pie chart for the additional electricity points Gender| Frequency| Yes| 33| No| 17| TOTAL| 50| Table 23 : Table for the frequency of the additional electricity points 66 percent of the respondents are agreeing to add more the electricity points at the library because it is not sufficient. 34 percent are not agreeing to add electricity points.Figure 24 : Pie chart for the space available for 12 hours room Gender| Frequency| Yes| 37| No| 13| TOTAL| 50| Table 24 : Table for the frequency of the space available for 12 hours room Data above show that 74 percent from the respondent agree that the library should provide more space available for 12 hours room and other 26 percent not agree. Figure 25 : Pie chart for the toilet condition Gender| Frequency| Yes| 18| No| 32| TOTAL| 50| Table 25 : Table for the frequency of toilet condition 18 percent of the respondent agreeing that the toilet should be improve and other 64 percent said that the toilet in good condition.Figure 26 : Pie chart for safety bag shelves Gender| Frequency| Yes| 48| No| 4| TOTAL| 50| Table 26 : Table for the frequency of the safety bag shelves 96 percent of the respondent agreeing that the safety bag shelves should be improves and other 8 percent are disagreeing. Figure 27 : Bar chart for the improvement of CCTV Gender| Frequency| Yes| 20| No| 30| TOTAL| 50| Table 27 : Table for the frequency of improvement CCTV 40 percent of the respondents are agreein g to improve the use of CCTV in the library. 60 percent of them are disagreeing to improve because they think the facilities are accurateFigure 28 : Pie chart for the photocopy machines and printers Gender| Frequency| Yes| 44| No| 6| TOTAL| 50| Table 28 : Table for the frequency of the photocopy machines and printers 88 percent of the respondents are agreeing the photocopy machine and printers should be improved and 12 percent are disagreeing. 2. 1Discussion Based on the data analysis and the finding, we also include all the opinion of the respondents as for their feedback regarding the questionnaire researching about the level of satisfaction towards library facilities.After doing this research, we found that some students are not satisfied with the library facilities. They want more such as want more space area in library, asking UITM management to improve the wireless in the library, put more computer as the students are many, increase the student safety things, improvement of th e toilet also, and they prefer want have a good network during office hours. All these opinions from their feedback show us that there’s more action needs to take place for achieved the level of satisfaction towards library facilities.In order to improve more the services in library, all the facilities provided are playing the role. It is because without the good facilities, how the library wants to offer a good service? Which mean the facilities are related with the services that the library offer. Some of the respondents are giving a good feedback but some are not. They believe that all the library facilities are need to be improve more in order to attract more student’s to come the library. It is because some student’s doesn’t like to come to the library because not satisfied with the facilities were provided.They feel uncomfortable and sometimes they felt that they prefer want study at room or their own places. 3. 0CONCLUSION Based on the data analysi s and findings, we discover that the level of satisfaction towards library facilities are not achieved a good level. Some of the respondents are giving a good feedback but some are not. They believe that all the library facilities are need to be improve more in order to attract more student’s to come the library. It is because some student’s doesn’t like to come to the library because not satisfied with the facilities were provided.They feel uncomfortable and sometimes they felt that they prefer want study at room or their own places. 4. 0RECOMENDATIONS Refer to the our research, we have been implemented to search what the elements or factors that need to be improve in term of the facilities at the PERPUSTAKAAN TUN DR ISMAIL. What we have been look into at this library, the things that need to seriously improvise are increase the availability of the chairs and table. This is because, the chairs and tables for the student to study are not supported with the numbe rs of student in the UiTM.Most of the student need to wait for their turn to study or to get resources, this is because the there has no place for them to sit while getting the information needed. So, by this the management needs to provide more chairs and tables for make any back up if there a lot number of students want to study at the library. Other than that, the facilities that need to be improve is on the providing additional number if plug accessibility. Based on what we see, most of the student will bring along their laptop to study at libraries.This is because of the wireless system are provided and easy for them to get through of information or data during the study session. But the problems occur when the availability of plug are limited and they have to get turn to using the plug for charging their battery. Some of the students are like to spend their time in library for making assignment, research or to get information in library. So with the limited number of plug it b ecome as a barriers to them for staying at the library for the long period of time. Moreover, the elements that need to improvise are provides more space for 12hours room.The availability of that room now, it cannot be vital with the student requirement. This is because, they need more space for study in that particular room. With the limited space which only can provide for less than 30 persons in that room makes the study for environment are not comfortable otherwise the space are very small and it is not suitable. So, the management needs to make up the space to become more relevant and also can support more students to using that room more effectively. Other than that, the management of library needs to manage the toilet condition.This is because, when the students want to use the toilet, they need to go down stairs and go to the toilet at the entrance of PTDI library. This is because, toilet which in the library is always under the maintenance and it is not properly for the acc essibility of toilet is not capable with not only for the student but also for the other users that come to our library. Therefore, increase in safety of beg shelf. At PTDI the safety of the bag are under the obligation of the students itself, but the place stated for the beg shelf are not suitable this is because it is located outside from the library and there is no lock provided.Although, the safety of the bag under the students itself, the librarian have to provide a proper place for the beg shelf in the meanwhile it can reduce of the pilferage cases. Next is improvement on using the closed-circuit television (CCTV). By having this system, the cases of lost of books, vandalism, students bad attitude and so on can be reducing although it cannot be fully eliminate. Otherwise is providing the room for pray. As we know, majority of the students in UiTM is the Muslim students, it is necessary for providing the space for praying. Moreover is, prerequisite more on photocopy machine and printer availability.What we have been look that, the photocopy machine are always cannot be used because of the breakdown and the machine are only two been provided. So, the management needs to provide more machines for the usage of students and its same goes to printer services. References Longman dictionary of contemporary English (4th edt. ). (2003). Harlow, England: Longman Ruin, J. E. (2008). Business planning and report writing. Petaling Jaya: Leeds Publications. Choo, A. F. W & Onn, C. T. (2012). Easy steps to report writing new revised edition. Marshall Lavendish (Malaysia) Sdn Bhd. Appendix