Review of literature on Postoperative Pulmonary Complications

Review of literature on Postoperative Pulmonary Complications According to Polit and Hungler (1999) the task of reviewing research literature involves the task of reviewing research literature involves the identification, selection, critical analysis and written description of existing information on the topic. Related literature which was reviewed is discussed under the following headings. Studies related to overview of the postoperative pulmonary complications. Studies related to chest physiotherapy and incentive spirometry. Studies related to overview of postoperative pulmonary complications Soledad Chumillas (1998) posited that pulmonary function is commonly altered after surgery, particularly in patients who have had chest or upper abdominal surgery. The physiological changes observed are directly related to anaesthesia (general or regional) and to the type of incision and surgical technique employed, and are reflected by decreases in total pulmonary capacity and pulmonary volumes and by a parallel decrease in Pa02. Yoder (2009) said that thoracic and upper abdominal surgery is associated with a reduction in vital capacity by 50% and in functional residual capacity by 30%. Diaphragmatic dysfunction, postoperative pain, and splinting make these changes. After upper abdominal surgery, patients shift to a breathing pattern with which ribcage excursions and abdominal expiratory muscle activities increase. Postoperative patients maintain adequate minute volume, but the tidal volume is very low and the respiratory rate increases. These abnormal breathing patterns, along with the residual effects of anesthesia and postoperative analgesics, inhibit cough, impair mucociliary clearance, and contribute to the risk of postoperative pulmonary complications. David Warner (2005) described that many factors responsible for PPCs are related to disruption of the normal activity of the respiratory muscles, disruption that begins with the induction of anaesthesia and that may continue into the postoperative period. The effects of anaesthesia can persist into the postoperative period, though via different mechanisms, as the effects of surgical trauma come into play. These are most pronounced following thoracic and abdominal surgery, and arise from at least three mechanisms. First, functional disruption of respiratory muscles by incisions, even after surgical repair, may impair their effectiveness. Postoperative pain may cause voluntary limitation of respiratory function. Finally, stimulation of the viscera, such as provided by mechanical traction on the gallbladder or esophageal dilation, markedly decreases phrenic motor neurone output and changes the activation of other respiratory muscles, in general acting to minimize diaphragmatic descent. Other factors that may contribute to PPCs include: 1) Reflex stimulation during surgery, and release of inflammatory mediators by drug administration, increasing airway resistance and limiting expiratory gas flow from the lung; if severe this can produce hyperinflation with risk of barotrauma and gas exchange abnormalities. 2) Impairment of normal mucociliary transport by anaesthetic gasses and endotracheal intubation which may delay clearance of pathogens and promote retained secretions 3)Impairment of lung inflammatory cells function by prolonged anaesthesia and surgery, which could increase susceptibility to postoperative infections 4) Impaired upper airway reflexes postoperatively, with may increase the risk of aspiration, and 5) Incomplete reversal of neuromuscular blockade. Rochelle Wynne and Mari Botti (2004) postulated that the pathogenesis of postoperative pulmonary dysfunction is associated with anomalies in gas exchange, alterations in lung mechanics, or both. Abnormalities in gas exchange are evidenced by a widening of the alveolar-arterial oxygen gradient, increased micro vascular permeability in the lung, increased pulmonary vascular resistance, increased pulmonary shunt fraction, and intrapulmonary aggregation of leukocytes and platelets. Variations in the mechanical properties of the lung lead to reductions in vital capacity, functional residual capacity, and static and dynamic lung compliance. Woerlee (2009) listed certain performance criteria for the respiratory system of a surgical patient. They are: The lungs must have sufficient oxygen to oxygenate the blood. The pulmonary circulation must eliminate carbon dioxide from the body to prevent carbon dioxide accumulation. The client must be able to generate a productive cough, otherwise mucus accumulation will occur resulting in atelectasis and/or lung infection or pneumonia. The client must be able to significantly increase their respiratory minute volume to compensate for factors such as increased postoperative metabolic rate, elevated body temperature, possible infections, pneumonia, etc. Poor performance in significantly raising and sustaining an elevated respiratory minute volume results in exhaustion and respiratory failure. Postoperative pulmonary complications account for a substantial portion of the risks related to surgery and anaesthesia and are a source of postoperative morbidity, mortality and longer hospital stays. The current basis for our understanding of the nature of Postoperative pulmonary complications is weak; only a small number of high quality studies are available, a uniform definition has not emerged, and studies have focused on specific patients and kinds of surgeries. Current evidence suggests that risk factors for Postoperative pulmonary complications are related to the patients health status and the particular anaesthetic and surgical procedures chosen. Age, pre-existing respiratory and cardiac diseases, the use of general anaesthesia and overall surgical insult are the most significant factors associated with complications. Election of anaesthetic technique, postoperative analgesia and chest physiotherapy seem to be the preventive measures that are best supported by evidence. (J.C anet, V.Mazo, 2010) J.C.Hall ., et.al (1991)evaluated the relationship between postoperative pulmonary complications and various putative risk factors in a prospective longitudinal study of 1000 patients undergoing abdominal surgery. Transient subclinical events were studied by defining postoperative pulmonary complications as positive clinical findings in combination with either positive sputum microbiology, unexplained pyrexia, or positive chest roentgenographic findings. The overall incidence of postoperative pulmonary complications was 23.2%(232/1000). These findings supplies clinicians and clinical nurse with a simple means of identifying patients who are at high risk of postoperative pulmonary complications after abdominal surgery. Postoperative pulmonary complications contribute significantly to the overall perioperative morbidity and mortality. Pulmonary complications occur significantly more often in patients undergoing elective surgery of the thorax and abdomen. These include atelectasis, infections including bronchitis and pneumonia, respiratory failure and bronchospasm. Sharma (2000). The study findings of Brooks-Brunn (1995) revealed that atelectasis and infectious complications account for the majority of reported pulmonary complications. Risk factors were thought to exaggerate pulmonary function deterioration, which occurred both during and after surgical procedures. 18 risk factors were reviewed regarding their Pathophysiology, impact on preoperative, intra operative and postoperative pulmonary function in this study. Identification of risk factor and prediction of postoperative pulmonary complications are important. Preoperative assessment and identification of patients at risk for postoperative pulmonary complications can guide our respiratory care to prevent or minimize these complications. Postoperative pulmonary complications were investigated in a total of 41 paediatric recipients who underwent orthotopic liver transplantation. Atelectasis was seen in 40 cases (98%) of the 41 recipients, and occurred in the left lower lobe in 28 cases (68%), and in the right upper lobe in 25 cases (61%). Radiographic pulmonary edema occurred on 23 occasions in 18 recipients (45%). Five recipients experienced two episodes of pulmonary edema during their ICU stay. Pleural effusions were observed in 21 cases (52%), of which 18 had right sided effusion and 3 had bilateral effusions. Pneumothorax occurred in 3 cases. Pyothorax, hemothorax, bronchial asthma and subglottic granulation occurred in one case each. The present study demonstrated that postoperative pulmonary complications are frequently observed in paediatric recipients undergoing orthotopic liver transplantation. (Toshihide et.al.,1994). Kanat et al., (2007) studied the risk factors for postoperative pulmonary complications in upper abdominal surgery. They concluded that pulmonary complications are the most frequent causes of postoperative morbidity and mortality in upper abdominal surgery. A prospective study on 60 consecutive patients was conducted who underwent elective upper abdominal surgery in general surgical unit. Each patients preoperative pulmonary status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry, blood analysis, anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time. Complications were observed in 35 patients (58.3%). The most complications were pneumonia followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. They recommend a detailed pulmonary examinations and spirometry in patients who will undergo upper abdominal surgery by ch est physicians to identify the patients at high risk for postoperative pulmonary complications, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely postoperative pulmonary complications occurrence. Serojo et al., (2007) in a prospective cohort study, studied risk factors for pulmonary complications after emergency abdominal surgery. Pertinent data were collected through interview and chart review and their association with the occurrence of postoperative pulmonary complications were analyzed. 286 consecutive children were included and 75 (28.2%) developed postoperative pulmonary complications. Pulmonary complications are frequent among children undergoing abdominal surgery and lead to increased length of hospital stay and death rate. Kilpadi ,et al., (1999) in a prospective study of respiratory complications, conducted a study for a period of six months with total samples of 584 patients, who underwent elective or emergency surgery. He found that 81 of them had 13.9% of respiratory complications, 68% had pneumonia and others included pleural effusion, empyema and exacerbation of asthma. Felardo et al., (2002) investigated the postoperative pulmonary complications after upper abdominal surgery. Two hundred and eighty three patients were followed from pre to postoperative period. A protocol including a questionnaire, physical examination, thoracic radiogram and spirometry was used during preoperative period. Sixty nine (24.4%) patients had pulmonary complications in 87 events registered. Pneumonia was the most frequent event 34% (30/87) followed by atelectasis 24% (21/87), broncho constriction 17% (15/87), acute respiratory failure 13% (11/87), prolonged mechanical ventilation 9% (8/87) and bronchial infection 2% (2/87). Pulmonary complications occurs more frequently than cardiac complications. The complication rates for upper abdominal and thoracic surgery are the highest. A better understanding of the risk factors associated with postoperative pulmonary complications is essential to develop strategies for reducing these complications. In any individual patient the benefit from a surgical procedure should be weighed against the risks it imposes. When possible, stabilization of respiratory status is advisable before surgery. (Muhammed Aslam, Syed Hussain, 2005). Decline in pulmonary function after major abdominal surgery is thought to be identified in daily assessment by observation of breathing and pain intensity. Measurement of pulmonary function is usually not included in the assessment of the patient in postoperative period. The aim of this study was to investigate the relationship between clinical observation of breathing and decline in pulmonary function and pain. Eighty nine patients admitted for elective major, mild and upper abdominal surgery, participated in the study. Clinical observation of breathing covered the following parameters like abdominal expansion, side expansion, high thoracic expansion, paradoxical breathing, symmetry of thorax expansion, ability to huff and signs of mucus retention. Pain intensity was assessed at rest and during breathing exercises and during coughing using a visual analogue scale. Peak expiratory flow rate were performed on the preoperative day and for seven postoperative day. A poor correlation is found between clinical observation of breathing and pulmonary function after abdominal surgery. (Johannes vandeleor et al ., 2003). Fung et al., (2010) compared postoperative respiratory complications in obese and nonobese children following surgery for sleep-disordered breathing. All obese children who had undergone adenotonsillectomy for sleep-disordered breathing from 2002 to 2007 were compared with age- and gender-matched controls. Length of hospital stay and the incidence, severity, and location of respiratory complications were compared.  Forty-nine obese children were identified (20:29, female: male). Overall, 37 obese children (75.5%) and 13 controls (26.5%) incurred complications (P = 0.000). Ten obese patients and two controls incurred major events (P = 0.012); 36 obese children had minor complications versus 12 controls (P = 0.000). Obese children had significantly more upper airway obstruction (19 vs. 4, P = 0.0003), particularly during the immediate postoperative period. The mean hospital stay was significantly longer for the obese group (18 vs. 8 hours, P = 0.000, mean difference of 10 hours). He concluded that Obesity in children significantly increases the risk of respiratory complications following surgery for sleep-disordered breathing. Sixty patients were studied to determine the incidence of postoperative pulmonary complications and the value of preoperative spirometry in producing pulmonary complications after upper abdominal surgery. On the day before the operation and for 15 days after the operation, each patients respiratory status was assessed by clinical examinations, chest x-ray, spirometry and blood gas analysis. A chest physician and surgeon monitored patients for pulmonary complications independently. In this study postoperative pulmonary complications developed in 21(35%) patients (pneumonia in 10 patient, bronchitis in 9 patients, atelectasis in 1 patient, pulmonary embolism in 1 patient) of 31 patients with abnormal preoperative spirometry, 14 patients showed normal preoperative spirometry, 7 patients showed complications. It was concluded that postoperative pulmonary complications was still a serious cause of postoperative morbidity. (Kocabas et al.,1996). Study conducted by Ephgrave et al., (1993) revealed that postoperative pneumonia was a major complication that had been linked to micro aspiration of pathogens originating in the gastrointestinal tract. 140 patients who had undergone major surgeries were selected. Postoperative pneumonia is present in 26 (18.6%) of 140 patients. Postoperative pneumonia is a morbid postoperative complications associated with presence of gastric bacteria during operation and transmission of gastric bacteria to the pulmonary tree after surgery. Studies related to chest physiotherapy and incentive spirometry Chest physiotherapy is an important therapy in the treatment of respiratory illness. It is very important to carry out this procedure in children for the purpose of loosening secretions from the lungs. Morran, et al., (1993) has done a randomized controlled trial on physiotherapy for postoperative pulmonary complications. A sample size of 102 patients undergoing cholecystectomy were assigned to control group and study group. The patients in the control group did not receive chest physiotherapy, while patients in the study group received chest physiotherapy. The study proved that without chest physiotherapy 21 patients developed atelectasis and 19 patients developed chest infections whereas with chest physiotherapy 15 patients developed atelectasis and 7 developed chest infection and 40 patients developed no complication. The author concluded that routine prophylactic chest physiotherapy significantly decreased frequency of chest infection (p

QA Fred Smith CEO of the FDX holding company that includes FedEx :: GCSE Business Marketing Coursework

QA Fred Smith CEO of the FDX holding company that includes FedEx Federal Express Corp. started tracking packages electronically well before the commercial Internet emerged. Now, that infrastructure has been firmly plugged into the Internet, letting customers track shipments in real time and even pull reams of shipping data into their internal systems. Meantime, the shipping giant is taking those lessons into new territory. It has launched a consulting practice that helps manufacturers tighten their own supply chains and reduce inventory requirements by more closely tracking the movement of supplies and finished products. Related Story: FedEx Delivers On CEO's IT Vision Additional Transforming Business Strategy Stories Transformation Of The Enterprise Home Page Colleagues and outsiders say it was all part of founder Fred Smith's vision, well before the commercial Internet, that "the information about the package would become as important as the package itself." Smith, now CEO of the FDX holding company that includes FedEx, spoke with editor in chief Robert Preston and managing editor David Joachim at FDX headquarters in Memphis. Excerpts follow: InternetWeek: How hands on are you when it comes to FDX's Internet strategy? Smith: I'm very intimately involved with our strategies as they apply to information and telecommunications. I'm not an expert in them, but I think I have a very good understanding of what they can do and the respective trends under way in those fields. InternetWeek: How vital is CEO involvement in the Internet strategy of a company? Smith: I think it's vital in almost every industry I know of. I mean, I don't know many industries as well as I do my own, but I am constantly amazed at the profundity of IT and the Internet in almost every field and human endeavor, whether it's medicine, farming, the military, or any other thing that I brush up against. It's just all pervasive, it's changing the face of everything. And those that are not involved in it do so at their peril, in my opinion. InternetWeek: What advice do you have to IT executives who recognize their own company as an Internet laggard but have trouble convincing upper management that there will be serious consequences to that? Smith: I guess my advice to them would be to either convince them or get out. They're going to be toast if they don't. Big businesses, particularly big businesses that are involved in lots of different activities, have a very difficult time dealing with qualitative issues and, I guess as Wayne Gretzky would say, skating to where the puck is going to be rather than where it is now.

King Lear :: essays papers

King Lear In the play King Lear written by William Shakespeare a collection of images are used to express different points Shakespeare is trying to relay to his audience. One reoccurring image that kept popping up was animal images. Shakespeare displays these animal images when King Lear and many of the other characters in the play talk about Goneril and Regan. The animals that Lear and the other characters compare the two sisters to are not very pretty. They are compared to the likes of tigers, serpents, and even monsters. These reoccurring images have an important idea behind them that Shakespeare hopes to communicate his readers. Shakespeare waste no time in comparing Goneril and Regan to animals. When Lear parts from Goneril at the end of Act I, after she has sneered at him and diminished the number of his retainers, he calls her a â€Å"Detested kite† (I. iv. 269.). He also compares her to â€Å"the sea-monster† (I. iv. 268.), by which he possibly means a mythological monster that would betray its own father. King Lear also comments on his daughters ingratitude using animal imagery when he said,† How sharper than a serpent’s tooth it is to have a thankless child† (I. iv. 295-296.). Lear comments once more on his daughter’s â€Å"monster ingratitude† (I. v. 40.). Lear is showing how he feels about how his daughters are treating him by comparing them to unpleasant animals. Lear in scene IV has a quarrel with his other daughter, Regan, where again he uses animal images to show how his daughters are sinking below manhood to animals. Lear seeks out his daughter, Regan, at Gloucester’s castle, and finds out that her husband has put his faithful friend Kent in the stocks and that both husband and wife have retired to bed and do not wish to see him. When Regan finally comes down, she tells him â€Å"You should be ruled, and led by some discretion that discerns your state better than yourself† (II. iv. 147-149). Lear responds by saying â€Å"struck me with her tongue, most serpentlike, upon the very heart. (II. iv. 159-160). Lear here again is describing Regan to a serpent, which is a large poisonous snake. Both daughters seem to him now like unusually cruel animals. They show this when they shut him out into the stormy night. In the storm scene, Lear’s hurt from his daughters affect his attitude to the mad Tom of Bedlam (Edgar).

Children of Heaven Review

Children of Heaven This movie made me very thankful for everything I have in my life, including my shoes. I found it sad that All could not Just speak up for himself. If All would have asked the man working the grocery store about the shoes, then he might not go to all the trouble in the first place. I found it sad that the children had to work, and never got to play. The quality of life for this family bothered me deeply, and it made me blessed for the childhood that I had. The kids in this movie worked almost as servants to the adults, maintained pristine manors, and showed great perseverance.I noticed most of the adults in the movie were very strict, stern, and seemed like they were not afraid to beat a child. All made some of the highest grades in his class despite his hardships, he was a responsible kid. I Just don't understand why he did not speak up about the shoes to his teacher, principle, or coach. It was sad to see kids having to stick together, and share a pair of shoes t o prevent one of them from getting a beating. All's sister should have asked the other girl wearing her shoes, where she got them.The girl may have Just given them to her in exchange for the en, or when she received her new shoes. This movie was one hardship after another, heartbreaking for me to watch. It makes me want to donate shoes for children who may not have any at all. It was sad to see people In the movie live In lavish mansion, and then compare It to All's home. All's dad was paid very good for his gardening work, this money would be a precious asset to his family. When the man at the mosque gave All's dad the tools, this showed how the Islamic community supported the others In need. Overall It seemed Like a rough situation to me.

The Future Of Nursing: Leading Change, Advancing Health

We are in a decade of change, as nurses we are set to be challenge on many levels in order to face these challenges we must all prepared. Recently the Institute of Medicine, 2010 (IOM, 2010) released a report on the future of nursing; its content outlines in great detail what changes will take place. A collaboration of many offered their expertise in and out of the field of nursing and how the following three areas may be enhanced or completely changed. This writer will attempt to give a single perspective on the issues of Education, leadership and practice and how they may be transformed over the next decade. The Future of Nursing: Leading Change, Advancing Health There have been many discussions by the IOM over the years about the impact of nurses on the care of patients and the obvious need for change. The pending arrival of the affordable care act (ACA) has propelled many of those changes to the forefront; we must remain steadfast in our goal to provide quality care to that patient who depends on us. When the implementation of transformation becomes not only a report but reality can and will it free us as patient care providers to offer a more advanced method of care? Transforming Education This initial goal will remain intact according to the opinion of the IOM report, that all nurses must be prepared to meet a diverse patient population. With that goal in mind the report indicates that educational requirements for the registered nurse (RN) will ultimately be geared towards higher degree attainment by the practicing nurse. Currently the pathways that are in place to obtain a nursing degree will not change but the nurse will be placed on a course to continue their education goals beyond that of and associate degree (ADN). The goal will be to enhance the programs in place and prepare the student nurse for a place in an undergraduate program; a plan to make that goal possible for all is also a need that the IOM report mentions as the current barrier. Affordability of nursing programs beyond that of the ADN now seems to be the greatest challenge; can these entities create such a pathway? Another proposal that this reader found interesting on education transformation, was the pathway for an increase in masters and doctoral degrees to increase the volume of prepared faculty. The current issues that are being faced now is that of faculty shortages in many of the nursing programs both at community and undergraduate campus’s. The ACA has what is noted as an incentive to offset lower faculty salaries which would provide up to $35,000 in loan repayments for eligible nurses who seek to complete advanced degrees. Patient Protection and Affordable Care Act HR 3590, 2010). With such incentives in place this pathway may be considered as a means to an end in the advancement of education by the career oriented nurse, creating leaders is the way to create change. Transforming Leadership The IOM also reflects on the importance of nurses taking a stronger position in leadership. It is time for nurses to take a place at the table of change, that misconception that we are in pla ce to perform and not create will soon be eradicated. The report indicated there is a lack of nurse participation on many directorial boards this is a reason to transform. The placement of these programs is fundamental (Institute of Medicine [IOM, 2010],) to increasing nurse participation. It is true some leaders are born into their roles but not all and with the implementation of these leadership programs this writer believes future leaders can be created. The creation of mentorship programs is also a way to create leaders, as nurses we must make room for those coming up behind us and nurture the leader that lies in us all. This writer found the idea of creating training programs for nurses to represent us on the political front was the finest of all the recommendations, as nurses we must incite change at the very top and creating voices of change on this level would be an incomparable transformation. The ability to have our contributions heard and implemented will create a movement that will carry nursing forward and upward, can we be the voice of the idea and transformation of nursing practice? Transforming Practice. Our scope of practice dictates the boundaries for which we practice, the idea of the IOM report indicate as nurses we must be able to practice to the fullest potential of our educational backgrounds. This is especially important for the advanced practice nurse (NP), their roles must be universally defined for the future. The increase in patient population will see an upsurge in patient load with a shortage of primary care givers and this can only be disastrous for those seeking care. Creating a universal scope of practice for NP will eliminate this issue and it must happen now. The report indicated the barrier to this was the apprehension of acceptance by physicians; can we change a lifelong idea? As this writer has assessed all the pending changes it was asked how these changes will affect the ability to offer care, it is believed that higher education will create a more diverse approach to care and as a patient educator this is key to this nurse’s specialty. As for the other notations regarding care and leadership, this writer believes leadership roles will enhance the confidence of the role of the patient educator, finally increasing the quality of care provided. Conclusion In closing a transformation of change can only happen with the active participation of all nurses, we must become active in every facet of our future and not leave it up to others to speak on our behalf.

The Process

How to make steak, mashed potatoes and green beans Growing up I was a very independent child. I always wanted to learn to do things for myself. When I was about seven or eight, I learned how to make steak. It instantly became my favorite food. Along the years IVe gotten better at making steak and many other foods. One of my favorite dishes to make is green beans, mashed potatoes and of course steak. It is simple to make and requires little preparation.It is very important to have all the ingredients before you start to prep and cook our meal. You will need: two pans, four potatoes, steak, one can of green beans, one pot, a potato peeler, can opener, pepper, garlic, seasoned meat tenderizer, onion and garlic powder, vegetable oil, butter, milk, salt, chives, and a standing mixer with a rotating bowl. Once you have all of that you can start to peel the potatoes. After you have done this, you can fill the pot up with water and bring it to a boil.You can now add the potatoes and let it c ook for about twenty minutes until they are cooked horoughly. You can tell if they are finished if you can stick a fork easily through them. You then drain the water from the pot and put the potatoes in the standing mixer. The standing mixer makes it easier to whip the potatoes and they come out with no lumps. After you have whipped the potatoes, you can put them into a smaller pot and turn on the stove. Now you add a cup of milk, sprinkle some pepper and salt into the pot, and add 3 to 4 table spoons of butter.You also add some chives for lavor and mix all the contents all together. Lastly you reduce the heat and cover your finished product. Now you can move on to the steak. First you cut the steak into pieces and place it into a bowl to be cleaned. You run it under hot water to get rid of any bacteria. After draining the dirty water, you start to season the steak. The seasonings you will use are pepper, meat tenderizer, garlic, and onion and garlic powder. After seasoning the meat you can dice the garlic and place it in a pan with vegetable oil.Once the garlic as browned a bit, you can place the steak in the pan with half a cup of water. The water will keep the meat soft and tender. The steak will be brown all the way through when it is finished. Finally, you can start with the green beans. First you open the can and drain the water. Then you dice the garlic like you did for the steak. In a small pan you add three teaspoons of vegetable oil and add the diced garlic. Next you add the green beans and turn on the stove burner to a low heat.Add some pepper, salt and garlic owder and mix it all together so that the seasonings can be evenly distributed. Once the green beans are hot, you are finished. You now have a delicious meal that is ready to eat. Cooking has become something that I enjoy doing. I love learning different ways to make the same foods and trying new foods and recipes. I love when I cook for my friends and family and they boast about how good the food was. It makes me feel good and want to keep cooking to get even better. I love cooking as much as I love to eat. Process Essay By ktcr

Reduce the Cost of Marker Making

RESEARCH REPORT HOW TO INCREASE THE EFFICIENCY OF MARKER MAKING AND DECREASE THE WASTAGE OF FABRIC? TEXTILE INSTITUTE OF PAKISTAN Shakaib Iftikhar (AMM-3) Tariq Zaib(AMM-3) Arsalan Javed(AMM-3) Faiza Noor (AMM-3) TABLE OF CONTENTS ABSTRACT4 INTRODUCTION5 OBJECTIVES6 SCOPE OF THE THIS RESEARCH6 LITERATURE REVIEW7 EXPERIMENTAL METHODOLOGY10 RESULTS11 DISCUSSION OF THE RESULTS14 CONCLUSION16 APPENDIXES†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦17 REFERENCES†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18ACKNOWLEDGEMENTS I would like to acknowledge and extend my heartfelt gratitude to the following persons who have made the completion of this Lecture Notes possible: Our Research Teacher, Ma’am Rakshanda Shah,for her vital encouragement, support and teaching. Ma’am Nazia, our Institute Apparel Lab Assistant, for providing markers and patterns. Mr Gamini, Head of Apparel Department for the constant reminders and much needed motivation. Mr Pardeep from Eastern Garments for providing us the lab settings and inspiration he xtended. All the workers and staff of Eastern Garments who helped us in experimentations. Mr Lalith, Mr Salman and Mr Arsalan for assisting in the collection of the topics for the chapters. And Most especially to my family and friends. ABSTRACT Marker is a part of a paper on which the patterns of  all parts of the garments are drawn so that garments can be made by using minimum quantity of fabric. Reducing the quantity means that maker is being made efficient so that fabric wastage can be reduced as m uch as possible.There are two methods of marker making, the first one is manually in which a specialized marker maker makes the makers and try to utilize all the fabric so that another piece of fabric is not required. The other method is computerized method called Gerber Technology. In it the markers are made in computers and the efficiency is set by computer to decrease the fabric wastage. Saving the fabric is crucial because is decrease the average cost so that profit maximization can occur. After conducting experiments the best method for increasing the marker efficiency is Gerber (computerized).It makes the most efficient markers which decreases the wastage of fabric. This saves the cost and benefits the garment manufactures as they can make several pieces (patterns) out of less fabric. INTRODUCTION In recent years the number of markers required by apparel manufacturers has escalated disproportionately to growth. Orders are getting smaller, the number of different styles is incr easing, and lead times are getting shorter  Ã¢â‚¬â€œ all of which put more pressure on the marker making department. So it is no surprise that new automated marker making tools are being launched onto the market.Niki Tait takes a look. The improved fabric utilisation associated with computerised marker making has helped this technology virtually take over from traditional manual methods over the last 25 to 30 years. With fabric accounting for around 50 per cent of the ex-factory cost of a garment (more than 70 per cent in low cost labour countries), the 5 per cent saving associated with automated systems is key. In reality these marker making tools are ‘computer assisted' rather than ‘computerised,' with the skill of piece placement still relying on the experience of the marker maker.The computer plays a passive role, controlling the nesting constraints such as tilting, rotation and buffering while the operator makes all the decisions. An experienced marker maker will remember combinations which have worked before, he can see what part might fit into which slot, and he knows what he can tilt slightly off gain to fit. In the last few years, however, CAD companies and research organisations throughout the world have been working to develop systems to produce markers fully automatically.It's an extremely complex process given all the possible combinations of pattern part placements within a lay, and one that only becomes worthwhile if the material utilisation matches that produced by a skilled marker maker using conventional computer systems. It is only now becoming a viable option as the costs of high speed processing power and memory come down and software developments catch up. But for manufacturers the timing is a happy one as the number of markers – and cost of making them – has escalated disproportionately to growth.Orders are getting smaller, the number of different styles is increasing, and lead times are getting shorter â€⠀œ all of which put more pressure on the marker making department. With automatic marker making a series of parameters can be set. These include: produce the best possible solution in 30 minutes; try different combinations until a minimum of 91 per cent fabric utilisation is achieved; find the best combination within 500 tries etc. The system can be left to work through a batch of instructions unattended both day and night, so time constraints become less of an issue.With most automated systems, however, there is also the ability to combine human intervention within the automated process. Most CAD companies agree this provides for the best solution, particularly where the marker is going to be used for many repeats, on deep, long lays or where expensive fabrics are going to be cut. OBJECTIVES This research has several objectives which are beneficiary for number of reasons. The first objective of this research is to increase the production per hour by increasing the efficiency. Effic iency is directly related to production because if the marker is efficient, it can be easily layed out on he large bundles of fabric. Another objective is to increase the efficiency of the garment, when the marker made is good, the efficiency will increase and overall quality of the garment will be improved. It will also decrease the waste produced by the cutting department since with marker making technology, fabric will be properly utilized. One more major objective is to meet the international quality standards like for example ISO and etc. The objective goal of 83% percent efficiency which is the best in industries currently has to be met.This efficiency had to be tested on manual and computerized in order to find which gives the more efficiency and saves the fabric. SCOPE OF THE THIS RESEARCH One of the benefits of finding the efficiency was that the apparel industries require less labour to produce the garmants. The turnaround time of maker making is faster if done all at one time and pricewise, it will cost less money to manufacture a garment in apparel industries just by paying a flat rate for the whole process versus paying regular prize for each individual job.The markers can be fully customized to fit any costumer’s designing needs and are offered to apparel companies, Professional business people, Artists, People with new design inventions, young designers trying to launch for the first time a collection and people in  general who want to create a small clothing line to sell their designs on an online website store. Turn around time for most jobs done through marker making is faster than making each individual pattern made separately.An efficient marker coordinates and organizes all the work flow to be done for the costumer and spends a great deal of time explaining each little detail of the design process to its design team who will be in charge and responsible for the completion of a given project. Pricewise, making a garment through 83 percent efficient computerized marker will cost a lot less money versus paying five to ten thousand rupees for the making each single pattern by hand. This amount of money is often spend by manufacturing companies who have the obligation of aying all the salaries of their design team which can add up to thousands of rupees every week not forgetting the fact that paying regular prize for each individual pattern will always be more expensive than paying a flat rate for all the work to be done. In addition an efficient maker has many advantages, one of them is the ability to create many pattern and lay them on several fabrics in one location. This requires less space and the company can save its lot of space. Turnaround time for all pattern to be made are faster if done all at one time. LITERATURE REVIEWFor industrial garments preparation, marker making is a very important chapter for highest usage of fabric and for lowest wastage of fabric. This is a process which is performed to draw the pattern pieces on the fabric before cutting. This may be done by drawing the pattern pieces on the fabric directly or by drawing the pattern pieces on a thin marker paper and then placement the paper onto the fabric lay. So, we can define the marker as bellow. Marker is a thin paper which contains all necessary pattern pieces for all sizes for a particular style of garments in such a way that, fabric wastage would be least.The representation or drawing of the arrangement of identified garment pattern relevant to the cutting of a batch material. The marker is placed on the material and provides guideline for cutting. Marker may be on fabric or held in computer data files. Marker width is equal to the minimum fabric width and its length depends on the no of pattern sizes that will be drawn. Preparations of Marker Making Before the marker making, some preparatory processes would be followed. The processes are discussed ago (In preparatory processes chapter).Without those, some oth ers preparations are * Marking Grain Line : Before marker making, the grain line of pattern and fabric must be marked. * Fabric Measurement : Before marker planning, the fabric must be measured carefully. Because, marker width is relevant to the minimum fabric width. * Fabric Faults : Fabric faults would be also under consideration. In a fabric roll, where any faults found, that points must be avoided for quality production and to least the fabric wastage. * Cutting Table : Marker planner should consider the cutting table length before making marker.Marker length must be less than the cutting table length. Constraints of Marker Making During marker making, the work of the marker planner is subjected to a number of constraints. These relate to i. The nature of the fabric and the desired result in the finished garment. ii. The requirements of quality in cutting. iii. The requirements of production planning. The nature of the fabric and the desired result in the finished garment * Patt ern alignment in relation to the grain of the fabric, pattern pieces normally carry a grain line.When pattern pieces are laid down the piece of cloth, the grain line should lie parallel to the line of the warp in a woven fabric or the wales in a knitted fabric. Where pattern pieces are laid across the piece, the grain line should lie parallel to the weft or course direction. If the marker planner lays down a pattern outside the stated rules for grain lines, then the finished garment will not hang and drape correctly when worn. This requirement to follow the grain lines restricts the freedom of the marker planner in choosing how to lay the patterns in the marker. * Symmetry or AsymmetryMany fabrics can be turned round (through 180. ) and retain the same appearance are called symmetrical. They require no special attention during marker making. Asymmetrical fabrics are those which are turned (through 180. ) and do not retain the same appearance. Examples of such fabrics are pile which is brushed in one direction and which show different reflection of light. The marker should be planned in such a way that it is in accordance with symmetry, asymmetry of the fabric. All pattern pieces of a garment should be along the same direction when laid down on a symmetrical fabric. * Design characteristics of the finished garmentsIf a vertical stripe does not show a complete mirror image repeat, the right and left sides of a garment may be mirror images of each other. In this case, a pattern should be placed on checks in such a way that the design matches when sewing up. During marker planning, a marker maker must have to think about matching the checks and stripes in a garment. His freedom is restricted here. So I think it?  ¦s a constraints for a marker maker. The Requirements of Quality in Cutting * For majority of cutting situations where a knife blade is used, the placements of the pattern pieces in the marker must give freedom of knife movement.A blade, which has width , cannot turn a perfect right angle in the middle of pattern piece and space must always be allowed for a knife to turn such corners. The amount of space depends on the actual cutting method employed. * Pattern count check that the complete menu of pattern has been included. * Correct labeling of cut garments parts is essential to identify correctly the garment parts for whole garment sizes. It is the responsibility of the marker planner to code every pattern pieces with its sizes as the marker is planned. The Requirements of Production PlanningWhen an order placed for a quantity of garments, normally specifies a quantity of each size and colour. If the sewing room requires the cut work urgently, the marker may make two markers. 1. Short marker and 2. Long marker. * For long marker, it can be made according to the size proportion and different sizes. This process is very much efficient and takes more time and increased shade variation. * For short marker and for the particular order two marker can be made, this process is less efficient but takes less time and more production and small cutting table. For complex garments long markers generally offer more opportunities for savings than do short ones. * The more sizes that included in a marker, the greater are the scope for fabric savings. Greater fabric savings and after lower total cost would normally result, from cutting a stepped lay with paper markers on top. However, though for greater efficiency, a marker maker needs opportunity to work with freedom, but for maintaining proper quality some criteria must be followed. That is why there are some constraints of marker making. Methods of Marker Making There are two methods of marker making. i. Manual method. ii. Computerized method.Here marker is produced in two ways. 1. Marker drawn directly on fabric lay. 2. Marker drawn on marker paper. EXPERIMENTAL METHODOLOGY In order to find out which method gives near 83 % efficiency, the data collected was analyzed by the means of statistical mathematics. 5 samples had to be selected from each; 1. Manual Marker Making 2. Computerized Marker Making The computerized Marker making will be further tested using 7 different computerized machines for making markers. In total there were 5 samples from manual and 35 samples from Computerized Marker Making which means that there were total 40 samples of markers. 75 yards of fabric was used to lay markers on them. Each technique and machine was given 175 yards of fabric and the total fabric utilized was 7000 yards. The experiment was done 200 times in order to get 5 samples from each technique and method. In order to find out the efficiency, there is a formula which calculates it. The formula is Area of the patterns X 100 Area of the marker Out of 200 samples 40 samples were selected through simple random selection. 5 samples were selected from manual marker and 35 samples were selected from computerized marker making.After sampling the results were put in the table and the mean of efficiency was calculated for the left out samples in order to find out how much efficiency at max could be given. RESULTS The 5 selected samples from each method and technique were taken out and their efficiency was calculated. After getting their efficiency they were put in the table to find out the mean efficiency produced by them. MANUAL MARKER MAKING Sample 1 | Sample 2| Sample 3| Sample 4| Sample 5| 76. 56% | 78. 34%| 67. 66%| 61. 2%| 67. 3%| Mean efficiency of manual marker making= 70. 2 % Efficiency from manual marker making can be of maximum 70. % but the required efficiency is 83% which makes the saves the fabric most. COMPUTERIZED MARKER MAKING LECTRA Sample 1| Sample 2| Sample 3| Sample 4 | Sample 5 | 81| 80| 79. 9| 79. 7| 81. 3| Mean efficiency from Lectra = 80. 38% Efficiency from Lectra marker making can be of maximum 80. 38 % but the required efficiency is 83% which makes the saves the fabric most. COMPUTERIZED MARKER MAKING NESTER Sample 1| Sample 2 | Sample 3 | Sample 4| Sample 5| 78. 9 | 77. 7| 81. 2| 81. 3| 80. 18| Mean efficiency from Nester = 79. 85% Efficiency from Nester marker making can be of maximum 79. 5 % but the required efficiency is 83% which makes the saves the fabric most. COMPUTERIZED MARKER MAKING GERBER Sample 1| Sample 2| Sample 3 | Sample 4 | Sample 5| 85| 86| 82. 3| 83. 3| 83| Mean efficiency from Gerber = 83. 92% Efficiency from Gerber marker making can be of maximum 83. 92 % and the required efficiency is 83% which saves the fabric most and it means that Gerber met the required efficiency percentage. Sample 1| Sample 2| Sample 3 | Sample 4 | Sample 5| 82| 82. 2| 81. 37| 82. 67| 82. 73| COMPUTERIZED MARKER MAKING AUTOMATIC NESTER Mean efficiency from Automatic Nester = 82. 1%Efficiency from Automatic Nester marker making can be of maximum 82. 1 % and the required efficiency is 83% which saves the fabric most. COMPUTERIZED MARKER MAKING ASSYST BULLER Sample 1| Sample 2| Sample 3 | Sample 4 | Sam ple 5| 81| 79. 8| 81. 8| 81| 80| Mean efficiency from Assyst Bullmer= 80. 72% Efficiency from Assyst Bullmer marker making can be of maximum 80. 72 % and the required efficiency is 83% which saves the fabric most. Sample 1| Sample 2| Sample 3 | Sample 4 | Sample 5| 82. 33| 82. 23| 81. 36| 82. 90| 82. 88| COMPUTERIZED MARKER MAKING TUKATECH Mean efficiency from Tukatech = 82. 34%Efficiency from Tukatech marker making can be of maximum 82. 34 % and the required efficiency is 83% which saves the fabric most. DISCUSSION OF THE RESULTS Lectra Because material savings are a fundamental factor for every apparel firm, Lectra has spent the last 25 years developing solutions that apply state-of-the-art technology for material optimisation. Diamino V4 is its latest computer assisted version which, when combined with Expert V4, provides an automatic marker-making tool that can handle all kinds of fabrics and generate entire markers or complete partially operator-processed markers.Lectra says it s â€Å"intelligent software† takes into account the specific requirements of different garments, fabrics and pattern pieces. Gerber Technology Maximizing fabric utilisation is not the only consideration of marker making: the time it takes is increasingly important too. Gerber Technology has modified its AccuMark and Micromark software to allow parts to be rotated according to specified laying and style rules. The grain line deviation can also be defined. For the actual automation of the marker production its software has been integrated with Nester Server. NesterNester is available in two versions: NesterServer as an upgrade to CAD systems from Gerber, Assyst, Asahi, Toray, PAD and VetiGraph; and the Nester complete nesting system. This software tool automatically generates cost-effective markers for production, costing and engineering. It also combines automatic and semi-automatic options. The company claims Nester's return on investment is realised in under six months. Fab ric savings with automatic nesting Nester Inc offers this real-life example of a sportswear manufacturer cutting $30 million of fabric annually. Four production markers were given to Nester to process automatically.On average, Nester generated layouts that were superior to CAD-based manual results by 1. 05 per cent. The average length used in the four markers was 714. 21 cm with Nester and 721. 85 cm with traditional CAD-based manual nesting. On average, NESTER outperformed a CAD operator by 7. 64 cm, or 1. 05 per cent. If this saving were extended over the entire marker population in this factory, 1. 05 per cent fabric savings would equate to $315,000 per annum. Pad Systems Although Pad Systems' software integrates with Nester, it also has its own automatic marker making system.Within this, individual pattern pieces are directly related to the base pattern piece, so any changes to the pattern are automatically reflected in the marker. This feature is important in a fast changing fa shion industry where patterns may be modified several times throughout the development of a style. New markers are based on a similar, though previously manually made, marker of a comparable style and material. Thus Pad's automatic marker combines the original manual skill of the marker maker with the processing speed of the computer.This combination, the company explains, results in similar fabric utilisation but the new marker is achieved in a fraction of the time. Assyst Bullmer Assyst Bullmer no longer supplies automatic marker making software to its customers, explaining that automarker. com uses the most up-to-date software, is maintenance-free, and is available 24/7. On their own CAD systems customers define the width of marker, the sizes to plan and constraints such as whether rotation or twisting off grain is allowed. This is then sent to the website and the results download by the factory or sub contractor.Users include manufacturers in Eastern Europe where the comparable cost of manual lay planning on a CAD system would be low. Tukatech Tukatech's automatic marker making facility is called Nest ++ and is of particular use in helping cater for overload or rush orders, for large ratio markers and to estimate the best efficiencies on many fabric widths during pre-production. Efficiencies are said to be comparable to manually placing pieces in the CAD system (approximately 1 to 3   per cent difference). Users can start a marker with manual placement and Nest++ will finish the job automatically.Benefits are said to include increases in material efficiency with subsequent decreases in material waste, time and labour savings in making markers; improvements in overall marker quality; tighter markers; avoidance of backlogs during peak periods; and fast, precise cost proposals for clients. FINDINGS After experimentation the GERBER machine, is the best in reducing waste and giving the more efficiency. It is better to install Gerber rather than installing any other experimented CAD machine. Manual should be eliminated as the system is very faulty and old. CONCLUSIONIn manual system the system is used to make maker for garment making is traditional. But in CAD system marker making is done in modern system. Marker efficiencies are not visible in manual system. Other hand, marker efficiency is visible in CAD system. Marker length is not visible in manual system while Marker length is visible in monitor screen at CAD system. In manual, once marker is made, it is not possible to increase its efficiency. But in CAD it is possible to increase the efficiency at any time possible which means that fabric can be saved. In manual if the marker is layed, nothing can be done about it.Marker copying is not possible manually, so it is very time consuming to trace each and every other marker out there. In CAD, by using Plotter as much as possible copy can be done. Manual marker making is very time consuming method whereas, CAD is a faster method. In man ual system quality cannot be assured, sometimes markers can be good other times really faulty but in CAD, it has quality assurance. Even though manual system costing is low, CAD is expensive but the labour cost reduced saves cost in the long terms and since markers can be utilized again and again there is no special need of hiring a professional marker maker to make the atterns and lay them on fabrics. Out of all the CAD system Gerber turned out to be the best since it has an automatic efficiency calculator and it evens shows and tells that this much amount of fabric would be wasted if the efficiency percentage is low. Therefore, apparel industries are recommended to use Gerber as their primary source for making Patterns and makers. APPENDIXES 1. Marker Making Marker is a part of a paper on which the patterns of  all parts of the garments are drawn so that garments can be made by usingminimum quantity of fabric. 2. Marker EfficiencyThe efficiency of marker making means that how ef ficient it is in saving the fabric. 3. Computerized Marker Making Markers which are made through the means of Computer 4. Manual Marker Making Markers which are prepared manually by a trained professional 5. Laying The putting of patterns/makers on the bundles of fabric. 6. Plotter This is in computerized maker making. In plotter line diagrams of patterns or makers are drawn. REFERENCES 1. Garment Construction Skills (Premlata Mullick) 2. Apparel Manufacturing (Sewn Product Analysis) 3. Patternmaking for Gerber Technology (Helen Joseph-armstrong) 4. www. scribd. com/doc/61990320/Marker-Making