Tuesday, March 24, 2020

Run Lola Run free essay sample

The 1998 film ‘Run Lola Run’ directed by Tom Tykwer uses visual techniques to convey messages to the audience and involve the audience in the experiences that the images create. The use of a variety of techniques create distinctively visual images that are both memorable and unique, they feature visuals that are highly distinctive. With the use of techniques including symbolism, characterisation, animation and camera techniques, Tykwer explores and conveys ideas about the nature of love, subjectivity and inescapabilty of time and the absurdity of chance events.Tykwer portrays the distinctively visual images of Lola running, the red filter scenes, animated sequences and the split screens. ‘The Highwayman’ by Alfred Noyes, also utilizes distinctively visual imagery in the areas of setting, symbolism and characterisation to explore similar ideas about love and fate. Tykwer’s post-modern film is both important and influential that is remarkable for its use of a variety of innovative techniques, such as a non-linear narrative and a combination of animation ad traditional film styles. We will write a custom essay sample on Run Lola Run or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The distinctively visual image of Lola running is formed through the use of characterisation and camera shots. The image of Lola running sticks with the audience and reoccurs throughout the entire film. Lola’s red hair and youthful, urban dress illustrates a unique character. Her red hair symbolises the passion she lives with, her pants and shoes look industrial, suggesting she is resilient and strong. Her belly and tattoo being exposed indicates a carefree confidence. The tracking shot engages the audience in scenes of Lola running, it creates a sense of speed and urgency.The camera tracks in various angles, often mid-shot and side-on, this particular shot type enables the audience to be â€Å"carried along† by Lola’s momentum, thus, feeling the energy and determinism of Lola. Tykwer often cuts to close-ups of Lola’s face while she is running; shot from front-on, doing so shows Lola’s determined expression. An example of this is seen in the first run when Lola runs across the train bridge. With the use of characterisation Alfred Noyes creates a very distinctive character in ‘The Highwayman’. The Highwayman wears a â€Å"French cocked hat†, a â€Å"claret velvet coat†, â€Å"perfect fitted breeches† and rides â€Å"with a jeweled twinkle†. This characterisation of the Highwayman creates an image of a romantic hero which is both unique and distinctively visual. The red filter scenes contrast so greatly with the rest of the film making them distinctively visual. The techniques used during the red filter scenes also result in a distinctively visual image. Tykwer uses medium-close ups, symbolism and bathes the setting in red light.The majority of the scenes are made up of medium-close ups; the use of these shots assists the audience in determining the characters’ feelings and emotions. For example Manni’s frustration in the first red filter scene. A red filter is used by Tykwer in the two scenes to create a red light on both Lola and Manni. The red colouring connotes the love and passion, binding the two characters together. The red also symbolises the danger present in their relationship through the involvement in the criminal world. Colours can be used to evoke certain feelings and emotions.Throughout the poem Noyes refers to the colour red. The colour red often connotes love and danger. In regards to the poem the colours red connotes love the love between the Highwayman and Bess, portrayed in the line â€Å"plaiting a dark red love-knot into her long black hair†. Red also represents the danger of King George’s men, â€Å"the redcoat troops came marching†. With the use of symbolism Noyes creates distinctively visual elements throughout the poem by relating the colour red to certain experiences or emotions.Noyes employs the use of metaphors to create mental images and set moods or atmospheres. In the opening stanza of ‘The Highwayman’ Noyes’s use of metaphors introduce the setting of the poem. It creates an omnious and foreboding atmosphere. The use of the metaphor: â€Å"the wind was a torrent of darkness† as the opening line provides an intense beginning to the poem and a distinctive mental image. The three animated scenes contrast so greatly with the rest of the film, the fact that they are animated makes them unique, and thus distinctively visual. The animated sequences emphasise the theme of chance as they cause the audience to focus more on the variances between the three runs. All three of the animated scenes have Lola running down what looks like a never ending spiral staircase, the spiral representing time and confusion. The spiral images reoccur throughout the entire film constantly reminded the audience of the idea of chance and time. The part that varies in each animated scene is the encounter with the â€Å"hoodlum† with his dog. Each encounter with the hoodlum gives the audience a hint of upcoming events.Tykwer’s use of animation and foreshadowing creates distinctive scenes that catch the audience’s attention. In the scene of the split screens including Manni, Lola and the clock, Tykwer uses slow motion mid-shots and soundtrack to create a scene that depicts the ideas of both the nature of love and the inescapability of time. Manni and Lola share the split screen, Manni looks to his left and Lola runs from the right to left. This illustrates the love between the couple and the dedication Lola has for Manni – here Tykwer invites the audience to consider the nature of love.An image of the clock appears at the bottom of the screen. This involves the idea of time, bringing it to the forefront. It plays the role of a third character in the film. We are never allowed to forget the relentless pressure of time that Lola and Manni face. Bringing the three main elements together in one screen helps increase tension. The scene builds to a climax as the audience see that their joint dedication has almost brought them together physically, however they are still controlled despite their devotion and energy by time.Tykwer conveys the nature of love, the absurdity of chance events and the subjectivity and inescapability of time through a number of distinctively visual scenes. He uses a variety of techniques to create unique scenes of Lola running, the red filtered scenes and the animated sequence. The use of these techniques engages the audience with the film and conveys the messages Tykwer aims to deliver. ‘The Highwayman’ by Alfred Noyes, also utilizes distinctively visual imagery in the areas of setting, symbolism and characterisation to explore similar ideas about love and fate.

Friday, March 6, 2020

Lead Time Management in Garment Sector Essay Example

Lead Time Management in Garment Sector Essay Example Lead Time Management in Garment Sector Essay Lead Time Management in Garment Sector Essay 2000). Lead-time typically includes two components: Information lead times (i. e. , the time it takes to process an order) and Order lead times (i. e. , the time it takes to produce and ship the item). Information lead time can be reduced by using very sophisticated and modern communication system while Order lead time can be reduced through efficient supply chain management (Simchi-Levi, David, 2000) A researcher named Marc Smith explained lead time in two ways (www. lsmar. com, 2004). First, Customer lead time, which refers to the time span between customer ordering and customer receipt. Second, Manufacturing lead time, which refers to the time span from material availability at the first processing operation to completion at the last operation. In his paper Marc Smith developed theories for the reduction of lead time in the equipment manufacturing company specially in vehicle manufacturing company. It is also applicable to the RMG sector. In the lead time reduction process, Lead Time Management in the Garment Sector of Bangladesh: An Avenues for Survival and Growth 20 identifying the beginning of the process and walking through the process is very important. In the RMG sector after order confirmation the process begins by sending information to the suppliers for raw materials (fabrics + accessories) and the process run through shipment of final product and received by the buyers. The whole of this process is comprised of the following steps order submission, scheduling sequencing, manufacturing and distribution. A manufacturer may be able to reduce lead time by taking some strategic measures in all of these four stages. From the above theory it is clear that the total lead time is customer lead time. Therefore we can write that; Customer lead time = [{Information lead time} + {Order lead time}] Total lead time = [{Information lead time} + {(manufacturing lead time) + (shipping time for import fabrics) + (Shipping time for export final product)} (Note that, Shipping time for import includes shipping time, unloading time and transport time from port to manufacturing point. Shipping time for export includes manufacturing time for final products and shipping time for export) Objective of the study The purpose of the present study is about analysing the present situation specially of the lead time management in the present business process of RMG export from Bangladesh. In view of the above purpose the specific objective of the study is to focus on reducing the lead time in relation to the business process and supply chain management. However the objectives of this study are; 1) To analyse the order lead time management process and 2) To develop a new business process to minimization of lead time Research Methodology The study is based absolutely on primary data. The primary data have been collected through free discussion and interviews with the key personnel of different company. Primary data have been collected from 50 Bangladeshi RMG units including 5 leading garment factories of Dhaka City on the basis of structured questionnaire designed in the light of the objective of the study. In this study the sample units have been selected randomly but 5 leading factories purposively. Interviews have been taken from Managing Directors, Managers and other officials of the merchandise department. Secondary data were also collected from some reports, articles, various stuffs that were provided by the companies. Collected literature, data and information have been analyzed in line with the objectives of the study. In this study conceptually developed some model, Lead time measurement equation have been used. As a real example, business process of a sample company has been discussed with the lead time measurement equation. Qualitative research method and various statistical tools like averages, percentages, growth rate etc. have been used in this study to interpret and analyze the collected data in the descriptive way. Findings and Analysis The RMG industry of Bangladesh still plays the role of tailor in the garments business. The required fabrics and limited accessories till now come from abroad. The industry is heavily dependent on imports and had to spend about 55-75 days to import fabrics from abroad (Nuruzzaman, 2007). This backdrop is the main reason for long lead time. Bangladesh garment export in volume is increasing @ 15-20 percent for the last 20 years, whereas Bangladesh RMG are depending only on Chittagong port (Nuruzzaman, 2007). The facilities of Chittagong port have not increased at the same rate. The containers kept stuck up in the port and 621 Nuruzzaman and Ahasanul Haque many containers remain jammed for 15-20 days, which is required to be released within three days. If the raw materials remain idle in the container at Chittagong port for 10-15 days, the garment industry would definitely face a serious negative impact (Kutubuddin Ahmed, 2002). According to an estimate, it takes about four days for goods to reach Chittagong from Singapore. But in a very sharp contrast, it takes about 18 to 19 days or nearly three weeks on average for the same goods to travel to the inland container depot (ICD) at Kamalapur in Dhaka. Besides the dilatory and cumbersome customs procedure and port operations also significantly delay the movement or release of goods. In Chittagong port it takes about 6 days to unload goods from a ship whereas for the same goods it takes just few hours in Singapore (M. Taheruddin,2004). About port management Mr. Anisul Haque, MD of Mohammadi group and former president of BGMEA stated,â€Å" Unfortunately we are spending 15-20 days to receive our fabrics from sea port to our factory and it is playing the main role to increase lead time†. Again to find out the probable causes of long lead time and for the empirical analysis 50 firms including 5 leading garments units have been chosen to collect primary data. They mentioned many causes behind this problem when interviews were taken but in the interview 100% i. e. f the 36 number respondents (Though 50 firms were chosen but 36 firms were interviewed successfully) put their comment on import dependency as a most important cause for increased lead time. Then 91. 66% i. e. 33 respondents on CBW, 75% i. e. 27 respondents on inefficient port management, 69. 44% i. e. 25 respondents on poor infrastructure and 41. 66% i. e. 15 respondents on communication system respectively. The same causes were ident ified in our analysis based on secondary data. This fact enhances the credibility of our findings. At the time of interview, the Managing Director of A. K. J. Fashions limited divided the lead time into three stages as it is illustrated in fig. -3. First stage, from P-Q (Fabrics suppliers – Sea port) the approximate lead time for the first stage is 40-55 days including the manufacturing time of fabrics, then from Q-R (Sea port Manufacturer) the approximate lead time for the second stage is 15-20 days and at last from RMG (Manufacturer Buyer) the approximate lead time for the last stage is 35-45 days. Figure 3: Basic Supply chain of Bangladeshi RMG Industries P Raw material Suppliers Source: Nuruzzaman, 2007 Q Sea Port R Manufacturers M Buyers The present estimated time from point Q to point R is unnecessary. Here the main task is unloading the container and carry it to the manufacturing point. The total procedure can be done by only 2 or 3 days through efficient management in port and good transportation system. But due to inefficiency of port management and poor transportation system it takes 15 to 20. From the above observation it is clear to us that, just for import of raw materials Bangladeshi manufacturers are forced to spend 55-75 days more. So import dependency for fabrics is the main reason of longer lead time. In the present analysis mainly the â€Å"Order lead time† (see the Lead time theory) will be considered and will be shown how can we reduce that time by an appropriate supply chain management. The manufacturers were asked a number of questions emphasizing this theme, how inefficient management in the chain can affect lead-time, and also what the consequences can be. In the interview when it was asked, all the manufacturers responded, order lead time is the main factor behind the lead time problem in the RMG sector. We can reduce maximum. 30 days by taking proper step in the supply chain. Most of the manufacturers responded that lead-time can be influenced if the buyer make contract with the raw material suppliers before giving final order to the manufacturers and if the government bodies take proper measures to increase efficiency at sea port. The Managing Director of Azmat Group stated, â€Å"We generally place order to the fabric suppliers after final contract Lead Time Management in the Garment Sector of Bangladesh: An Avenues for Survival and Growth 622 with the buyers and count 15-20 days to make fabrics. This manufacturing lead time can be reduced by the help of buyers or buying house. They can make ready their required fabrics at first and then they can make contract with us. As such we need not waste 15-20 days for the required fabrics. † Some manufacturers pointed out two main points responsible to increase lead time i. e. shipping time and unloading procedure at port. Some other manufacturers pointed out the poor infrastructure in railway and road transport to move their materials from port to manufacturers factory. They all believe that order lead-time can be reduced if government authorities take proper steps o increase the efficiency of the port and develop the rail and road transport. It seems that the respondents have different but almost same opinions on this issue. A manufacturer, K. M. Fashions Ltd. , expressed his opinion in a more logical way and stated, â€Å"To reduce lead-time effectively we have to reduce import dependency as soon as possible. Immediately we can reduce 30-40% lead time only by proper and efficient management in the supply c hain. † The largest RMG manufacturer Opex group responded, Lead time is generally 90-120 days for the woven garments. But immediately we can reduce 30% of lead time through proper management in supply chain during import of fabrics and 15% would be possible by only developing port facilities. If we develop our textile sector and procure fabrics from the local market we can reduce 60% of total lead time. For the knitwear garments we procure all raw materials from the local market so there is no lead time problem in the Knitwear garments sector. From the above discussion, it appears that the manufacturers of RMG sector mainly face order lead time problem and this problem occurred in the supply chain due to inefficient management. Time consumed in the first four steps in the supply chain is the basic reasons for increasing lead time. It is possible to reduce a major portion of order lead time by improving the other three areas namely, communication, port management and transport management in the supply chain. We can get a clear idea about lead time in the supply chain by considering the equation of lead time and put average estimated time collected from the interviews for each step. We know that; Total lead time = [{Information lead time}+ {(Order lead time)}] Or, = [{Information lead time} + {(time to manufacturing fabrics) + (time to shipment of fabrics)+(time to unloading fabrics and customs formalities at port) + (time to take fabrics from port to manufacturing point) + (time to sample approval and production of final product)+ Time to shipment or export of final products)}] Or, 120 = [{7} + {(15)+ (25)+(14)+(6) + (23)+(30)}] From the above equation, we can say that through the first four stages a manufacturer received fabrics from the suppliers after 60 days on average. Out of this the shipping time of 25 days is constant. There is no chance to reduce this shipping time but we can reduce the rest 35 days. There are two parties and various activities involved between suppliers and manufacturers in the supply chain. It can be seen in the fig. -4 broadly. The activities and time consumption area have been illustrated here through four boxes (A-D) or stages. Figure 4: Lead-time and fabrics importing process A B C D Manufacturin Suppliers Manufacturing g fabrics Shipping time (Receive order time shipment of fabrics) Unloading Manufacturer Unloading fabrics at sea s plant/ transportation time port warehouse Source: Nuruzzaman, 2007 623 Nuruzzaman and Ahasanul Haque After final contract with the buyers, manufacturers first place order to the foreign fabrics supplier (A). Then the supplier manufactures fabrics (B) and send fabrics by shipment. After a certain time the ship reaches at the port (C). Here after unloading and completing some custom formalities fabrics are sent through train or road transport to the manufacturers production-plant/warehouse (D). For this total process from A-D manufacturers need 55-75 days. At the time of import a proper management in the supply chain can reduce 30-35 days. The rest of the time of 25-35 days is needed only for shipment. It is known from the interview that most of the buyers have no regional offices in Dhaka. These are either in Bangkok or Singapore. One of the largest European garment sub-contractors based in Dhaka is Hennes Mauritaz (HM) from Sweden (Asia invest, p-11, Sector 4. ). The regional offices and the buyers resident in Dhaka can build a stock of the required quality of fabrics in advance before making final contract with the manufacturers. It will definitely reduce the manufacturing time. Again the proper and efficient management at port and good transportation system can reduce time to receive raw materials from port to manufacturing plants. But if we avoid fabric import altogether then we can reduce 55-75 days from the total lead time and we will be able to assure export of RMG products by 45-60 days regularly. Landmark group is a leading garment manufacturer in the knitwear sector of Bangladesh. It states, we do not face lead time problem for our RMG products. We generally take 45-60 days to export our product because we need not to spend any time to import raw materials. We procure all knit fabrics and accessories from the local market. Therefore in conclusion we can say that by efficient supply chain management we can reduce 29% of total lead time. But to survive in the competition we have to reduce lead time by minimum 50% and we can reduce 55-60% of total lead time by avoiding import and abolishing import dependency attitude. Analysis the lead time management of a model Company (Sharmin Group) The company’s some successful and unsuccessful business process with different buyers have been analysed here to have a clear idea about the way to minimisation of lead time. Generally, after getting final order, the company collects fabrics as per buyers direction from the foreign suppliers. After collection of fabrics they prepare sample as per design. Then after approval of the sample the company goes for mass production and shipment to the buyers. To complete the whole process the company generally takes about 90-120 days but sometimes for some buyers it takes about 110-140 days. There are also some buyers who complete the whole process by only 50-60 days. The company takes 45-50 days in all to approve the sample and finish the production following the sample approval process. We can see the sample approval flow chart in the fig. -1 of Appendix-1. Some buyers like BMB Apparels follows this sample approval flow chart, but most of the buyers even follow shorter processes. The interview was taken very closely with the Managing Director of Sharmin Group. At the time of interview he was found scared for the possible awful situation in the post MFA period. He stated, we have all but just for want of fabrics we are going to face stiff competition. What he said about the business operations of the company could be summerised as follows. After getting the final order, the company communicates with the suppliers through e-mail and over telephone. For this task the company spend few days. Mr. Hossain said that they were not worried about the information lead time. They generally take 5-7 days for this process. He said, â€Å"In the garment business suppliers are not permanent, we had to communicate with one or more suppliers for fabrics in time after getting final order. A good numbers of accessories are procured from the local market. So e-mail and telephonic communication are sufficient for the RMG companies. At the time of interview it was gathered that the company was facing problem mainly in the supply chain i. e. order lead time for importing fabrics. The company, Sharmin group also faces problem in the sample approval process. In the supply chain the company had to spend 45 days on an Lead Time Management in the Garment Sector of Bangladesh: An Avenues for Survival and Growth 624 average which is not negligible . Again, the sample approval process is also cumbersome. It takes enough time and thus contributes to increase lead time problem. Mr. Hossain expressed that the company could reduce a certain portion of lead time by taking some appropriate measures but 60% of lead time can be reduced by avoiding import dependency and by considering alternative source of fabrics supply. In Fig. -2 of appendix-1 the estimated time can be seen at different stages of the manufacturing process of Sharmin group. The estimated time was shown according to the information delivered by the Managing Director of Sharmin Group. Most of the buyers follow in this process to purchase garments from this company. At the time of our discussion on the present situation of the RMG business, Managing Director of this company told us that he was afraid for the post MFA period. The company was certainly going to lose its business due to long lead time in the post MFA period. He urged that immediately we should take some proper measures to reduce lead time. At the time of interview it has been informed that the company was doing business successfully with a European company where lead time was in between 45 to 60 days. It is the competitive lead time in the RMG sector of Bangladesh. In the figure-2 of Appendix-1 total business process of Sharmin group has been visualised through A-F stages. From this figure we can get clear information about the estimated time in six different stages like, A-B, B-C, C-D, D-E, E-F and from F to Buyers. The total lead time in this process for Sharmin group is 120-140. There is a buyer named BMB Apparels doing business with Sharmin. It strictly follows 100% of the sample approval flow chart the RMG business process like the figure-12 (see appendix-1). Therefore its average lead time is 130 days. But the other buyers like JC Penny, American Eagle do not maintain the sample approval flow chart of fig. -1(Appendix-1). They approve sample in a normal procedure and spend 5-10 days for approval. In this case they take help from local office or local agent. Therefore their average lead time is in between 90-120 days. At present the company is doing business successfully with Corona maintaining a minimum lead time. In this regard Mr. Hossain urged, â€Å"we have to consider this success story with the buyer like Corona and find ways and means to deliver garments product to the buyer by 45-60 days†. When asked for the reasons for the success in the business to the Managing Director, opined his success is mainly due to the procurement of fabrics from the local market. The buyer Corona at first makes their fabrics ready then contact with the manufacturer for order placement. The buyer takes just one or two days for sample approval. As a result the company is able to cut down the lead time by about 60-70 days. According to the figure-2 (Appendix-1), the average information lead time is 6 days and the average order lead time is 129 days for the Sharmin group. So reduction of order lead time is the crux of lead time problem. Out of 129 days, in the supply chain, total average lead time is 52 days. By taking some proper measures like making fabrics available in advance, developing inland transportation system, improving management efficiency at port etc. , it is possible to reduce about 23 days in B, C, D and E stages of supply chain. In the supply chain the rest of the time is for shipment. The company can cut down this time only by avoiding import. It is also possible to reduce 30 days in sample approval process by adopting normal sample approval process performed by other buyers or by encouraging the buyers to open a local office in Bangladesh. Considering the equation of lead time and putting value in that equation three types of buyer of this company can be analysed. First time we are considering BMB apparels from UK. We know that; Total lead time = [{Information lead time}+ {(Order lead time)}] Or, = [{Information lead time} + {(fabrics manufacturing time) + (fabrics shipment time)+ (unloading and transportation time) + (sample approval and production time of garments product)+ (shipment time for export of final products)}] = [{6}+ {(11) + (24) +(12)+(35+12)+(30)}] So, total average lead time = 130 days In this study for the BMB buyer, manufacturers order lead time is 124 days. In the supply chain the company spends totally (11+24+12) = 47 days for import of fabrics where 20 days can be saved. 625 Nuruzzaman and Ahasanul Haque Time for the last two stages is common for all manufacturers. Here manufacturer spends (47+30) = 67 days where maximum time is consumed by sample approval. The company spends about 35 days for sample approval process for this buyer. It is unusual. So here sample approval process is the main reason for increasing lead time. Secondly, the buyer JC Penny from USA has been considered. For this buyer, Total lead time = [{Information lead time}+ {(Order lead time)}] Or, = [{Information lead time} + {(time to manufacturing fabrics) + (time to shipment of fabrics)+(time to unloading fabrics and customs formalities at port) + (time to take fabrics from port to manufacturing point) + (time to sample approval and production of final product)+ shipment time to export of final products)}] = [{6} + {(12)+ (25)+(14)+(6) + (23)+(30)}] So, total average lead time = 116 days Now form the above calculation it is clear that doing business with the buyer JC Penny, USA, manufacturers order lead time is 110 days. In the supply chain the company spends totally (12+25+14+6) = 56 days for importing fabrics where about 24 days can be reduced. Times for the last two stages are common to all manufacturers. Here manufacturer spends (23+30) = 53 days. Where maximum 10 days is spent for sample approval. It is a normal process. So in the above calculations it has been observed that the four values as underlined above are the principal reasons for the increase of lead time. Thirdly has been considered the buyer of ‘Corona’ from Italy. For this buyer, Total lead time = [{Information lead time}+ {(Order lead time)}] Or, = [{Information lead time} + {(time to sample approval and production of final product)+ (shipment time to export of final products)}] = [{1}+ (17)+(30)}] So, total average lead time = 48 days. Here in this case the manufacturer does not have to import fabrics for Corona. The buyer himself supplies fabrics from their own textile mill located in Bangladesh. For this reason the order lead time is only 47 days. After getting order the company spends totally 48 days in the supply chain to export final products to the buyer. In this case as there is no need to import of fabrics the RMG company does not face any manufacturing lead time, transportation related problem and unloading related problem at port. Therefore the manufacturer does not have any problem in the supply chain. We know time required for the last two stages are common to all manufacturers. So there is no scope to reduce this time. Here buyer (Corona) communicates with the prospective manufacturer over telephone and takes the sample to the manufacturer physically and approves the sample within two/three days. For that reason information lead time and sample approval time are very minimal in the total lead time. From the above discussion and analysis of some buyer’s success and other failure in reducing lead time, one can draw a conclusion that if Sharmin group could avoid import and collect fabrics from the local market, the lead time would be between 45-60 days. It will be more competitive if the buyer would open a local office in Dhaka. This will minimise sample approval process. While integrating all the findings from the survey and the case study we can draw a conclusion that in the current RMG business manufacturers are facing lead time problem due to import dependency i. e. import of fabrics from foreign market. This problem is exacerbated due to inefficiency in the supply chain management. Lead time could be further reduced by taking some appropriate measures in manufacturing, unloading and transportation system but it does not help the manufacturer to be more competitive. If the manufacturers could find some alternative source of supply in the local market and collect fabrics locally. That will be more logical, appropriate and helpful in the direction of lead time reduction. Considering all the above analyses a new model of RMG business process has been proposed in fig. -7, which is expected to be helpful in reducing lead time. Lead Time Management in the Garment Sector of Bangladesh: An Avenues for Survival and Growth Figure 7: Proposed business process for RMG Industries in Bangladesh Buying house/ Buyers agent 626 Foreign buyers Local market Garments company (Manufacturer) Backward linkage industries Buyers own textile mills Order flow Collect raw materials Final product supply flow Information flow Conclusion The RMG sector of Bangladesh has entered in the quota free market after 2005. From that time this sector is in a very disadvantageous situation due to long lead time which has negative impact on export growth. Through analysis of empirical data it has been found that import dependency is the major bottleneck and it is the main factor for greater lead time. Just due to import of fabrics manufacturers are to count shipment time, unloading time, customs clearance time and transportation time from port to ICD( Inland container depot ) at Kamalapur, Dhaka. Import dependency arises out of the absence of sufficient backward linkage industry and for this reason a total additional 55-75 days are spent in the import process of fabrics by RMG sector of Bangladesh. As a result this sector is facing long lead time which is 90 to 130 days on the average. From the analysis it is clear that the impact of information lead time is very negligible on total lead time. It contributes only 6%. However, order lead-time has a great role to increase the lead time. By the analysis it was found that fabrics manufacturing time, shipping time, unloading time and transportation time are included in the order lead time. In conclusion considering the above analysis it has been found that import dependency is contributing 50% or more in the problem of long lead time and it is the main factor for the problem of long lead time in the RMG sector. Sample approval is another factor contributing for long lead time. The buyer from Italy for ‘Corona’ brand taking 48 days to complete all the process. It is the standard lead time to compete with the other manufacturer and exporter of the world. It becomes possible only for avoiding import of fabrics. For the buyer of Corona, manufacturer collects fabrics from the local market from their own textile. So, reduction of lead time is possible when the RMG sector ensure the availability of fabrics from the local market by developing backward linkage industry specially in the oven sector and by establishing textile mills by the buyer for their own consumption. 27 Nuruzzaman and Ahasanul Haque Azad, R. (2004), Readymade Garment Industry in Bangladesh: Competitiveness and sustainability, unpublished Ph. D. thesis, Dept. of Marketing, R. U. , Bangladesh. BGMEA research cell, BGMEA, BTMC Bhaban, 7-9, Kawranbazar, Dhaka. Charles J. Murgiano, CPIM, Short lead time=Tall profit, Wellesley: Waterloo Manufacturing Software, Advanced Planning and Sched uling Technology Paper, waterloosoftware. com/leadtime. html, Retrieve; December 10,2007. Cooke and Morgan (1998), The Association Economy, England; Oxford University Press. Gothenburg University website (2005), http://elsmar. com/Lead_Time/tsld006. htm, Retrieved on September, 2005. Khan, Shahiduzzaman (2007), â€Å"Apparel Industry faces daunting tasks ahead†, Editorial report, Financial Express, September 9, 2007. Kutubuddin Ahmed (2002), Impact of MFA phase out on the apparel industry of Bangladesh and remedial measures fir its survival, Bangladesh Apparel and Textile Exposition souvenir, Dhaka, Bangladesh. Li, J. Q. , Shaw, M. J. and Tan, G. W. , (2000) Evaluating Information Sharing in Two-level supply chain, management science, 1999. M. Taheruddin (2004), Problems and prospects of Garment Industry, The Daily Ittefaq, Wednesday, 23rd June, Dhaka, Bangladesh, P- 10 Munir Quddus, Salim Rashid (2000), Entrepreneurs and Economic development- The Remarkable Story of Garment Exports from Bangladesh, The University Press Limited, Dhaka, Bangladesh, P (23-80). Nuruzzaman, Md. (2008), â€Å"Lead time reduction and the application of Process Management- A study on selected RMG units in Bangladesh†, Journal of Business Research, Vol. 10, June 2008, P-63 Nuruzzaman Md. (2007), Developing Export of RMG products in Bangladesh: Analysing the lead time†, Management Trends, Vol. , No. 1, P- 1 Nuruzzaman, Md. (2005), â€Å" Development of Readymade Garment Business (RMG) in the process of Lead Time reduction- A study on Bangladeshi Readymade Garment Sector†, Draft Master Thesis, GBS, Gothenburg University, Sweden Schary, Philip B. (2000), Managing the global supply chain, Indian edition, Viva books private limited, Delhi. Simchi-Levi, David, Kaminsky, Philip. and Simchi-Levi, Edith (2000), Designing and Managing the supply chain, McGraw-Hill international edition, Singapore. References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] 12] [13] [14] [15] Lead Time Management in the Garment Sector of Bangladesh: An Avenues for Survival and Growth Internet source: http://elsmar. com/Lead_Time/tsld006. htm Retrieved on July 2004. 628 Appendix-1 Figure 1: Sample Approval Flow Chart Proto type Sample Green Seal Sample This should be made in the correct weight of material or knit. Requested by the QA/ Buying Office when an order is placed. The quality assurance team will make comments regarding fit and size. Also 1 meter of the intended bulk base fabric must be submitted for UK fibre content testing. Along with the completed test report request from stating the tests proposed for the style. Please note green seals will not be approved without the completed test request form Red Seal Sample A full size set in the correct base quality fabric and trims, in any available colour are requested in accordance to the critical path,(with enough time for a second remake to be made if necessary) before production commences. No samples are to be sent in substitute base fabrics. A full size set is required for all styles, but not all colours. Photo Samples and Presentation Samples The above samples must be a good representation of production in bulk fabric with correct details and trims( including labels). We require 2 samples per colour/style. Sizes to be confirmed by buyer. Press Samples Press samples will be required for ceretain styles and must be a good representation of production in bulk fabric, with correct details and trims(including labels). Sizes to be confirmed by buyer. Gold Seal Samples One sample of each colour in each size must be sent to the quality assurance team for the attention of the relevant technilogist. A minimum of 3 working days must be allowed for approval prior to shipment/despatch from factory. i. e. If 6 sizes and 5 colours, one samples of each size in each colour, and two sizes in the same colour. These need to be correct for style, size specification, fabric colour, trimming qualities and colours. Made to the correct manufacturing standards on the correct machinery. Mock Shop Samples Four samples per colourway, correctly packaged will be required with the gold seal samples for mock shop purposes, the buyer will confirm these. No shipment can be made without a signed certificate of relese from both the inspection team and buyers quality assurance department Repeats There is no requirements to obtain green red sealing samples for repeat purchases. However gold seals are required. Contract Placed Green Seal Sample Test request form to be completed Red Seal Sample Photo Press Sample Presentation Sample Gold Seal Samples original test reports. Approved certificate of release to be obtained Mock Shop Samples if required Inspection Shipping Source: constructed for this study based on interview 29 Figure: 2 Nuruzzaman and Ahasanul Haque A Manufacturer communicates with the suppliers Information time, 5-7 days Suppliers (Receive order of fabrics) Manufacturing time, 10-12 days Manufacturing fabrics shipment Shipment time, 2225 days Unloading fabrics at sea port transport to the Manufacturing point Unloading transportation time, 10-14 days Sample making, approval production Sample approval production time, 45-50 days B C D E F Shipment to the buyers Shipment time, 28-32 days Final destination Source: Constructed for this study Based on Interview

Tuesday, February 18, 2020

Sexual Harassment & Organizational Behavior Essay

Sexual Harassment & Organizational Behavior - Essay Example A culture within an organization is developed that will determine its leadership methods, communication channels and group dynamics within a teamwork frame work through the formation of well structured elements. Creation of these elements depends on the organizational setting and the people involved in day to day running of the company. These people include; watchmen, secretaries, salesmen, supervisors, managers, firm owners, directors among others. All of them form the organizational structure and its behavior depends on their individual behaviors. The basis of this model is that it provides power and authority to the organizations’ management to punish errant members of its organization. Employees are inclined towards obedience and looking unto the boss for advice and direction. Any unwelcome conduct or contact that touches on sexual privacy is sexual harassment.3 It affects both men and women although the latter are frequent victims. The following are incidences considered to be sexual harassment. Not every employee in the organization smokes or rather take cigarette in their daily life as a form of pleasure. Smoking as is widely known is harmful to not only the healthy of the smoker but also the person inhaling the smoke from the cigarette. Honesty is very important in an organization not only to the managers but also to individual relationships. Cheating downgrades an individual’s character, integrity and the organizational performance. This group of people are demeaning and demanding in nature. They are not tactful in nature but they mean to offend anyone. They don’t give out important assignments but they earn respect and trust from the rest of the members. They normally have problems with rules, schedules and work hours. In most cases this group of people lose tract of what is going on with the organizations and they are likely to miss details of important duties.

Tuesday, February 4, 2020

The causes of crime are ultimately matters of individual Essay

The causes of crime are ultimately matters of individual responsibility and choice. Critically discuss - Essay Example Many of the different approaches to dealing with crime are developed within those frameworks from the various assumptions and values which hold sway within that particular nation. It is more likely that, for countries or systems that believe a criminal is a product of his or her environment, money will be spent on rehabilitation and treatment with much less emphasis on custodial sentences. For those who believe people are responsible for their actions and intend to commit crimes (indeed intention, or mens rea, is required in all systems in order to convict someone of crime), the emphasis is likely to be on punishment, generally not specifically intended to address rehabilitation, such as custody. Clearly these concepts require a great deal of unpacking which will be done in the course of this essay. The key thing is to examine the various explanations as to why people commit crimes, be they biological psychological or sociological, and what sorts of criminal systems such approaches g enerate. It is quite imperative to begin this analysis by acknowledging the variety of definitions of crime as used by various criminal justice systems all over the world. The variety of such definitions has been brought about by the modern society whereby some people differ on what is good and what is wrong. In relation to this, some crimes are said to be acceptable in some circumstances by some groups while others, non-criminal, actions are believed unacceptable. What then ringers in our minds is who has the power to define the term crime? However, the term has had a number of definitions. To start with, a crime is said to be an act prescribed by law and is subject to punishment. It can not only be an act, but also an omission which is failure to act where law enforces a duty to act. It is worth noting that in the recent times, crimes are not only being restricted to acts and omissions that can violate that rights of other people, but also those which can either harm the

Sunday, January 26, 2020

Treatment Of Clostridium Difficile Infection Health And Social Care Essay

Treatment Of Clostridium Difficile Infection Health And Social Care Essay As a nurse working in acute medical ward for elderly, I work closely with patients with C. difficile infection. I have noticed the effect of C. difficile infection in elderly can be fatal. C. difficile is a gram positive anaerobic bacillus. They colonise in the oxygen deficient areas of the body. That can cause life threatening conditions, including diarrhoea, colitis and septicaemia and resulting death. C. difficile infection can cause serious illness and a significant cause of patient morbidity and mortality. It is a major cause of hospital acquired diarrhoea. C. difficile infection can cause serious illness and hospital outbreaks .It can cause significant financial burden on NHS. It is estimated that the increased length of hospital stay itself can cause an excess of around  £4,000 per patient. The number of death certificates mentioning C. difficile infection in England and Wales fell by 29% between 2007 and 2008 ,after increasing every year since records began in 1999(National Statistics,2008). According to Weston (2007), Clostridium difficile was first identified in 1935s, but until the late 1970s it was not identified as the cause of pseudo membranous colitis following antibiotic therapy. C. difficile infection is more common in elderly (over the age of 65). People who have a long stay in health care settings, those who have recently had gastrointestinal surgery and those who have a serious underlying illness that compromises their immune system are also at high risk to get C. difficile infection. In-patients are also at high risk if there are hospital outbreaks. Poor infection controls are also an important risk factor. Causes Antibiotics are considered as the most important cause for C. difficile infection. Any antibiotic can cause C. difficile infection, but Broad spectrum cephalosporins, broad spectrum penicillin and clindamycin are most frequently implicated. The second most commonly named antibiotic is Co amoxiclav (Health Protection Agency, 2008). The use of proton pump inhibitors such as lansoprazole, omeprazole and pantoprazole are also potential risk factor for C. difficile infection (Leonard et al., 2007). The disruption of normal harmless bacteria in the gut, because of antibiotic therapy also allows the C. difficile to multiply to greater number. The bacteria start to produce toxins. The antacids suppress the gastric acid secretion and as a result, C. difficile bacteria, including the spores are less likely destroyed. The reason for community associated C. difficile infection was unclear but it is become clear that the reasons for the majority of the infections are associated with antibiotic pr escriptions or hospitalisation (Wilcox et al., 2008). Transmission The transmission is through faecal-oral route. The infected patients acquire the organisms directly from other patients with diarrhoea. The route of transmission may be direct, via the hands of health care workers or via the hands of patients or via the environment. Asymptomatic people who are colonised with C. difficile are also can be able to transmit the disease. About 3% is the colonisation rate in healthy adults, but this increases to nearly 20 % in older people especially in chronic care wards. The spore form of C. difficile can survive in the environment for five months or more on hard surfaces. It is considered that the primary route of transmission of C. difficile infection via healthcare workers hand. Clinical features and pathogenesis The most important clinical feature is sudden onset of offensive smelling diarrhoea during a course of antibiotic or who had antibiotics with in the previous two months. Patients may pass soft or watery stool more than twice daily or in more severe cases more than 20 times accompanied by severe abdominal cramps (Weston, 2007). Abdominal distension, fever and dehydration may also be present in more severe cases. Unless C. difficile is diagnosed, the patients can be miss- diagnosed with irritable bowel syndrome. C. difficile infection is a major health problem worldwide that leads to increased morbidity and mortality. Healthy adults carry around 500 species of bacteria in the colon, 90% of which are harmless (Weston, 2007). C. difficile colitis results from the disruption of normal colonic flora and C. difficile colonises in the oxygen deficient areas of intestine. The spores are able to replicate and produce toxins that can lead to mucosal damage and inflammation. In a healthy adult t he normal colonic flora inhibit the growth and colonisation by C. difficile. The antibiotic therapy may disrupt the normal flora and allow the C. difficile to colonise very rapidly. After colonisation the organisms produces two protein exotoxins( Toxin A, an enterotoxin and Toxin B , a cytotoxin) in to the colonic lumen. These are responsible for diarrhoea and colitis. Toxin A binds to the receptors in the intestine and cause extensive tissue damage, inflammation and oedema. Both toxins posses cytotoxic activity against cultured cells by same mechanisms but they differ in cytotoxic potency, toxin B is generally 1000 times more potent than toxin A and to play a major role in activating inflammatory repose (Weston, 2007). Toxin B is more important than toxin A in the pathogenesis of C. difficile infection in man. According to lab test reports there are 100 different types of c difficile stains. The most recognised epidemic types is ribotype 027.The most important feature of ribotype 027 is hypertoxin production, 10 to 20 times more toxin than other stains. The C. difficile infection caused by ribotype 027 are more likely to be severe with increased complications such as renal impairment, severe colonic dilatation and sepsis (Freeman et al., 2007).The clinical features include increased severity of illness, failure to respond to antibiotics ,abdominal distension. Raised CRP and rising WCC particularly in patients who may have appeared to respond to antibiotics and deterioration in condition and appears to have higher mortality rate. Diagnosis Laboratory studies of stool sample will help to detect c difficile infection. Stool culture will help to detect the presence of difficile with toxin production. Stool enzyme immunoassay (ELISA)will detect both of the toxins ( A or B). For toxin B Stool cytotoxicity assay will be positive.Endoscopy may demonstrate ,but it is the least sensitive for diagnosing C. difficile as compared to stool assays., Sigmoidoscopy alone may not reveal any abnormality if the disease is confined to the right colon. Colonoscopy is more useful. Because of the risk of perforation Sigmoidoscopy and Colonoscopy is contraindicated in patients with colitis (Weston, 2007). Treatment The treatment of C. difficile infection depends on the severity of the illness. At my work place, the patient is closely monitored and isolated. A stool chart is maintained using Bristol Stool Chart. All antibiotics that are not required are stopped. This will help the normal bacteria to thrive again in the gut. If any patient develops C. difficile infection at my work place, we conduct a thorough investigation for the causes and we notify the antibiotic management team to review the patient. The team will review the patient in the ward (rounds Wed/Fri.) or via the phone. There will be a root cause analysis to find why the patient developed C. difficile infection? In some patients fluid and electrolyte replacement and nutrition review may also be necessary. In mild cases of C. difficile infection, patients are monitored for 48 hrs before starting antibiotics. In severe cases, antibiotics may need to be administered immediately. Metronidazole and Vancomycin are the two preliminary ant ibiotics used in the treatment of the infection (Weston, 2007). Usually a 7 to 10 day of therapy is required. Oral metronidazole 400mgs eight hourly for seven to ten days is the first line of treatment. It is contraindicated in women who are pregnant or who are breast feeding. The most recognised side effects of the metronidazole are an unpleasant metallic taste, nausea, vomiting, diarrhoea, abdominal pain, headache, pruritus, rashes, dizziness and reversible neutropenia. Vancomycin is known to cause the spread of vancomycin resistant bacteria. Vancomycin is used for severe, life threatening cases of C. difficile infection. It is also used for patients unable to tolerate metronidazole and failed treatment with metronidazole. Vancomycin is expensive. Oral vancomycin is not completely absorbed or metabolized in the gut and is excreted in the stool unchanged. This is ideal in the treatment of C. difficile infection. The recommended oral vancomycin doses for adults are either 125mg or 500mg four times daily. The use of a rectal vancomycin enema (500mg diluted in 1000ml of 0.9% sodium chloride injection) is also an alternative. A recurrence of symptomatic disease with re infection occurs in 5-20% cases. Management of repeated relapses is more difficult. The options include slow tapering of vancomycin or metronidazole over a period of six weeks and vancomycin combined with rifampicin for seven days. There are also case reports of successful treatments with intravenous immunoglobulin which contains antibodies to c difficile toxins. The studies shows oral administration of limited bacteria or yeast helps to reconstitute the gut flora and there is a potential to prevent infection.The ability of these organisms to colonize and also to prevent and treat the c.difficile is unclear. (Department Of Health, 2009). Surgery may be needed for small number of cases especially if C. difficile infection progress to fulminant colitis and perforation. Loperamide (anti diarrhoea drug) is contraindicated for C. difficile infection because this will slow down the clearing of toxic bacteria (Weston, 2007). Prevention Control Preventing the spread of C. difficile can be challenging as hospitals tend to have an increasing population of elderly, debilitated and susceptible persons, which naturally increases the number susceptible hosts within the environment. Isolation Isolation should be implemented in conjunction with the infection prevention and control measures to minimise the risk of spread to other vulnerable groups. Private room/side room is recommended, especially for patients who are fecally incontinent. Cohort symptomatic C. difficile associated disease patients only with other symptomatic C. difficile infected patients, to minimise environmental contamination. Patients with C. difficile infection may be moved to other rooms or bays when the diarrhoea ceases (no diarrhoea at least 48 hours) (Department Of Health, 2009 and Health Protection Agency, 2009). Hand washing Barrier nursing Contact precautions should be used for C. difficile infected patients with diarrhoea. Proper hand washing is essential. Alcohol-based hand gels are not effective in reducing the spread of the organism and are not recommended. Disposable gloves and aprons should be worn when caring for the patients. It is recommended that not to share the equipments between the patients. It is a good practice to inform healthcare workers and visitors that a patient is on contact precautions, such as labelling the door of the room, without disturbing patients privacy. Last year we (My work place) spent  £1,280.32 for soap, alcohol, gel and moisturiser. Environmental Cleaning The environment of a patient with C. difficile infection should be cleaned thoroughly at least twice per day. An approved hospital disinfectant-detergent should be used for all environmental cleaning. Terminal cleaning (stage cleaning) of ward area is essential after the discharge or transfer or death of a patient with C. difficile infection. (My ward) Decontamination of equipment Do not share equipments among patients to prevent cross infection. Commodes and bedpans are heavily contaminated with spores and are considered as vehicles of cross infection in C. difficile outbreaks. It is ideal that symptomatic patients have their own commodes or toilet facilities. Proper disinfection must be essential. Transfer of Patients Transfer of patients with C. difficile infection or disease to another ward, unit, or to the long term care facility must be informed prior to the transfer that the patient has C. difficile infection. Same notice must accompany transfer of patients with C. difficile infection to a long term care facility (Department Of Health, 2009). It is not necessary to have absence of diarrhoea or negative stool cultures before the transfer of a C. difficile patient to a long term care facility. On the patients discharge, we need to notify the primary care physician (My ward). Rectal Thermometers Since the outbreaks C. difficile in hospitals and long term care facilities, rectal thermometers are restricted to use. For the routine use Electronic tympanic thermometers are recommended (Department Of Health, 2009) Education Ward should conduct training programmes to the health care staff. Ensure that patient / family information leaflets are given out. Anti microbial management team It is the responsibility of the hospital trust to develop anti microbial management team. That should consist of a consultant microbiologist, pharmacist and prescriber. The trust also needs to develop restrictive antibiotic guidelines. These guidelines specifically need to address to avoid the use of broad spectrum cephalosporin, broad spectrum penicillin and clindamycin especially in elderly and minimise the use of fluroquinolones, carbapenems,that we follow in my work place. It is also a good practice to have an infection control link nurse to each and every ward. It is their responsibility to do proper training for staffs and auditing the clinical area. Outbreaks of C. difficile infection in Long Term Care Facilities An outbreak of C. difficile infection is defined as three or more cases of symptomatic C. difficile infection mainly in the same area of the hospital ward within a period of seven days. Infected patients should be placed in isolation room or cohorted. Patient(s) can be removed from precautions if there is no diarrhoea .There is no need to wait for negative stool culture to remove the patent from precautions. An education program regarding C. difficile infection and its transmission and prevention should be conducted to all health care workers. Need to highlight the use of gloves and aprons and moreover proper hand washing. The health care facility need to monitor for any significant episodes of C. difficile infection, and then need to liaise with local health department for further assistance (Walker K et al., 1993). Possible Solution Conducting education programmes and workshops for health care workers and public to increase the awareness of C. difficile infection can contribute a major role in reducing the number of C. difficile infection cases within the healthcare system. Need special attention to personal hygiene. The primary route transmission is via the hands of healthcare workers and other patients and residents. It is very important to perform proper hand washing and barrier nursing (gloves, gowns). Environmental hygiene is also very important factor in controlling C. difficile infection. Regular and proper cleaning of patient rooms with anti bacterial cleaning agents is essential as C. difficile toxins can stay in the environment for several months. Changing the way doctors prescribe antibiotic therapy is also an important strategy in control the C. difficile infection. Because C. difficile infection is always associated with the use of antibiotics, It is also recommended to have an antimicrobial management team for each hospital (Department Of Health, 2009). In cases of recurrent C. difficile infection experts agree that the non antibiotic treatment have a positive impact. The use of toxin binders neutralises the effect of toxin producing stains and to helps the intestinal flora to restore .Tolevamer, developed by Genzyme Corporation is the first non antibiotic treatment approved for C. difficile infection (www.mediscape.com). Mandatory surveillance of C. difficile infection in the United Kingdom When looking at surveillance reports, many of the hospitals in the UK have been affected with outbreaks of C. difficile.  We can see that the large increase in the number is between 2000 and 2007.It is the responsibility of the  hospitals in the UK has to measure and report to the Department of Health.  The surveillance should include the number of positive cases, number of severe infections, the number of required surgery cases and number of deaths. The surveillance of C. difficile infection is taking to get a target for 30% reduction from 2007/2008 numbers by 2010/2011.  In 2007-2008, there were 55,498 cases reported across England. In 2008-2009, the cases reported dropped to 36,095. i.e., cases dropped by 35%. Last year our target (My hospital and my community) was 180. The number of cases reported was 171, 98 of which are from hospital (7 cases from my ward).This year, the target is 155. Social, economic and political issues. C. difficile infection is expensive to the NHS. The total identifiable increased cost of C. difficile infection causes an excess of  £4000 per case. Such high costs can be used to justify expenditure on personnel and/or other control measures to reduce the incidence of this hospital-acquired infection. There are notable outbreaks of c. difficile infection worldwide since 2003.Outbreaks was reported in Montreal, Quebec and Calgary, Alberta, in Canada. Approximately 1400 cases affected, death count 36 89.A similar outbreak reported at Stoke Mandeville Hospital in the United Kingdom between 2003 and 2005, in which 33 patients died. In 2007 Maidstone and Tunbridge Wells NHS Trust was heavily criticized by the Commission, have heightened media and made public awareness. In 2009, four deaths reported at Our Lady of Lourdes Hospital in Ireland also thought to have links to Clostridium difficile infection. The prevention and control of C. difficile infection in health care settings is bec ome a global public health challenge.(Health Protection Agency 2009) Conclusion C. difficile infection is a major problem in hospitals that is associated with the use of antibiotics. C. difficile infection also recognised as one of the major health care associated infection. It is estimated that C. difficile infection affects between 40000-60000 people in the UK every year. The prevention and control of C. difficile infection is very important. The three main elements of prevention are: Need to restricted use of antibiotics; Strict isolation precautions and barrier nursing when looking after patients with diarrhoea and Through cleaning of clinical areas. Poor hand washing is known to play a key role in the spread of infection. Hand washing facilities in the hospitals such as the number of hand washing sinks and their position, and type of taps are also need to be inspected. Hand washing protocols is low in many hospitals. C. difficile infection needs treatment only if it is symptomatic. Most of the people make full recovery and in rare cases the infection can be fatal. Infection control teams need to develop education programmes to improve compliance and regular auditing. It is everybodys business to participate to prevent and control C. difficile infection with in the health care system. The health care workers need to follow the hospital infection control policy.

Saturday, January 18, 2020

Operating Plan Essay

We will First Operate in major tube metropoliss. get downing with Bangalore. and so Mumbai. Delhi. Chennai. Goa. Pune. Kolkata. Gujarat etc. After Targeting to these metropoliss. we will seek to aim the rural India which is about 70 % of India. How will we advance? We will advance through ADVERTISEMENT in ONLINE FORUM. SOCIAL NETWORKING SITES. Locally celebrated Theaters. Souvenirs given to clients. App Stores. humanoid market apps. PRINT MEDIA which is about read by every other individual normally. like Hindu. Times of India. etc in Bangalore and besides some local trade names etc. What will be our gross revenues publicity activity? Peoples would be able to book a whole new wave for household acquire together. a birthday party with their films. counter tiffin or dinner etc all made available in the coach. with some anterior engagement of minimal 7 yearss. Besides if a school or college wants to demo a educational reappraisal. or a documental to their pupils. the squad may take attention. travel to school and demo assist them with all things they needed with anterior engagement. We will be besides publishing a base on balls which will be a three clip one-year base on balls in which you can see film thrice a month with that base on balls delivering every clip you come. This will be chiefly for our twenty-four hours today clients. The one-year base on balls will besides incorporate vouchers for free Zea mays everta. or some price reduction on repast and besides some other value added services. How Will We Sell? Our chief purpose is to gain net income with making a strong client relationship. We will sell our Tickets through our ain web site. Bookmyshow. com. After some clip in long term we will do our ain apps in Iphone. android market. Ipad etc. The Timings will be pre decided. and a hebdomads timetable will besides be decided. which will demo non merely new films. but sometimes a educational movie. and local linguistic communication movies of the metropolis we operate in. Where will we park? We will park our cinevan in a short distance from our clients place. A soap of 1 kilometer far in any vicinity we decided. We will park someplace where there is ample of infinite for vehicles to come and travel. This will assist in modulating the traffic. We will besides take anterior permissions for all our topographic points. etc How will we acquire our train? We will import in the beginning and so we will seek and improvize our squad and add some interior decorators who can plan our train which will be more broad etc. our current train will suit around 70 people at a clip. How will Caravan be like? Caravan will be a coach which will hold a same experience as if you are sitting In a multiplex. The Acoustics section will be taken attention of and a finest of all will be used at that place.

Friday, January 10, 2020

Care at the end of life Essay

It is a fact that humans are born to die. What was once considered a natural part of life has changed to an experience that may be more painful for the patient, family, and caregivers due to the advances in medical care. New procedures have allowed life to be extended longer than ever before. The question is: has the dying experience improved? This paper will include a review of death and dying from the perspectives of the patient and caregivers. An unfortunate case will be discussed, and the organizational structure, culture, and governance that led to this situation will be reviewed. Recommendations for the changes necessary to prevent such cases in the future will be included. Ms. Smith was a 66 -year -old female with breast cancer that had metastasized to her lungs and liver. She had two adult daughters who lived in her home town and one of them had a young child. Mr. Smith was a 70- year-old retired factory worker. Ms. Smith had gone through lengthy chemotherapy and radiation treatments that had left her weak and debilitated. She developed pneumonia and experienced a respiratory arrest. She was placed on a ventilator and was weaned off the ventilator after two weeks. She remained in the Intensive Care Unit (ICU). Her family stayed with her as much as the ICU visiting hours allowed, but she was often alone and told her family that she was in pain and wanted to die. The nurses were  concerned about her pain needs, but were also worried that too much medication could cause another respiratory arrest. Ms. Smith languished in the ICU for two months until she did have another respiratory arrest and died without her family at her side. She and her family had agreed that she would not go back on the ventilator, and the physicians had written a Do Not Resuscitate (DNR) order. They had planned to move her from the ICU, but they hesitated to place her on a regular floor. Everyone involved in the case believed that it was not handled well, and a team was assembled to determine how to improve the care of the dying. A review of the literature found that this institution was not alone with their concerns that the care of the dying needed to improve. Autonomy is one of the core bioethical principles that focuses on the right of every individual to make choices regarding health care decisions. Providers and caregivers spend a great deal of time instructing and coaxing patients to take control of their own health. But these providers are often surprised and upset when patients with life-limiting illnesses express a desire to control the timing and circumstances of their end-of-life experience (Volker, Kahn, & Penticuff, 2004). In their study, they found that people with advanced cancer expressed a wide variety of preferences for personal control and comfort, and that many wanted to remain as involved as possible in their daily lives for as long as possible. Organizations can play a key role in policy changes to support the needs of these individuals. Providers are trained to see death as the enemy, and sometimes forget that death is a natural part of the human experience. Joe Cantlupe’s story in Health Leaders stated that â€Å"we don’t always deal with the issues of death and dying very well in our culture† (p. 14, 2013). The Institute of Medicine published a report that concluded that many patients die in pain, are not referred to hospice in a timely manner, and the improvements in care have not led to improvements in care at the end of life. Fortunately, there have been efforts to study the patient’s perspective of death and dying as well as the perspectives of nurses and physicians. These studies are leading to a better understanding of the experience and the methods needed to improve the quality of end of life care (Cantlupe, 2013). It may seem strange to consider quality about end of life care, but it is recognized as an ethical obligation of health care providers and organizations. Singer, Martin, and Kelner studied 126 patients on dialysis, diagnosed with AIDS, or residents of long-term care facilities, to determine their views on end-of-life issues. Their results identified five domains of quality care at the end-of-life. These were â€Å"adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones† (p. 163, 1999). The participants expressed fear of lingering or kept alive when they could no longer enjoy their lives. Many stated that they would not wish to go on life support if they were not going to improve or have a chance to live a normal life again. Several mentioned that being placed on life support was the same as being a guinea pig. There were conflicting reports on the choice of dying at home or in a hospital. Some wanted to be at home, but others felt that was a burden on the family (Singer, Martin, & Kelner, 1999). Another study by Gourdji, McVey, & Purden in 2009 interviewed palliative care patients about the meaning of quality of life at this stage of their illness, and the factors that would improve their quality of life. They found that several factors, including their approach to life, their approach to their illness, and their ideal of quality of life shaped their end-of-life experiences. These patients stressed that they most wanted to continue what they had been doing for most of their lives for as long as possible. They also wanted to help others when possible and live in a caring environment. They often mentioned the use of humor and a positive attitude in the environment. When they discussed their illnesses, they expressed frustration with their physical limitations, and hopelessness when the disease reoccurred. As providers began to understand the gap between their traditional training and the needs of patients, researchers began to evaluate the skills needed to provide a better quality of end-of-life care. Nursing had long considered the choices made about artificial nutrition or hydration, palliative treatment, or symptom control to be in the medical domain, and the nursing role was often unclear. Nursing is involved in the end-of-life care. They are with the inpatient on a 24-hour basis, they use a  patient-centered approach to care, and they have experience and expertise in caring for dying patients and their families. Case studies have found that the nurses’ involvement in end-of-life care is not only about the technical decisions in the care process, but also that the daily interactions that nurses have with patient’s vulnerabilities make them ethically sensitive to the needs of the patient and family (Gastman, 2012). The International Council of Nurses (ICN) developed a code of ethics that stated that nurses are responsible to alleviate suffering as well as promoting health and preventing illness. By expanding the scope of end-of-life care beyond the narrow medical definitions, and aligning the code of ethics with a broader definition of end-of-life care to expand beyond the hospital setting, nursing can become more involved in end-of-life care (Shigeko, Nague, Sakuai, & Imamura, 2012). The role of the primary care provider in end-of-life care has also been studied, and these studies have found that despite the continuity and comprehensiveness of primary care, few Americans die under the care of their familiar provider. Many patients have reported feeling abandoned by their primary care provider at the time of death. Care at home by primary care providers benefits many patients and the health care system overburdened by hospitalization cost (Silveira, & Forman, 2012). On the other side of the care spectrum, the role of the intensive care provider also can be improved. White and Curtis (2005) studied the need and the impact of shared decision- making on critically ill ICU patients. They found that while involving families in end-of-life decisions is a complex task that requires excellent communication skills, the more time spent with families discussing and explain the issues, the higher the family satisfaction. The hospital where Ms. Smith died was the average institution with an organizational structure that included a Chief Medical Officer and Medical Directors of each specialty area. There was a Chief Nursing Officer as well as Nursing Administrators responsible for the care of patients. They had been very focused on treating illness, and considered themselves successful. The review by the improvement team helped them to see that they needed to change their perspective and consider less paternalistic alternatives to caring for patients at the e nd-of-life. These alternatives usually save cost as well as providing better care at end-of-life. The reimbursement for palliative care programs has been slow, and this has  prompted many hospitals to team up with local hospice programs or nursing facilities to decrease cost. Palliative care has been shown to extend the life of patients, reduce cost, and be more satisfying to the patient and family. Multidisciplinary teams that include physicians, nurses, social workers, psychologists, and spiritual counselors, work together to relieve the suffering, pain, depression, and stress that is often a part of chronic illness. These teams may also include nutritionists and therapist when needed by the individual patient. These programs listen to even the simple requests of patients and families. They work with the patient to get them to the best environment for them and to allow them dignity and control at the end of life. These teams are also moving to the outpatient area to prevent or decrease hospi tal admission and improve quality of life (Cantlupe, 2013). Conclusion Ms. Smith’s hospital should implement a multidisciplinary palliative care team. They should also add education to the program so that the patients and families are better informed about the results of care decisions such as ventilation, hydration, and nutrition. The hospital personnel need to be trained about palliative care and shift their paternalistic approach to a patient-centered approach. It is doubtful that Ms. Smith would have remained in the ICU for two months if there had been a palliative care program in place. She may have been able to transfer to an inpatient hospice center where her family could stay with her, and she would not have died alone and in pain. References Cantlupe, J. (2013, September). A fresh look at end-of-life care. Health Leaders, 12-22. Gastman, C. (2012, September). Nursing ethics perspective on end-of-life care. Nursing Ethics, 19(5), 603-604. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/1041054841 Gourdji, Iris. McVey, L., & Purden, M. (2009, Spring). A quality end of life from a palliative care patient’s perspective. Journal of Palliative Care, 25(1), 40-50. Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. (2012, September). Defining end-of-life care from perspectives of nursing ethics. Nursing Ethics, 19(5), 608-616.