Okay. Good morning, everybody. So for today, we'll be discussing and we'll be continuing our discussion on the different specimen collection and handling requirements and procedures for clinical chemistry one. So again, good morning to everybody. So if you haven't, I hope you're already finished with the patient preparation, which will be included in your quiz next meeting, which is on, which will be the second meeting for this week. Okay. So for our next meeting for this particular week, you'll be having your quiz in this particular topic and also in your patient preparation. So please do prepare for that. Okay. Please do prepare for that. So for today's discussion, I just want to give you a rough overview of the things that we're going to discuss. So first and foremost, we will be discussing about the different types of specimen or the different types of samples in clinical chemistry. So we're just going to have a brief discussion about this. At the same time, we're also going to talk about your method of collection. So some of these are actually very much familiar to you. We're actually just reviewing some of the topics. So I hope most of you will be able to tune in and really listen properly for all our discussion. And the third part will be the collection tubes and devices and the different additives and the different anticoagulants that are found in your test tubes or evacuated tubes. And finally, we'll be having a review on the protocol of specimen collection, handling, processing, and transport, which will be a second part of this video, which will be given to you next meeting. Okay. Which will be given to you next meeting together with the chain of questions. Okay. So let's get started and discuss about the first one because our review for today will be quite long. But again, I hope that all of you will be able to catch up because most of the things that we're going to discuss today are just reiteration review from your PMLSP-2 subject. Okay. So of course, when we talk about your samples, okay, there are different types of samples in the clinical chemistry laboratory.  So all of these things can be measured in the clinical chemistry section, although among these five samples, the one very much common to the clinical laboratory and the clinical chemistry section is your blood in the form of your serum. So your urine, your CSF, your parasynthesis fluid, and even your amniotic fluid, those will be discussed further in your analysis of urine and other body fluids. But for this particular morning, we're just going to have some discussion about the samples which are also vital when it comes to their function and uses in the clinical chemistry section. So let's get started with the first one and we're going to talk about your blood. When we say blood, there are actually three forms that we can use in the laboratory. It can be your cool blood, your plasma, and also your serum. So we're going to talk about them one by one. So when we say cool blood, okay, when you say cool blood, we use both the liquid portion and the cellular components of the blood.  So please do remember that this particular sample does require blood collection into a vessel or into a test tube that contains your anticoagulant. So when we say anticoagulant, please remember this because I actually noticed that some of you are still having a hard time or are confused when it comes to the function of your anticoagulant. Remember that when you put an anticoagulant in a test tube or in a container, the specimen that you will have there will either be your cool blood and if you centrifuge that, okay, dahil meron na siya anticoagulant because that particular tube contains your anticoagulant, when you centrifuge that specimen, you will get your plasma, which will be discussed in a short while. So again, remember when we say cool blood, remember when we say cool blood, it is not clotted, it is not clotted, you use your anticoagulant with this one, so your cool blood in the clinical chemistry section is usually being used for HPA1C or glycated hemoglobin, which is used in the monitoring of diabetes. So please do take note that when it comes to your cool blood, again, we use both the liquid portion, which is your plasma, and also your cellular component composed of your white blood cells, red blood cells, and also your thrombocytes or your platelets. Again, remember that when it comes to cool blood, we use your anticoagulant, anticoagulant that prevents the clotting or the formation of fibrin, okay, the formation of your fibrin, it prevents the clotting through different mechanisms, which will also be discussed towards the end of this discussion. Now moving forward, aside from your cool blood, of course, we also have your plasma. So your plasma, okay, your plasma is actually the yellow or the clear or the pale yellow liquid that you would see on top of your background cell if you centrifuge your cool blood. So again, let's have that in mind that your plasma was yielded from your cool blood. So if you have your cool blood, it does have your anticoagulant preventing the clotting. So walang pangumuwanang dugo, there is no clotting that happened. If you centrifuge that, you will get your plasma. So your plasma again is normally a clear to slightly hazy pale yellow fluid or liquid that is separated from the cells when a blood in an anticoagulant tube was centrifuged. Please do remember that your plasma still contains your fibrinogen. Sir, what is fibrinogen? Fibrinogen is one coagulation factor, okay, fibrinogen is one coagulation factor that is the substrate for your thrombin. Your thrombin is the one that will convert or the one that will activate your fibrinogen into becoming your fibrin. And if there is fibrin formation, there will be clotting. Merong pangumuwanang dugo. Pero, but if you use your anticoagulant, the formation of your fibrin will be prevented and various mechanisms. For most of your anticoagulant, their mode of action is by chillating your calcium.   Because they prevent, they are anti what? Anti or they prevent coagulation or the formation or the solidification of your blood through the formation of your fibrin.   So to cut the long story short, if we centrifuge your cool blood and it does contain your anticoagulant whether that is an EDTA, a sodium citrate, a potassium oxalate or a sodium or lithium heparin, okay, when you centrifuge that you will get your plasma. Then one protein, okay, one protein unique to plasma that cannot be found in your serum is your fibrinogen, okay, again that is your fibrinogen. If we're going to talk about your coagulation factor, your fibrinogen is actually your coagulation factor one. Again, your fibrinogen is your coagulation factor one. So for most of our clinical chemistry measurement, as you all know, we use your serum. But sir, where are we talking about plasma din? Because plasma is used for STAT or other tests that requires fast turnaround time. To take for example, your doctor requested for your electrolyte and it is STAT, they need to look immediately. So instead of waiting for five minutes if you're using your thrombin, instead of waiting for 15 to 30 if you're using a red plastic tube, or instead of using 30 to 60 minutes before the blood clot, if you are using your red glass tube, you can simply use your green top tube. Take note that only your green top tube so that you can use that and you can yield, okay, you can get your plasma and measure that and you can simply measure the electrolytes immediately without waiting for the complete clotting of your sample, okay, for the complete clotting of your sample. So that's one thing that is very good when it comes to your plasma, okay. That's one thing that is very good when it comes to your plasma because, okay, within your plasma because, okay, because your sample doesn't need to wait for it to clot. We don't need to wait for the blood to complete clot before we can run the sample in the laboratory. So that's the second sample that we are using in the laboratory, your plasma. Now finally, okay, the one that is very much common and very much widely used in the clinical chemistry section will be now your serum. So let's describe your serum first. So your serum is the liquid portion now of your clotted blood.   Remember, okay, remember that when it comes to your serum, it is also a clear pale yellow fluid, especially if your patients are fasting, although if your patient did not fast, it might appear hazy or cloudy due to the presence of lipids, specifically your triglyceride in your sample. So the major difference between your plasma and your serum is that your serum does not contain your fibrinogen. Again, your serum does not contain your fibrinogen. Unlike your plasma, that's one of their main differences. Number one is that your plasma contains fibrinogen, serum do not have your fibrinogen. Bakit wala na siyang fibrinogen? Why is it that your serum doesn't have your fibrinogen anymore? Again, because this particular sample is clotted. So your fibrinogen was converted to fibrin, hence the formation of your clot in your blood. So your serum samples must be allowed to completely clot approximately 30 minutes to 60 minutes if you are using your red glass tube, 15 to 30 if you're using your red plastic and 5 minutes if you're using your orange top that contains your thrombine. Remember everybody that when it comes to complete clotting time, you need to allow the blood to clot completely to prevent the formation of your latent fibrin clot. So what's the synanigan that's related to your latent fibrin clot? Remember that your latent fibrin clot can cause, again remember that your latent fibrin clot can cause interferences when it comes to your measurement. Why? Because your latent fibrin clot can clog your pipetors, your machine that can cause erroneous results in your samples. So those are the different blood specimen that we can use. You can have your whole blood, your plasma in your serum. So as for the information of everybody, what is the most commonly used sample among those three? It is your serum. But please take note that for most of the machines now, and for most of our agents now, we can use your plasma, you can use your serum. But again, the million dollar question is sir, what would be the deciding factor unto when I can use my serum and when can I use my plasma? Simple. Remember that in the establishment of your reference interval, we need to standardize the processing, the collection, and even the measurement of your sample. So if the reference value or if the reference interval you have in the laboratory was established using your serum, then it is best for your laboratory to use your serum. If you use your plasma, then it is best for your laboratory to use your plasma. If you use both, you use your serum or your plasma in establishing. When you are establishing your reference interval, you use both your serum and you also use your plasma. Then you can use either the either specimen when it comes to your laboratory. Ganan lang sya ka simple. Always remember that it will always depend upon how you establish your reference interval, including your fasting. I think I was able to mention that our last meeting in the patient preparation part. So when it comes to patient preparation, again, you can use, again when it comes to patient preparation, you can use either the fasting requirement that you use for in establishing the one that you use when you establish your reference interval. So those are the blood specimen, are the blood samples that we are using in the clinical chemistry section. Of course, quick sideline discussion will also use your urine. So remember that your urine is an ultrafiltrate of your plasma and it does consist of your urea and other organic and inorganic chemical dissolved in your water or dissolved in your urine. So it is the second most common fluid of determination in the laboratory, second to blood, second to your blood.  So remember that there are different types of urine.  There are different types of urine in the laboratory but for most of it, we are actually using in clinical chemistry. For most of our measurement, we are either using your midstream catch or your random if it is just a simple measurement of your creatinine or your microalbumine. But if we are measuring, like take for example electrolytes, other components of your urine, we're usually using your 24 hour urine. Again, in clinical chemistry, we usually use your 24 hour urine. So please take note of that for our urine. So aside from urine, we also have your cerebrospinal fluid or your CSF. So your cerebrospinal fluid is also an ultrafiltrate of your plasma and will ordinarily reflect the value seen in your plasma. So if you are now on the CSF part in your AUBF, you will be able to notice that some of the measurement of your plasma is being mirrored in your CSF. So remember that when it comes to the collection of your CSF, we usually collect it on the fourth and fifth lumbar vertebrae between the fourth and fifth or fifth and sixth lumbar vertebrae of your patient. So remember that on a usual basis, if you are able to collect your CSF properly, you can get three or more samples from your patient. So if it is irregular or a normal collection and you are able to get three test tubes, so this will be the order of draw. So the first tube will be for clinical chemistry or serology. The second is for your microbiology and the last one will be for your hematology. Again, the last one will be for your hematology. Now here's the thing. What if you're only able to collect one tube of cerebrospinal fluid and all of your sections will be sharing with that one specimen? What will be the order of draw? So remember that the order of draw for your, rather the order of processing, not order of draw anymore. The order of processing, if you only have one CSF tube, the first section that needs to get their hand into your CSF will be your microbiology. Because they need the specimen sterile, so the first one that will be processing the specimen will be your microbiology, followed by your hematology. And the last one will be your, the last section to use your specimen will be your clinical chemistry section. Sir, why clinical chemistry section will be the last? Because they will simply centrifuge that and all cellular components, they will not be using that in the measurement, only the liquid portion of your CSF. And then in hematology, they need the entire specimen including the cellular components. In microbiology, the reason why it is the first section to use your CSF tube, it's because they need a sterile procedure. Again, please take note that that order only happens, okay? Again, that order only happens if you only collected one tube of CSF. Kapag isa lang yung nakolik mo na CSF tube dahil na short ka o wala ng CSF na nilalabas yung patient, okay? If there is not enough sample and you only collected one CSF tube, then the order of processing will be from micro, hema, and then plentim, sero for the last one, okay? That is your CSF, okay? Your CSF, your seru cross-binal fluid. Now, second to the last, we also have your serous fluid. Serous fluid can be in the form of your pleural fluid, pericardial fluid, and peritoneal fluid. So remember, your serous fluid is the fluid that lines the inner cavity of our body to prevent friction and abrasion between your organs. So let's take, for example, right now, I'm breathing. But why is it that my lungs is not having friction with my heart? It is because of your serous fluid. So there are three types of serous fluid. We have your pleural fluid. Pleural fluid is the one that lines your lungs, okay? It is the liquid that is surrounding your lungs. Also the reason why most in Filipino term, we have this thing called tubig sabaga. This is actually the one that they are pertaining to, okay? When your pleural fluid is in excess, okay? That is what they term in tagalog as tubig sabaga, okay? That is your pleural fluid. Your pericardial fluid is the fluid that lines or surrounds your heart, preventing the friction of your heart from other body organs inside our body, okay? So that is your pericardial fluid. And finally, the one that lines your gastrointestinal tract and other organs, okay? In that particular cavity are your peritonal fluid, okay? Those are now your peritonal fluid.  So this one is your peritonal. The one that covers your heart is your pericardial. The one that covers or lines your lungs, these are your pleural fluid. Sir, what do we, what do you mean by Torah synthesis, pericardial synthesis, and parasyntesis? This is the process of the, this is the collection process of your pleural fluid. So the pleural fluid is collected through Torah synthesis, your pericardial fluid is collected through pericardial synthesis, and your peritonal fluid is collected by your doctors and your medical, medical technologists through parasyntesis, okay? Through parasyntesis. Again, Torah synthesis, pericardial synthesis, and parasyntesis. So you need to take note of those three. How are this serious fluid collected and in which particular cavity can we find this particular serious fluid, okay? So in excess, okay, in excess, this will be detrimental and these are associated with different diseases on the body, which will be discussed further in your AUBF. Now finally, we also have your amniotic fluid. Your amniotic fluid on the other hand is the fluid or the liquid that lines, okay, that lines that is within your amniotic sac, okay? That is within your amniotic sac. So as you can see, you have the fetus within your amniotic sac and the liquid that they have within that is your amniotic fluid. So what is the use of your amniotic fluid? So your amniotic fluid is a product of a fetal metabolism and the constituent that are present in the fluid can provide information about first the metabolic processes that took place within your fetus and also aside from your metabolic, aside from metabolic byproducts, you can also determine, okay, you can also determine the fetal maturation of your fetus through the help of your amniotic fluid and finally, then you know that aside from that, your amniotic fluid can also serve as an early specimen for molecular testing for your infant or for your fetus. So if you wanted to know the chromosomal analysis of your fetus, you may do so by using your amniotic fluid, okay? By using your amniotic fluid. Now finally, okay, those are the different specimens that is being used in the clinical chemistry section.  Your serous fluid and finally, we also have your amniotic fluid, okay? Your amniotic fluid. So hopefully everything was clear and you're able to understand all the things that I've been saying all this time regarding the different types of samples in the clinical chemistry section. Now let's move forward to the next part of our discussion which will now talk about the different collection method in the laboratory. Although some of these will be, will just be a review, I will be going through this particular discussion quickly. Okay, number one because some of these were already discussed in your hematology, specifically your capillary puncture. And then in our laboratory part, we're already finished discussing about your vene puncture. So I'll be showing to you some of the slide and I think I will be able to, you'll be able naman din, you'll be able to take a screenshot of the procedure. And then I'll give you some tips on how you should study this particular part, okay? When it comes to method of collection, there are actually four types, okay? Four systems or four collection methods that are being used. We have your arterial puncture, we have your skin puncture, also known as your capillary puncture, also known as your heel puncture. You also have your central venus access device, okay? Or your CVAD method of collection.    So let's go first with your arterial puncture. So first with your arterial puncture, that syringe are being used instead of evacuated tube. So why are we using syringe? Because there is already a pressure exerted by your artery. So when we do your arterial puncture, we do not pull the plunger, it will just move on its own. Why? Because of the pressure in your artery, okay? The pressure in your artery will be enough to move the plunger and then fill now your barrel. Again, we do not use your evacuated tube. Why? Because they already contain your negative vacuum.  And we do not need that. We do not want that for arterial puncture. Why? Because there's already a pressure that will be exerted by your artery. So the common arterial site puncture inside our body are your radial artery, your brachial artery and your femoral artery. Radial artery, look for your thumb. This is your thumb, okay?  So this part, this one is your radial artery. So if you can feel the pulsation, okay? If you can feel your pulse through your radial artery, that is your radial artery people. Next is your brachial artery. Your brachial artery is the artery nearest to your basilic vein, okay? The reason why we do not usually use your basilic vein is because we might tend to, we might accidentally heat your brachial artery. And of course, we have your femoral artery. That I cannot show because, of course, that is already the femoral artery, but I can give you your picture.  And of course, your femoral artery that are found in your groin. So remember that your arterial puncture are usually used for your arterial blood gas analysis or in general for blood gas analysis.  Remember, in the order of draw for your microcollection tube, the first tube to be collected is for your capillary blood gas, okay? Capillary blood gas. But if you're going to choose between the two, which one will be the most ideal or the most accurate specimen to be used in the laboratory? It will be your arterial blood, okay? It will be your arterial blood. So remember when it comes to your arterial puncture, remember this people, we do not use your tourniquet. Again, we do not use your tourniquet when it comes to arterial puncture. Why? Because, okay, so I guess I was able to put this on your quiz, on your previous, that we do not use your tourniquet in collecting your arterial blood or in doing your arterial puncture because it already had, it already have its own pressure, okay?  Your modified allen test needs to be performed first. So for your modified allen test, you can actually read that on your Henry's. So please take note to read and review the process of, the process of modified allen test. But in general, I'll just give you an idea what is modified allen test, no? Your modified allen test is being performed in the laboratory so that, okay? Your modified allen test is being performed in the laboratory so that we can determine if the artery can be punctured, okay? Why? If we puncture your radial artery, it will no longer be able to supply oxygen, oxygenated blood into your hands. That's why you need to verify if your ulnar artery, ulnar artery, from your pinky going down, this one is your ulnar artery. Ulnar artery thumb is your radial artery. So if you're going to puncture your radial artery, we need to make sure that the ulnar artery will be sufficient enough to supply blood into your hands. Why? Because if not, that will be a big problem for you and your patients. Okay, so you need to check the perfusion of your hand, okay? And how do we check the perfusion of your hand?  This is not just in your hand but perfusion is a general term.  So again, to check the perfusion, you need to perform your modified allen test. Again, that is your modified allen test. In tagalog, your modified allen test binagawa natin to para makita, mag-check kung sapat ba ang ulnar artery na iiwan mo para patuloy na dumalo yung dogo dun sa kamay mo. Kasi kung hindi, you cannot perform, okay? If your modified allen test is negative, if your modified allen test is negative, you cannot perform your arterial puncture. You cannot perform your arterial puncture. Now moving forward before I proceed to your skin puncture quickly, please do remember that when it comes to your arterial puncture, we use a different angle, okay? We use different angle. Remember that when it comes to your veni puncture, the ideal angle will be 15 to 30 degrees, okay? 15 to 30 degrees for veni puncture, but for arterial puncture, it can range from 30 degrees to 90 degrees Celsius. Not 90 degrees Celsius, 90 degree angle, okay? So 30 to 90 degree angle depending on the side, okay? Depending on the side. If you are, okay? If you are collecting through your radial artery, the angle should be 30 to 45 degrees. 30 to 45 degrees. Although for most of the time, we use the 45 degree angle for your radial artery. For your brachial, okay? For your brachial and your femoral, we use as your 90 degree angle. So perpendicular. So take for example, this is your, I know this is your arm, you just simply puncture that this way, okay? I guess you can see my, so yeah, so 90 degree angle for femoral and brachial, 45 degree angle for your radial artery, okay? So that's all the things that I want you guys to remember when it comes to arterial puncture. Number one, in arterial puncture, we collect your arterial blood. We do not use your evacuated tube. These are the particulars site of collection that we can utilize for arterial puncture. We do not use your tourniquet. We need to perform modified alentas before performing your arterial puncture. And finally, your arterial puncture is used for your arterial blood gas analysis, which is important in clinical chemistry specifically when you are determining acid-base balance disorders, okay? Acid-base balance disorders. Now finally, aside from arterial puncture, we also have your skin puncture, also known as your heel puncture, also known as your capillary puncture in the laboratory. Okay. So, apologies if you cannot see the, you know, I'll stop my sharing quickly, okay, just so that you guys can see, okay? So remember that when it comes to your arterial, when it comes to your skin puncture, okay, when it comes to your skin puncture, it's very important for us to remember to wipe the first drop of blood with a clean dry cloth. Again, I'm not going to discuss na further the procedure when it comes to your skin puncture. Please do review. Again, I will not be discussing it thoroughly because it's already done in hematology lab and even in the, eventually in the lecture, so please review that. So you need to wipe the first drop of blood with a dry clean, dry cotton or gos. So always remember to cut or to puncture the site, perpendicular or across the fingerprint, 90-degree angle or perpendicular dapat. Do not milk the site because it will cause hemolysis and excess tissue fluid. Remember that the lanset, the needle of your lanset is measured 1.75 millimeter and the depth of incision for your infant should be less than 2.0 millimeter and for your adults, okay, 2 to 3 millimeter na depth incision. So please do remember the common site of collection for your skin puncture. For adult and for older children, you can use the third or fourth finger of their non-dominant hand. You can also use your ear lobe. You can also, of course, use your heel for your infants, most specifically the lateral side of the plant, the lateral side of the plantar surface of the heel. Okay, the lateral side of the plantar surface of the heel, which is this one. So remember, I always reiterate this that it is best to use the lateral side of the infant's heel because in the medial or in the median part, you have your posterior tibial artery that might be accidentally punctured during your capillary puncture. So remember, when it comes to your fingerprint, you need to puncture across or perpendicular to your, perpendicular to your, what do you call this? It should be perpendicular to your fingerprints. It should be perpendicular to your fingerprint. Of course, please do remember the things that are also important in your skin puncture like the use of COVID and iodine because it can increase your bilirubin, your uric acid, your potassium and your phosphorus. Aside from that, you need to use your warming device. Warming device that should be less than 40 degrees Celsius. This time, Celsius na talaga. It should be less than 40 degrees Celsius to warm the site so that it can, you can increase the blood flow in that particular area where you will be collecting your blood. Now, in addition to that, we also have, of course, your central venus access device, your CVAD, okay, it can provide a ready access to patient circulation, eliminating multiple phlebotomy. So, these are usually for patients that are actually chemo patients that where or dialysis patient in which their veins are being preserved for therapy or for dialysis. So instead of being used for phlebotomy purposes, we can simply use your CVAD so that we will avoid multiple phlebotomy to our patient or multiple collection or extraction from our patient. So, how can we do that? So, we can use your central venus access device. So, it will eliminate multiple phlebotomy and most especially useful for critical care and even in surgical situation.  But on the femoral area and in addition to that, your central venus device okay, your central venus device needs to be when you are collecting blood central venus access devices. It's important for you to take note of your discard tube. Your discard tube hopefully is familiar to you because we also use your discard tube if we are collecting blood from a patient with IV fluid inserted to them.  Your discard tube usually we collect a minimum of 2 ml and a maximum of 5 ml. 2 to 5 ml of blood we collect that first. Take for example you're gonna collect for coagulation and then chemistry and you are collecting through a central venus access device so the first thing that you need to do is to collect blood through a discard tube. Discard tube because obviously you will be discarding this blood because it is contaminated by intravenous fluid or it is contaminated because it will be passing through the line of your CVAD so the first thing that you need to do is to collect sufficient blood 2 to 5 ml to be drawn in a clear and in a clear test tube or a clear test tube a plain test tube or a simple red test tube okay just to clear out the line okay to avoid any contamination from your patient again ha we need to collect a discard discard we need to collect blood for your discard tube 2 to 5 ml and then after collecting the discard tube okay after collecting the discard tube that's the time now that you can collect your samples so if it is your light blue your yellow if red top heparin your lavender so you can collect them na after collecting your discard tube okay again your discard tube will not be used for any test in the lab because it is contaminated okay it is contaminated um it is it will really just be discarded but take note you don't need to inform your patient na okay again you don't need to inform your patient na mom hi tatapon ko dito taran no okay we're not going to mention that to your patient okay so that is your central venous access device again because usually um done and useful useful for critical care patient surgical situation including those who will undergo dialysis and chemotherapy okay so moving forward um eto lang um a quick um a quick reminder on the order of draw in your category lines this is found or taken from your henry's so again you need to draw uh in some textbook in makol take for example 2 to 5 but in henry's 3 to 5 siya okay 3 to 5 so 3 to 5 ml in a sya range or a discard tube and then you can now collect your um your tube for blood culture your antico anticoagulated tube and then for your clotting uh for your clot tubes your red top and then other serum tubes okay other serum tubes but again one thing that i want always you guys to remember is to first collect your discard tube okay your discard tube so if if you guys could see note like um there are um there are procedures that needs to be performed before arterial puncture that is modified alentis for skin puncture warming the the side for CVAD naman collecting a discard tube first okay now finally this one is very much common to you this is your veni puncture so when we say veni puncture this is um blood collected from a patient's vein which also what we term as phlebotomy so what we collect here are the oxygenated blood because it is the one that passes through your uh that passes through your vein um and the common uh common the commonly used vein for veni puncture are located in your anticubital fossa so of course um you guys are very much familiar so the best vein for veni puncture is your median cubital vein second choice is your cephalic vein and the third one that the least the least preferred vein is your bacillic vein okay so again this is the order your median cubital your cephalic vein and your bacillic vein if we're asked what is the most preferred vein you answer your median cubital vein but if you are asked guys what is the most preferred site the answer to that is your anti anti or anti-cubital fossa but of course there are patients um that were already underwent mastectomy um there are other complications like take for example hematoma rash or other bruising on that particular on the anti-cubital fossa what would be your alternative site of course you can use um when the anti-cubital fossa or the anti-cubital veins are not accessible you can actually um collect your blood through your dorsal venus arc or your metacarpal plexus your metacarpal this one on your on your race or you can collect through your dorsal your dorsal venus arc okay on your um what do you call this pa um on your hands okay so you will be collecting through your iam you will be collecting through your hand sure have you experienced collecting blood um other than the anti-cubital fossa yes i've collected blood ven i've already collected blood through your hands and even through your feet okay there was a time that our patient um doesn't have um any accessible um vein on their anti-cubital fossa i cannot shut down naman the IV fluid because um the patient's the patient's um situation at the time is was critical so they need to have the IV fluid running so our only choice left was their foot okay so i collected uh blood through the foot of your patient but remember if you're gonna do that in the future the one thing that you need to remember okay before collecting is that you need to confirm if your patient are diabetic or not if your patient are diabetic your foot the feet of your patient are no no you cannot collect blood or you can yeah you cannot collect blood through your feet um if your patient are diabetic but if they are normal naman then you can do so okay you may do so again sir bakit hindi po kong pwede pag diabetic because remember their um their uh what do you call this their wounds don't heal normal as normal as um us na walang diabetes okay now walang diabetes okay so please do remember that okay please do remember that so for the procedure here is your procedure i'll be giving you um five seconds for each slide so five four three two one zero so remember the things that you need to review here of course the procedure the purpose of the procedure which is actually on your laboratory manual laboratory exercise number two okay and then yeah next slide five four three two one okay let's move forward diwan parang nga go online shopping na hawa na tayong in sir mark so last slide okay please take a photo okay ma'am sir pa take pa pa take na pa ka ng screenshot five four three two one and zero so please review the procedure of your vene puncture um the distance how to do your cleansing of course your antiseptic technique i already have discussed in the previous discussion in the pre um and in the patient preparation the alternatives and the different and the different antiseptics that you need we need to use okay now moving forward of course um i hope all of you are still okay there um this one will be quite long um discussion but again these are actually just to review na okay um these are actually just to review of your phlebotomy so of course we're gonna now discuss the different devices for blood collection so of course you have here your 30k your blood collection system either syringe evacuated in your wing infusion set your land set and your micro collection tubes together with your evacuated tubes okay so for your 30k remember that your 30k is made up of a pliable rubber usually latex or a strip of velcro so ayan this is surely um usually you we are using your latex but this one this is a type of a velcro na sample a velcro 30k so remember that we use your 30k to aid us to help us locate your patient's vein so much of my discussion about 30k was already discussed in the pre uh analytical patient patient preparation but again let me reiterate to everybody that you need to apply uh you need to apply your 30k at your patient's arm during venipuncture and once blood flow was established you can already remove your 30k so that's one thing no if you're reading your books and even in most of the webinar seminars and conferences we've been na um once your your blood flow is established you can already release your 30k again once your blood flow was established kapag meron ng kumasok na dugo sa hub you can already release your 30k so aside from that um remember that it should not be left um um on your patient's arm longer than one minute and if you're going to reapply your your 30k you need to wait for two minutes before reapplication please to remember the distance of your 30k application from the site it should be three to four inches away from the phlebotomy site or ten centimeter if we're going up if we're talking about your metric system aside from that in case that you don't have your 30k or you have patient obese patient that um uh obese patient and we cannot use the 30k to them kasingan na grow old or hindi kasha okay hindi kasha yung 30k we can actually use your blood pressure cuff just remember that when you're using your blood pressure cuff the blood the pressure that you need to exert should be below the diastolic pressure of your patient or in general it should be less than 40 millimeter mercury okay again an alternative for your 30k if you don't have your latex or your velcro 30k you can use your blood pressure cuff but remember to apply the pressure lower than your diastolic um diastolic pressure or just to give you an idea now it should be less it should be um less than or equal to 40 millimeter mercury okay less than or equal to 40 millimeter mercury if you're using your blood pressure cuff again what's the what are the instance that you are using your blood pressure cuff number one if there is no available 30k in the laboratory and secondly if your patients are obese and the 30k does not fit them okay and the 30k does not fit them now aside from your 30k of course we'll also have different blood collection system that are being used in the laboratory the first one are your syringe so your syringe um the usual syringe that we are using the most common gauge of your syringe is 21 gauge okay for your um normal patient for your your patient that has normal veins we are using your 21 gauge so remember by the way that your your gauge and your bore are inversely proportional or indirectly proportional the higher the gauge okay the higher the gauge the smaller the bore the high the lower the gauge the larger the bore okay the larger the bore or the when you say bore yung butas okay the the bore or the hole in your needle okay the usual length of this the usual length of the the needle is 1 to 1.5 inches in length okay the needle is 1 to 1.5 inches and then of course please do remember that your 21 gauge is most common for your uh is the most common gauge for your syringe okay for your blood collection if we are collecting from fragile vein fragile geriatric elderly um or pediatric the infants or the chill uh or the kids we are using your 23 gauge okay so if your vein are fragile if you have um patients um if you have elderly or children na patient we need to use your 23 gauge you also use your 25 gauge if you are collecting blood through the scalp okay scalp yeah scalp okay if you're using if you're collecting through your scalp you use your 25 gauge so again please remember the different parts of your syringe we have your bevel it should always be bevel up your the shaft of your needle that is uh the needle is 1 to 1.5 inches in length you have your hub and then you have your graduated barrel you have your plunger and this is completely assembled syringe system um in addition to your syringe system if we're using your syringe system of course we need to transfer the blood um that we collected so usually we use your syringe transfer yeah we use your syringe transfer device so in your syringe transfer device uh we transfer your blood okay so that uh we could prevent the hemolysis of your blood of course aside from your ETS we also have your evacuated tube system your ETS which is the most common and the most efficient system and is the preferred um collection tube uh collection system by the CLSI for um collection collecting your blood so it is a closed system preventing exposure um to air contaminants um and to air and other contaminants in the environment okay again this is the most common and these are the different parts or the different components of your evacuated tube system so you have your multi sample needle so it is a two-way needle okay you have your tube holder or your adapter and of course you have your evacuated tube evacuated tube that has different colors and those different color signifies different uses or different additives within them okay so those are your evacuated tube system so please take note of them so again these are the components your multi sample needle okay that will allow you to collect multiple tube of um multiple tubes of blood unlike your your syringe that is a single vene puncture so if you use your syringe 5 ml you will only be collecting at most 7 ml but if you use your ETS like for example last time I collected blood from a patient I collected 12 uh test tubes from a patient okay so that's very important for you to remember okay so for your evacuated tube remember that there's a vacuum present already negative pressure that's why upon inserting your evacuated tube the blood will already be flushing into the tube okay or will be collected into your tube okay so that is it for your ETS so aside from that we also have your wing infusion set or your butterfly so it is an indispensable tool for collecting blood for small difficult vene such as hand vene if you're using your dorsal plexus um veins of your elderly patients pediatric patients and most specifically also helpful if your patients are um cancer patient because they're they we will really have a hard time or difficult time collecting blood from them okay so aside from that of course um please do remember that the the needle of your wing infusion set or your butterfly is usually one half or three fourth inch okay and it's connected to a five to twelve inches long tubing so this one um you have your your needle okay your needle around one half to three fourths inch and then you have a five to twelve inches long na tubing okay five to um twelve inches long na tubing and here you can insert either your um you can insert here your syringe or sometimes you can simply insert here your adapter and then you can collect through your evacuated tube system okay again remember that when you're using your butterfly or your wing infusion set you need to have a discard too why because um the first few drops of blood or the first few ml of blood are contaminated with air because um it needs to fill in the tubings first okay so aside from that other devices for your blood collection specifically for your skin puncture um and for your skin puncture are your landscapes so of course you already know this you have your your capillary tubes your red capillary tubes contains your heparin okay your your your heparin your blue uh your blue hematocrit tubes does not have your anticoagilan okay wala sya anticoagilan of course ayan these are your um um micro hematocrit tubes remember that they hold around 50 to 70 micro liter of blood so this is your hematocrit tube which will be discussed further in hematology so we're just discussing and reviewing it briefly here in clinkem and finally you also have here your um bullets or your micro collection tubes again for the order of draw for your micro collection tube the first tube should be collected for your capillary blood gas again i want you guys to be particular when it comes to this because um there's arterial blood gas and there's also capillary blood gas and then followed by edta and then other tubes with additives and then your non additive tube will be the last one okay so that is for your micro collection tube but now what about your um what about your evacuated tube of course we also have okay also have your uh we also have your evacuated tube system okay we also have your evacuated tube system and we also uh will be using okay we will also be using your we will also be using your we'll also be using your order of draw for your evacuated tube system and for everybody I want yun na, na by this time, I want everybody to review and memorize this table, okay? So the different color, stopper color, the different stopper colors, the different anti-coagulant and additives that they contain, the different type of specimen and their use and of course the mechanism of action. When you say mechanism of action, the action of the anti-coagulant or the additive found on your tube, okay? So for the order of draw, okay? For the order of draw, okay? Again, I'll give you five seconds, five, four, three, two, one to screenshot this. You can also find this at table three dash four of your Henry's. So please again, this is one table that you need to memorize, that you really need to take into heart from this day on, okay? From this day on. So please take note of that and finally this is the order of draw for your, this is the order of draw for your, for your samples or for your evacuated tube, for your evacuated tube. So the first one is of course your yellow. Again, when it comes to order of draw, we refer to them by color rather than by additive. Why? Because yung na, when we say color, we go by the color of the stopper or the colored top tube, okay? So have your yellow, your light blue followed by your serum tubes.   And then just for the information of everybody, the black top tube should be collected after your gray top, okay?  So this is the order of draw and then the other tubes will be collected after your gray top na. Again, after your gray top. Example of that yung, take for example, your black, so after sila. They are being used after your gray top. Again, please remember the inversion. So again, like what I mentioned, the magic number is eight except for your gold top. You need to mix them for five times, your red plastic five times and then your light blue top, okay? That contains your sodium citrate. You need to mix them for three to four times. So again, why is there an order of draw in the laboratory? Why do we need to perform and why do we need to follow the order of draw? Simple, ladies and gentlemen, because your order of draw, okay? Because your order of draw now refers to the order in which tubes are to be collected during your multiple tube draw or are filled from a syringe. So your CLSI recommend the order of draw following this order, okay?  Again, please refer to them according to color. And now the ultimate purpose of this is to prevent first the carryover or cross-contamination of anticoagulants and at the same time to cross contaminants of blood then from one tissue from the other. At hand from that is this also to prevent tissue, trombo-plastin contamination and also to prevent microbial contamination, okay? To prevent microbial contamination in our patients, okay? So please remember this is the purpose, the sole purpose of your order of draw. Hindi dito dahil trip ko lang parang mas mag- parang it is of better colors, Kim or whatsoever, no? It is because we are preventing cross-contamination or carryover. There is what we call your anticoagulant reflux, okay? What do you mean by anticoagulant reflux?  So we also need to prevent that from happening because if that happened you will be contaminating the succeeding tubes that you will be collecting, okay? That you will be collecting. So that is the order of draw. Again, please remember it's very important for you guys to take note and to, I really want you not to memorize this because this will get you very, very far, okay? So if there's one thing that I want you guys to take from Glen Kim, okay? As I, of course, from all the other topics that we discussed. When asked of the different anticoagulants, you know now what are those. So I also want you guys to remember which one will give you your plasma and which one will yield you your serum because a lot of you are still confused with that, okay?  If it does not have your anticoagulant, then if you centrifuge that, you'll get your serum. Again, ladies and gentlemen, I want you guys to remember that inside your test tube, it's not always anticoagulant, okay? para sa mga Filipino students namin. Ang test tubes mo hindi pala, again, anticoagulant ang laman. That's why we call them additives because there are different additives within your test tube, okay?  So hindi lahat ng laman ng test tube, not all component of your test tube are anticoagulant. Some of them are clot activators or some of them perform different purposes that are vital in our collection. So with that being said, we'll be discussing the different tubes briefly. So I'll be discussing them and highlighting some of the things that I need you guys to remember. So let's start off with your yellow SPS. I call it yellow SPS because there is another yellow top tube which will be discussed in the special tube that contains your acid citrate dextrose. So your yellow SPS contains your sodium polyanethylsulfonate and I want you guys to be specific because if you only answer sodium polyanethylsulfonate, that's wrong because the correct answer is the 0.025% of your sodium polyanethylsulfonate. Again, we are using your 0.025% sodium polyanethylsulfonate in the laboratory. So what is the purpose of your 0.025 sodium polyanethylsulfonate in the laboratory? So it aids in the bacterial recovery by inhibiting your complement. It inhibits your complement, it inhibits your phagocyte and it can also inhibit certain antibiotics. So your yellow SPS are usually for your microbiological test or your microbiological culture in the obviously in the bacteriology section. So please do remember that your sodium polyanethylsulfonate is also, A is also an anticoagulant. So your SPS, the action of your SPS is by inhibiting rather by chelating. They are able to inhibit your complement, your phagocyte and other antibiotics in the laboratory. And more specifically, it is able or capable of inhibiting your complement and at the same time, preventing coagulation by chelating your calcium. Again, here, your yellow, it inhibits your complement, it inhibits your phagocyte by binding to your calcium. That is your 0.025% sodium polyanethylsulfonate. Again, yellow SPS for bacteriology and it should be stare it. Second, after your yellow SPS, we collect now your light blue top. Your light blue top can either contain your 0.105 molar or 0.129 molar of your sodium citrate. We have two formulation for your sodium citrate. It can be your 3.2% or 3.8% sodium citrate. Remember that your light blue top is best for coagulation test specifically your protrombin time and your activated partial thromboclastin time. That is what you mean by PT. Protrombin time with international normalized ratio. That important for now.  What are coagulation test? We are determining if your body has enough coagulation factor that will aid or will help in the formation of clot or in the formation of your fibrin. So your PT is your protrombin time.  So remember when it comes to your light blue top, it preserves your labile coagulation factor. So there are coagulation factors. These are proteins as well. So there are a list of coagulation factor but do not worry that will be part of your hematology to next semester. So again, when it comes to your light blue top, it contains your sodium citrate. And it is very important for you to remember the blood to anticoagulant ratio which is 9 is to 1. 9 is to 1. Again, the correct blood to anticoagulant ratio is 9 is to 1. 9 is to 1. Blood to anticoagulant. Please take note of that. Because most of the students when we switch that, what is the anticoagulant to blood ratio? They will still answer 9 is to 1. But the correct answer now will be 1 is to 9. So remember that when it comes to your light blue top, this one is very sensitive when it comes to volume. So you have a triangle here. So the ideal one will be in the middle of the triangle that is the correct volume, the correct fill volume for your light blue top. The upper part of the triangle that will be the maximum will still be accepted in the laboratory. And then the lower part of the triangle, okay, the lower point of the triangle that is the minimum. So if you reach the minimum, we can accept the specimen. If you reach the maximum, we can reach the specimen. If it exceeds the maximum or it was short, or it was short, or you had a short draw, okay, the collected blood was short, okay, below the minimum that will be rejected, okay. Underfilled, overfilled light blue top will be rejected. Again, underfilled and overfilled light blue top will be rejected. Again, because we are maintaining and we are making sure that the blood to anticoagulatration should be 9S21, okay. 9S21. So aside from your light blue top, let's go now to your serum tubes. Okay, so when we call, when we say serum tubes collectively, these are group of tubes that when centrifuge, when you centrifuge the specimen, you will get your serum. And generally we can divide your serum tubes into two. We have your serum separator tubes and we have your simple serum tubes. When we say serum separator tubes, these are the one that contains your tixotropic gel, okay. Again, these are the one that contains your tixotropic gel. Ladies and gentlemen, I will not be accepting answers like inert gel because you need to be specific. These are tixotropic gel, okay. So your red gray top tube is an example. These are tiger or speckled red top tube, okay. Red top tube, when you say speckled, there are speckled of gray or black colors on their stopper. So these are usually being used for clinical chemistry, okay. You will get your serum, okay. Out of it. So you need to mix it for five times, okay. Five inversion. So again, your red gray top tube, does contain your tixotropic gel clotting time within 15 to 30 minutes, okay. So aside from your gray top, your red gray top tube, red and gray top tube or your tiger red tubes, of course you have your gold top tube. Your gold top tube is the most commonly used in the laboratory. Although in the Philippine setting, you will still see a lot of red top tube. Remember that your gold top tube, it does contain your tixotropic gel. Okay, your tixotropic gel and it is being used for clinical chemistry section. Again, please take note of the table that I have given you in Henry's. You need to memorize and familiarize yourself with that. Now, aside from your gold top tube, okay.  Why do we call them serum separator tube because they do have a barrier, a physical barrier that will separate your serum from the cellular component of your blood and that is through the help of your tixotropic gel, okay. That is through the help of your tixotropic gel. Please do remember that there are certain tests in the clinical chemistry section that discourages the use of your serum separator tube because some of the analytes, some of your, for example, therapeutic drugs and some of your trace elements of metal, they tend to adhere on the gel. That's why we do not use your serum separator tube. So if we cannot use your serum separator tube, then that's the time that we can use your serum tubes, okay. Your serum tubes. Your red top tube, your plastic contains your silica particle. You need to invert it for five times. It is usually being used in chemistry, immunology and blood backing. Highlight on immunology. Similarly in clinical chem, it's specifically in trace element, therapeutic drug, heavy metals. We do not use your serum separator tube because of the gel. In immunology, we also discourage the use of your gold top or any tube that contains your gel. Why? Because your antibodies, okay, your antibodies tend also to adhere to your gel. So if your antibody adhere to your gel, you will not be able to measure them in the laboratory that will lead to a falsely reactive, falsely non-reactive or a false negative result. As for your serum tube, your red top tube, again, it contains your silica particle.  So those are the other components of your plastic. You need to invert them for five times. So the reason we converted to your plastic tubes because glass tubes are somehow hazards in the laboratory. But again, there are times that we cannot go away.  Again, because glass test tubes are nonporous, okay, meaning to say they can preserve the anticoagulant within them. Unlike in your plastic tubes, okay? So aside from your red top tubes, read your red plastic. We also have your red glass. It doesn't have any additive. So it does not have any gel and your no clot activator. So it doesn't need any inversion.  Okay. So the usual coagulation time or clotting time, rather, for your red top tubes, your red glass, okay, is 30 minutes to 60 minutes or one hour. Okay. So aside from your red, your red glass, you also have your orange top tubes. Your orange top tube contains your thrombin. Okay. It contains your thrombin. The clotting time is usually five minutes and it is being used for clinical chemistry and other stat samples. So before, as you heard me mention kanina, in stat samples for clinical chem, we usually use your plasma, specifically the one that are collected in your green top tube. But now we can use your orange top tube because it contains your thrombin. Your thrombin will readily convert your fibrin agent to fibrin. It will clot within five minutes only. Okay. But of course, there are certain limitation when it comes to your orange top tube. Specifically if your patient has thrombocytosis or increased platelets, it is still best to you. It is best to use your green top tube in case of stat electrolytes. Okay. Specifically for your electrolytes. So aside from orange top tube, of course we have your light green. Your light green contains either your lithium heparine or your sodium heparine. But this one, light green denotes the presence of your gel. So these are plasma separator tubes. Bakit plasma separator tube? Because it doesn't simply separate your plasma from the pack red cell, but it uses a physical barrier in the form of your tixotropic gel. So your light green contains your sodium or your lithium heparine together with a gel separator. In this case, your tixotropic gel as well. So this is also being used for chemistry section. And for your plasma, for your plasma tube, let's start off with your green top tubes. Okay. Your green top it only contains your lithium or your sodium heparine without, that is without gel. Okay. So please correct that without gel. Okay. Without gel. Also used for chemistry. Now, aside from your, aside from that, remember that your lithium heparine and your sodium heparine are your anticoagulant. Anticoagulant in your light green and your green top tube and their action is to inhibit your thrombine. They inhibit your thrombine. So please remember that because for most of your anticoagulant, most of their action is by preventing your or by reacting or acting by binding to your calcium. Your green top is the only one that your green top is the only one that contains your heparine and it is the only one that inhibits your thrombine.  There are two formulation of your EDTA, your dipotashong and your tripotashong EDTA and it is being used in hematological, most hematological processes or procedures but in clinical chem, we are using it in measuring your glycated hemoglobin or your HBA1C and I think that I need you guys to remember when it comes to your lavender top is that the most common formulation that is being used in the laboratory is your K2 or your dipotashong EDTA. In our quizzes, abbreviation will not be accepted. So please remember ethylene diamine tetraacetic acid without spaces in between except for acid. So aside from your lavender, again the last tube to be collected will be now your great top tube that would contain two components. There are two additives that are found in your great top tube your sodium fluoride and your potashong oxalate. Your sodium fluoride is an anti-coagulant.  So in clinical chemistry we can use your great top tube in the collection of sample for glucose, lactate and also alcohol or your ethanol. So remember that when it comes to your sodium fluoride it inhibits your it inhibits or it binds directly to your magnesium okay? Bind to your magnesium inhibiting your enzymes okay? That will inhibiting your enzymes that are essential in your glycolysis. So we prevent the degradation of your your glucose by your red blood cells. Okay? By your red blood cell.  So your great top tube is a best alternative to that. If you don't have your gel separator. Okay? So because it will be preventing your glycolysis. Other special tubes okay? So those are the routine tubes that you can see in the laboratory. Okay? So you have your yellow okay?  There are also other special tubes that I want to discuss briefly.  Sprayed dried EDTA and it is usually used for blood banking and molecular diagnostic pink top tube pink top tube. So sir it does contain K2 EDTA so what is the difference between my pink top and my lavender? Your pink top tube contains a special labeling okay? Special labeling special label that is allotted for your blood bank so that is for your pink top again for blood banking and molecular diagnostic it contains your sprayed dried K2 EDTA I guess I was not able to mention no? Your K2 EDTA can be of two form your K2 EDTA is sprayed dried your K3 EDTA is in liquid form okay? in liquid form so aside from that I was able to mention this na kanina we have your white top tube your white top tube contains your EDTA and your gel usually for molecular testing white blood white top tube for molecular diagnostic and next we also have your royal blue top your royal blue top can be of two form actually it can contain K2 EDTA or sodium heparin and in some royal blue color top they also contain silica particle so when you're using your royal blue you can actually collect serum if it contains your silica particle if it contains your K2 EDTA or sodium heparin it you will be able to collect your plasma okay? so these are usually for toxicology for your trace element and your heavy metas so please do remember that your royal blue top even though there are some there are other tube that already contain your K2 EDTA and your sodium heparin your royal blue denote that it is for toxicology now finally last three tubes we have now your yellow top tube this one contains your acid citrate dextrose okay? your acid citrate dextrose is for your your yellow top tube is for your blood banking but most specifically this is for your HLA phenotyping or paternity testing so DNA testing HLA phenotyping these are these are also molecular techniques but not PCR okay? HLA phenotyping and paternity testing what are we going to use your yellow top tube but not the yellow top tube that contains 0.025% sodium polyanethol sulfonate but the one that contains your ice acid citrate dextrose or known as your ACD okay? that is your yellow top tube I will not be discussing your acid citrate dextrose as an anticoagilan for blood bank muna because that is different okay? here the purpose of your again, I want to be clear the purpose of your acid citrate dextrose in a test tube is to preserve your WBC okay? more importantly to preserve your WBC that will be used for HLA phenotyping and paternity testing I need to specify ACD in the test tube because there is an ACD your acid citrate dextrose that can be found in your blood bags okay? and they have a different purpose okay? so that is for your yellow top tube now we also have your what? we also have your tantop tubes okay? your tantop tubes okay? if it is a glass tantop tube the anticoagilan or the additive is heparin if it is a plastic tantop tube it contains your K2 EDTA K2 EDTA is again a spray-dried type of EDTA so your tantop tubes are usually used for lead testing or lead determination so unlike your royal blue your royal blue that is for your trace element which actually lead belongs to but we are not using the royal blue for lead instead we are using your tantop tube that is to denote that this particular sample collected in your tantop tube is exclusively for lead testing okay? for lead testing now finally last tube for today your block top tube your block top tube contains your buffered citrate dextrose buffered citrate dextrose that is that is already a in another world okay? your block top tubes contain your buffered sodium citrate rather your buffered sodium citrate is used for Westergren ESR I need to be specific it is only for Westergren ESR okay? Westergren ESR we use your block top tube and unlike the other citrate your light blue top which has a blood to anticoagulant ratio of nine is to one the blood to anticoagulant ratio for block top tube is four is to one four parts blood one part anticoagulant that is for your block top tube again blood to anticoagulant ratio is four is to one and this is exclusively for your Westergren ESR ESR which means your erythrocyte sedimentation rate okay? much of your ESR this week in your hematology laboratory but please remember for your block top tube we are using that for your Westergren ESR with a blood to anticoagulant ratio of four is to one with that that ends now our discussion for today so thank you so much for listening okay? thank you so much for listening so if you have any questions or clarification feel free to send me a message by the end of this meeting so thank you so much for listening and please do prepare for your quiz next meeting for your specimen collection and also patient preparation so with that thank you so much for listening have a nice and great day ahead of you a great week ahead of you thank you so much for listening and I'll see you on our next class bye


verything like either in print or through computers with a lot of older people in the neighborhood that don't access that a lot of that kind of information. And I think when you have some sound information, sound, that's not a good word. So concrete information to share would be a good time to call a meeting at Chamberlain School or something. And inform the citizens that way. Instead of, they aren't gonna probably go on a meeting at the airport because I think they're intimidated and they feel like Gene Richards is going through the motions of what he has to do to follow through to get what he needs. But I think if we show an interest in promoting what we know, we're gonna get better participation in a personal manner. To both of those points, I would also just push back a little bit on the airport statement that they want to hear from the people and not the elected officials. And the defense of the people, they're busy.  They held elections every year to have representatives representing their interests. And this is what we've committed to. And so I- I think he doesn't care because the people are the ones gonna be receiving the insulation treatment. Wait, is that that again? The residents are the ones that are gonna have to sign individual documents. You know, they're gonna receive insulation and treatments for their home. So it's like the FAs, like the people that live in that vicinity are the ones that we're talking to specifically. And I understand that, but does it mean that we can't go, you know, it deploys some extra information to say that, oh, you know, maybe we could affect their personal opinion a little bit. I mean, we have our own court of public opinion in the city that we have conduits to, right? So we should exercise that right. Well, and there's other sound mitigation opportunities like burn, which an individual homeowner isn't gonna say, hey, number one for me is a burn, probably, but the city could say overall, that is something that seems to, as if it would be really helpful to a large group of people that maybe aren't complaining so much now, but sometimes you- Well, the interesting part- You don't know how noisy it is until it's quiet. You've got an interesting part. It could be your proximity to the airport as well. Yes. Because if you have 900 homes, those that are closer might be more affected by a burn, those that are further away by an insulation. So I think there's so much that, you know, as I say, knowledge-wise to help people with, you know? And you know, even stuff like, if my next door neighbor wants to get insulation and will sign an easement, but I don't. So is the plane only gonna fly over that house? At a low level and not a bind? I mean, what are the parameters for all of that? And I think those are questions that people have that, you know, who can answer that? Uh-huh. So I think you have to have people that have good information available too when you're informing the public, because the questions can be really scattered and seem odd, but- And some have done certain things so their home have already replaced windows, but maybe it's the insulation part. So, you know, it's not going to be the same thing for everybody necessarily. Totally agree, you know? Well, we certainly is this. I heard the information, excuse me. You know, Meryl Weinberger came to my house for a meeting and I mean, he was just like laying soul out, like all the things he was gonna do to protect the people of South Burlington, but I don't see that. And I don't see that with Gene Richards. So I think there's a real general distrust for information. But I think the people that people are gonna trust are people that work, you know, that are representing us here in the city. So I think you have to be careful how they get their information in order to, if they're not feeling like they're being strung along. Well, I think as a city, I mean, we certainly have to, I need to know more information about the navigation easements, but to your point, Carmen, that's conceivably something that the city government says there aren't gonna be any navigation easements. Period. I think that comes to the FAA. Well, yes, but my understanding is the... The city could turn it down. Yeah, that maybe that, I'm just saying, maybe that's a stake in the ground that's a broader. Is there precedent for that in other communities? Well, I don't know, but Jean did say, or no, Duchette said, you know, some places don't have them. Some places write their own. And I haven't seen any, so we don't even know what they say, except I think it's... On the agenda tomorrow. That is on the agenda for tomorrow. It's key, you know, if you have a community, as you say, okay, seven people said, well, I don't care about the navigation easement, that's fine. So, I guess they can't sue or they can't get any more money or something, but... Right, it just seems like there might be some things that the political arm of this community should be able to advocate for and get as part of the proposal. And then the individual... That's on the agenda, so... Yeah, Paul, do you have your hand up? Yeah, Paul Conner, Director of Planning and Zoning. The consultant for the airport did provide us with a summary memo that has a couple of examples that we're happy to share with you all, so you can take a look at them. There are some questions in there along the... There should be some questions posed, I think, around what are the metrics by which a community decides whether it's appropriate to have navigation easements and or to what should be in them if they are going to exist. So, I think those are questions we'll pose tomorrow. The FAA guidance on this is the most circular statement I've come across. Basically says that the FAA encourages them, but doesn't require them, but encourages them, and it can't... It's very strict, so there's lots of room for interpretation. I'm sure what they really mean is you have to have them if you want money, but you don't have to have them. Yeah, I think that's pretty much what they're saying. Without really saying, yeah. Yeah, but... But if, in fact, some places don't have them, or they're written their own, you know, that leaves something open. I think that would be important. Any other thoughts?  So, as things evolve, maybe I'll report back, and maybe some of the heat can come out of the conversation and we can get somewhere. I'm hopeful most of the time. Good initiative. If I created heat, I apologize. I didn't mean to... No, I didn't say that to make you apologize. I get it. Let's push the conversation. So, all right, it's 9.15, so Sue would like a very little break, and then we'll reconvene right on schedule at 9.30 for October financials. What's the password for the Wi-Fi here? I can't... Thank you. It's a 575 Dorset. I can't get on the Wi-Fi. You can't get on ours. It's a new phone I've been on here before. No, I could open that clerk thing when I came in. Then it shut down, and I couldn't open anything else. Are you still not getting your stuff through the box? No, I can open it at home, and I get through everything. Can't open it when I get here.  I love it that, but all the blue things so I can get in, can't get in. So I'm gonna regret it all ahead of time. Okay, and you're connected into our office. Hey, listen, I'm probably off base with this.  Check and see if you've got a bumped off. Tim can't get on. Tim can't either. I can't, no, I gotta find out what the password is. I know.  I can get into the agenda. I get here, and I can't open the attachments.  It was so much easier when we dealt with the box. I could get in with the box. Can you access it when you're here? What, the Wi-Fi? Yeah. Just get on this guest Wi-Fi? Yeah. I have been able to, but I don't do it because it runs my battery down too. Oh, okay. So, but I have a new phone here that I'm trying to. My. This is the city, yes. My secretary has gone to Dallas for training and she's calling me tonight, and I'm thinking, what's going on down there? Why is she calling you? Oh, she's doing some training in the system of earthquake programs down there. And so we sent her to Dallas for the training and it was just where they were doing the national training. And she's calling and I'm, so that's why I had to get up and say the blog. You gotta call Kathy, find out what's going on. She was so, she hadn't flown in 10 years. She had never flown alone. And she was, she was a rock. But that was yesterday. So Mark, it was up 210 points that they opened today and then they went kind of like glided down to like. Where did it close? 80, 80, 40, here I'll tell you, oops. Still over 24. Oh, yeah, yeah, yeah. Well, here, have a little. Jesus, it was funny the other day. McCain says he'd vote for the bell and it goes up 320. Yeah. Oh shoot, I don't know. And Charlie Moose gets nailed and it goes down. It was only up 58 on the Dow, 24, 290. But it started. Wait a minute, Charlie. Like, the Dow traveling for the holidays. So it started boom right up there and then it just kept petering down. What's interesting though is that IBM did kind of be opposite. Did it? Bushner. When? Bushner. Oh. Yeah. Yeah, you don't want to offend a counselor right now because I can't get on the city. Because I'll see what's going on. So she said Cindy Bushner. Let's go talk. Yeah, no, it's, you know. I know, I know. Jesus. Did one of those work for you? It's scary. It wasn't. Oh, my wife, I just. So if I. Let's go just be city. Oh, it was. That one. I couldn't have to last capital B at once. If I go to Senate. I don't have to have to be at once. Okay, let's go back and try. See? It says South Bowlington City Guest. Yes. So that's where I'm supposed to be. To you. I think Paul will tell you it's 575 Dorsey. It wasn't enough. Another one. Oh. Jesus. Take your hands. All right. Mr. Connor. I am listed as South Bowlington City Guest. It's checked. South Bowlington City Guest. Why is it when I go into the clerk thing? Yeah. Okay. I can't open anything. Try going. The clerk base tries me. Go to click on TOC there. No, that's not the right one. Okay. Sorry. Go back to the meeting. December 4th there. Try clicking on document. Now see if those open up. Anything? Wait, give me a second. Try one of them. It is. It's going. I mean, it's quick. Hang on a sec. Stop clicking. This clerk thing drives me a little bit bananas. Damn it. The Wi-Fi is. How about all? How about Hit List? What's the password for the guest again? Capital, ask capital B, small wireless. Nope. Okay. About Brahms. I couldn't. No. All right. Pat, I'll play with that and see. See if I can get it. How about Hit List? Hit List. Okay. That worked. I'll play with that and see if we can solve it. All right. I've had the same thing happen to me that drives me bananas. Well, it's interesting. And I mean, I've read everything at home. Okay. And that was fun. Then I get in here and it's like. Yeah. And it recognizes the SB guest. Yeah. The guest one is weird though, because it gives us access to some things, but not other things. Like you can't get your email. But it won't open any of them. Right. So I think Al told me that we can get you the regular SB city one, not just the guest one. I just don't remember the password. That's fine. Yeah. Yeah. Well, I mean, I guess sometimes I would like to sit and say, yeah, what line are we on? Yeah. It's like you're the outlines and stuff to talk about. Yeah. So this is really the end of this one. Yes. Yes. Okay. I'm out of here. I'm out of here. Where are you? You leave it. What are you doing? Have a wonderful choice. Oh, you want to go wings. Oh. So now you're going to come with me. Yeah. I've been with you for only for a couple of weeks. Oh, no. I love that. Yeah. When will you get back? Would you like a hug goodbye? Wow. Okay. See, she got the email today to wear the green. I suffer a lot. I suffer with depression. Oh. Well, since I retired, it really has exacerbated that. Light helps. Yeah.  And up until a year ago, I took my mom.  So this is my first year without mom, so it's all. So where do you go to? Do you have other relatives there? No. But friends. A lot of friends. In the neighborhood, yeah. Where do you go now? I don't know. It's in India. So about 25 miles a year, it's the Palm Springs. This is in California. Yeah. People who work in Palm Springs live in India. So is this like your mom's home out there? It was a kind of a shift back then. Nice. When they paid for their house names. Yeah. Then they bought this little climb. Nice. It is. And then it's like, it's a new climb. Safe. You're going to have great weather. I think so. Oh. Well, my sister. I'm going to play every other Monday at 3.30. I am going to turn on the computer. And get the. And watch the city council. Oh, that's great. You'll be five minutes late. Great. That's OK. I'm going to watch. And you can turn on and watch the airport commission. Something outrageous happens. I will send you all the evening.  I leave Berlin, South Berlin, to look what happens. Yeah, say. Hey, we're on time. Well, we appreciate your being here all the time. Thank you. Thank you. That's what I'm looking for. Is she OK? 10 minutes. Did you reach her? I've been one in five minutes. You didn't get her? Did you listen to her voicemail? I actually stretched that because I figured. Yeah, there is. I figured you might be listening. You tried to follow her, right? Well, we didn't have to. I adjusted to how that says they have them. Bye. Yeah, so. Sleep would be nice. It's Kathy. Just want to let you know everything's going good. I'm having a great time. Full is wonderful. And they made some really good friends. So I'm going to tell you the doc. She's not coming home. She's not coming home. Rain is getting too much. Talk to you later. Six. Jesus, all right. So there's nothing wrong with her. She's fine. Well, I figured this is you probably still had enough money for the bar. Can I say more? She's what you're trying to say. We gave her like $100,000 in case she needed anything, even though she gets picked up at the airport. Everything is taken care of. But I said, look, those goddamn Uber people, parking just any old place, they don't do anything. I don't like it. They shouldn't have. Oh, they're terrible. Well, they don't. We get money. The airport gets money from Uber. Because if you come in and pick somebody up, that's the only fair way. People were lovely as well. Uber has to pay a fee to the airport? No. No, no, no. It's a period of time. People get to drop off at the airport. Because all cabs pay sometimes. Well, theirs is different, because they don't sign on to the Medallion type. But they had to go through all of the conditions But they don't have to pay. But no, there is a drop-off or a pickup. But if you walk out to the airport drive, it's free. Probably, yes. And that's why Green Mountain Cab sits out there. The other day. Well, they park over there. They don't want to come in the airport without any money. I understand that. I understand that. I mean, it's just capitalism. It is. Except when you have to work on this Saturday. He says, you know, I'm trying to support my non-kids. He's one of the, if you go up Main Street in Manuski, normally we would have closed the houses of freaking cabs. And we pay him $70,000. No, seriously, if you look at it, it really is. We're on our way to Mass on Sunday at St. John Gianni. You know, it's every other driveway.  Anyway, and they owe, I'm a treasure for this. It's a very good deal. Of course, we will stay open. We're getting killed by Uber at that time. And he said, because he said, I pay my seat in the city of Wellington. I'm trying to support my nine kids, you know? I understand. And I thought, that's what this. You know, but what? Some of the cab companies, we have heard the fact that business people are slow-growing a lot of people didn't know we were there. But people go to get in the cabs. They stink of smoke. Blooming every day, even though the cabs do. These are regular cabs. Wait, the cabs stink of smoke, or the people stink of smoke? The cabs. Oh, yeah, no, a cab's right here. And they said, they have been very happy with Uber, which is a nice job. No, I've used Uber since July. That's a high source, but I've used Uber times. Everybody would get a cab. It's a really quick way if you have one of these. Yes. And this is how they should govern all public transportation now. It should be. So you know where they are and where they're coming. We've got kids that travel a lot for business, you know? They're right in front of them. And Uber, I mean, I don't know. But anyway, it's like, my son said Uber was little. He said, the cities he said are just amazing. Well, how was my son? But apparently, lots of problems with Uber. Yeah. They're right in front of them. You know, I used to feel good. OK, so let's come back to order. Bring your gavel back. I know. So I'd like to reconvene the South Rowington City Council for their December 4th meeting. And we will continue with item 16 on the agenda, October financials. And Tom Hubbard, take it away. Thanks, Helen. So with a linear measure, we're 33% into the air. You know, we're third of the way done, which is hard to believe already, but taking us through the month of October. And as we stand right now, our revenues just over 28% expenditures at 32%. Not a huge story to tell you at this point. A lot of what the expense, the larger expense items have been have been stuff out of the CIP, vehicle purchase, computers, transfers that we made into certain funds at this point and some of the note payments. I mean, those are the bigger things that, as you look down through the budget and expenses, that are more than 33%, they kind of fall in those major categories. And on the revenue side, we're going to be receiving revenue in the local options tax during November, so that will be on your next report. Is that received once a year? It's four times a year, and one of them is a partial payment in each fiscal year. So we have three full payments and then one partial. And each of the years. How is that looking? I think so far, it's on target, Tim? It's on target. Yeah, I mean, this is usually the bigger one, this period through the February one that we get. I'm just trying to assess whether or not Amazon taking taxes is actually getting back to the state. Yeah. They don't. Yeah. I mean, they collect some, but they don't force third parties to collect any, right? Have you had any gotten any traction with the state or the tax department in getting a more granular accounting for the? We haven't. We've inquired, and I know they're busy, but we're going to be persistent. Even like a list of the different businesses, just to kind of see that list. So we're still doing some exploring on our end. I know that Andrew is continuing to have conversations with folks down there in the tax department, and we'll continue to pursue that. Have we mentioned that to the legislative delegation? I just wonder. Have not at this point. I mean, Sorotkin's on finance. I mean, I don't think it's just South Burlington who might be interested. Yeah. We used to do legislative practices. Are we going to do one of those again? I think it's too late. We should have scheduled one, but I think it's probably too late right now. Most of them will be there at the CCRPC one. Yeah. But we could do one in January. But a legislative happy hour, that's a better time to agree so much. And we'll do it at the end. And on tape. I mean, you make note of that.  No, but we could do one early in January. I'll talk to David about that tomorrow. I just think that would be helpful to have some of the. And I would be, and we're curious to. Suspecting that Ginny Lyons might be interested for Williston to find out if they get everything they. Yeah, I mean, I asked the state this independently like over almost a year ago.  And they're like, that's a closely guarded confidential number. And I go, well, I guess I understand that. But it's like somebody should be watching the henhouse from there just because they should be able to correlate that to taxes. I mean, to, you know, to income taxes and just understand changes year to year and find out. Because you just want everybody to pay their fair share. That is all we want, right? And for the municipalities to be able to participate in that. Sure. Well, we make the assumption that they're appropriately counting properties in South Burlington. And not awarding that to another community. I mean, half the population thinks that the Sheridan's in Burlington. Yeah. Sure. Now, they know they should, they should be able to know that at the tax department. But still, yeah. At least, anyway. Right. Well, anyway, that's just a suggestion. And thank you for following up on that. Keep at it. Yeah. Yeah, I encourage you to. Thanks. Thanks. But I interrupt it. So are you? Enterprise funds are in good shape. Not much to report there. Like Kevin mentioned earlier, a lot of projects going in stormwater. And we'll continue. We're in the process of finalizing the budget. Hope to have a draft for you at the next meeting. And then our budget meeting, I think, is scheduled for January 9th, 8th or 9th, somewhere in there, which would be a special meeting. So I hope to have a draft for you. Hope to have the audit at the next meeting. I know that Ron is still looking for some pieces of information. He still needs evaluation from our actuary. So if all those pieces come together, Ron will report to you on the 18th at the next meeting, as well as our actuaries. So that will be a pretty significant piece of our next meeting, one of those two reports on the 18th. Yep. Can I ask about the warrants for this meeting and the charges? About the what? The financial warrant that we had. Oh, warrant. I thought you said the warts. And I was like, huh? So the two charges for various furniture for the library, I mean, is that having any impact on our budget for this year at all? So no, because other than the fit up cost, which does have an impact on it, Tim, the furniture, the bookshelves, the equipment, all that, all those appropriations came out of City Center Reserve Fund, because we really see those as transferable items into a new library. So that was the bigger piece of that. And those were the expenses that were on the sheet today. Tonight. OK. And this probably is inappropriate to ask, but I'll ask it anyway. Since the Blanchett funds were not available to us for some of this, is there any way to recoup that once we move to the new library? The next new library? Well, I think I think. Since we advanced the money. Yeah, we had we had largely anticipated that City Center Reserve funds would pay for the architecture and engineering work. But the library board of trustees indicated that they saw that as an eligible activity for Blanchett funds. So we will just swap into that fund for things that we would have used. So it kind of went like that. All right. So if we had that washed, then I fell better with that. OK. So it was disappointing to me that they didn't want to participate in that. Because they thought that the furniture would be old after three years. Well, as you come to my house, you want to see old furniture? Yes. I said, what kind of people go to the library that would ruin furniture in three years? But anyway. All right. We're able to try some of it out today. It's nice. Did you see it? Not yet. Did you fall asleep? No. Oh, you're going to like it. Very nice. Oh, that's nice. Cool. Is that it? Any other questions? Good. All right. Item 17, consider convening as the South Burlington Liquor Control Board. I move that we convene as the South Burlington Liquor Control Board. Second. We have a motion and seconded. All in favor, say aye. Aye. OK. Where is Dave's cosmic? We are now the South Burlington Liquor Control Board. And we have exactly one first class license that Dave's cosmic subs Vermont. Is that in the blue mall? Is it going to be in the blue mall? 150 York Street. That's by the Chinese food place, right? Where is that? That's prior to the blue mall. Mr. Lee's, no? 150, I think. 100 is the other mall. I thought it was. I can't open the thing, so. I don't know what I did to my, oh, here we go. What's the number? 150, OK. Dorset Street. Oh, here's that. The wrong one, sorry. Google map it. 150. This is in the blue mall. Where in the blue mall? Yeah. What's empty? Potta Vita Eastern Mountain. Are they closed? No, Eastern Mountain isn't in the blue mall. Oh, not the blue one, the other one. Oh, well, they have all different little shops. I know, I was just, yeah, which one it was. Is somebody closing in the blue mall? Again, sports, and I didn't notice anything empty. I do not know, OK. Well. Whatever, are there any concerns about them having a first class? They've been passed off by everyone else before it comes to us anyway, right? Yeah. So I would move that we grant the first class license to Dave's Cosmic Subs Vermont. Second. Any further discussion? All in favor, signify by saying aye. Aye. All right, so Dave gets his. I move that we come out of what? Liquor control board. Second. OK, all in favor, aye. Other business, the item I had brought up, we already discussed. So if there are no other items, I know. Well, we didn't have Justin here for an important piece. Hold on to your hats tomorrow. Hold on to your hats. Is it going to be windy? Very windy. 30 miles an hour out of the south, southeast again. Maybe gusting to 40.  This has been a boom for roofers, I've noticed, since the October 30th. October 28th, 30th, yes. Oh, it's going to be 50, though. It's going to be 50, but it's going to be really windy. So that's not bad. Find one to count. Yeah, but it's windy. Windy. We have to get a whole new roof. You do? Uh-huh. Because of the storm? Yeah. Wow. You blew some shingles? We have tarps that are stapled onto our roof. Did you have shingles or slate? Why don't we just all volunteer to come over and help replace it? Yeah, right. I've done roofing before. I've done some roofing. OK, so I would entertain a motion to adjourn. So moved. Second. All in favor? Aye. All right. So we'll see everyone on the 18th, including Mike. Thank you. You can probably anticipate an executive session on the 18th. OK, we'll start with the executive session. First thing, we might be able to tell you some kind of story. I won't have to worry about that. Should you do roofing as a kid? No, no, no. Oh, no, no. It's not a two-minute story. It's like a four-minute story, but remind me sometimes. I know, no, that's OK. And I didn't.


That brings us to the end of this course on demystifying networks. What you have learned are concepts of how the MAC layer works, concepts of how the network layer works, how the transport layer works, how applications talk to each other, the security aspects and some troubleshooting aspects. We hope you have had a good time learning this course as much as we have enjoyed creating this course for you. One other point that we wanted to make through this course is that learning is not necessarily happens only by watching videos of lectures by experts but learning also happens by doing things as well as learning from peers. We hope you have had a good experience learning from your peers as well. Now let me ask Kavya about her friend, whether her friend who had come to her with a problem was that problem solved for her? Yes it was and she was also interested in the way we were explaining her using analogies and Jantar Mantar articles. I think it was more relatable for her because we used contexts which are more familiar and that's why it was easier for her to understand the concepts first and then get into technical jargons. How about the simulations with the packet tracer? So the simulations with the packet tracer were a really interesting thing that we tried and some interesting things that also happened were trying to connect the analogies and the packet tracer simulations by creating those virtual network of say that Manali and all which actually came out of the analogies and then we were able to experiment with different devices how they can be connected and as we always say with the simulation it's like a playground so we should always keep experimenting if you have anything. If you feel curious that how does a campus network work why not write out on that. So that I feel brings a very rich experience along with all the topics that we have been discussing. Yes and one more thing that you might notice is that both Kavya and Ashutosh are soon to graduate from their PhDs and soon they will also be in the position that I am sitting in. So let me also ask them about their experience as instructors in this course. I think this course was basically fun. Yes definitely. And initially there were a lot of nightouts for planning and then for brainstorming we will do that we will do this and then when the course actually started we started recording and putting things into weak structure then it became more structured and then we were a little bit, it had to be in that format. The fun thing was a little reduced but then nonetheless it was interesting because this was not like traditional course. We still had too much space to do this or that. So I completely agree with Kavya and some other things were like so every time we think of a new idea what happens is it really you feel energetic about it you think of a number of things that you want to execute but when it comes to the execution level there are challenges but that idea is that you should find ways to how you can overcome those challenges and eventually you do find out ways. So one of the things that has worked with us was the way we organized it initially at a very abstract level like at a weak level then we went into okay in every week how do we do different videos and then each and every topic wise. And then what became easier even in the part of when we were shooting the course so what became easier is we could sequence rather following the analogy of how it happens in a network. We could sequence the videos we could shoot videos which were of the similar category all differently and then later on reassemble it as it happens in TCP. So this was a very insightful especially for creating such kind of a course. So my purpose for involving Kavya and Ashutosh as TAs for this course has been served because they are more than TAs you know they are at the level of co-instructors and once they graduate I am looking forward to them offering their own MOOCs in their own rights. So thank you for being with us for this MOOC. There are several other courses which now build upon these concepts that you have learned. So it's not that this is the end of it and there are several some of these concepts we have introduced to you in the form of LXTs and there could be entire courses for example one area which we have not touched upon at all is the theory which is behind all of these things. So there is a lot of equations and theory that models such networks. So there could be entire courses on that. So many of these courses some of these you will find in NPTEL itself some of these you might find in other MOOCs and so on. So depending upon your interest you are welcome to go ahead in whichever way you want in your journey to learn networks and understand them better and better. Thank you for being with us for this course on demystifying networking.