The Effect of Competition, Jit and Tqm Essay Example

The Effect of Competition, Jit and Tqm Essay Journal of Economic and Social Research 10(1) 2008, 35-72 The Effect of Competition, Just In Time Production and Total Quality Management on the Use of Multiple Performance Measures: An Empirical Study Melek Eker* Fikri Pala Abstract. This paper is an empirical investigation into the use of multiple performance measures in manufacturing organizations. Specifically, the relationship between multiple performance measurement system and competition factors, JIT practices and TQM practices is examined through the data collected from 122 manufacturing firms from the Turkish top 500 companies in 2005. The results show there is a linear relationship between using multidimensional performance measurement system and the firms that have high market position are those that are using JIT and TQM more than others. JEL Classification Codes: D29, M29. Keywords: Multiple Performance Measures, Competition, Just in Time Production (JIT), Total Quality Management (TQM), Factor Analysis, Multi-nominal logistic Regression Analysis. 1. Introduction Performance measurement is a concept of modem business administration history. The organizations in the market have to identify with concepts such as dynamism, scarce resources and complexity and have to show high performance to survive thereby needing to measure and to evaluate their performances accurately. This means for firms that performance measurement is more than a systematic action, but today, performance measurement and evaluation system is the most important managerial tool for organizations. Nowadays, because of high specialization, division of labour and high competition, its clear that performance should be thought more Department of Management, Uludag University, Bursa. Department of Management, Uludag University, Bursa. 36 Melek Eker Fikri Pala elaborately as a concept and discussed not in a result-focused but in a process-focused way. (Albright, 2006:157-174; Yasin and et al. , 2005: 323). In this context, it will be possible to state two types of criteria conteming the performance measurement in organizations. These are financial and nonfina ncial performance criteria. Financial criteria evaluate the performance in terms of monetary assets gained and therefore attach importance to the result. We will write a custom essay sample on The Effect of Competition, Jit and Tqm specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on The Effect of Competition, Jit and Tqm specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on The Effect of Competition, Jit and Tqm specifically for you FOR ONLY $16.38 $13.9/page Hire Writer On the other hand, a non-financial criterion evaluate the performance in terms of units or divisions and work processes in a company and highlights the actions that provide final financial result and enable its sustainability. Its possible to separate performance criteria theoretically, but both are linked practically. In fact, firms are organizations in business to make a profit, but today it is possible to argue that there are various functions in organizations and therefore financial performance is likely to be affected much more by non-financial processes. Hence, performance measurement has to have a structure containing both flnancial and non-financial criteria. (Wruck and Jensen, 1998:401^23). Due to its effect on how successful firms are, performance measurement system has to contain accurate and reliable information, which is so critical to business organizations because of its roles in future planning, evaluation of targets and actual results, and decision-making matters affecting employees are all based on the strength of the information contained in performance measurement evaluative processes. However, the more important point needing to be noted here is that generally the meaning of performance for organizations has become limited to only profitability or financial incomes. Undoubtedly, firms are profltbased organizations, but more than that, they have to be sustainable. Making profitability sustainable depends on managers abilities to see all developments in and around firms and evaluate them according to future results. So, this underlines that the concept of performance should not be confined only to financial results, but also should have a wide meaning including the non-financial criteria as well. Balanced Scorecard (BSC) is a performance measurement model, which was proposed as a result of this obligation. Three reasons for using multiple performance measures are: (1) perceived limitations in traditional accounting-based measures, (2) Fisher (1995) ndicates that many firms believe that financial measures are too historical and backward-looking, lack predictive ability to explain future The Effect of Competition, Just In Time Production and Total Quality 37 Management on the Use of Multiple Performance Measures: An Empirical Study increasing competitive pressure and (3) applying new management techniques like TQM and JIT needed for non-financial measures (Itner and Larcker, 1998: 217-218). Performance should therefore not be interpreted only as profit-focused activities but also as non-financial activities directed toward obtaining or following profit process. This kind of new comprehension on performance measures points to changing perception of firms toward performance. In this context, improvements in information technology make it easy to observe internal and external business processes, consequently making it possible to apply BSC. (Donovan, 1-3). Hitherto studies have shown that the use of non-financial performance measures by the firms is directly related to such variables as market competition, computer aided production, new production techniques, the structure of firm (size, culture, technological situation and adopted strategy etc. ) and sector structure. The aim of this study is to determine whether the multidimensional performance measures are used or not by the manufactures of top 500 firms in Turkey and if theyre used, to define the relationship between multidimensional performance measures and. firms market position, market competitive density degree, JIT and TQM practices. In this context, first the literature and the developed hypotheses on the subject will be reviewed and then the designation of sampling and factor analysis, descriptive statistics, multi-correlation and multinomial logistic regression analysis results will be described together with the results from our empirical study. 2. Literature Review and Hypotheses 2. 1. Literature Review Many factors contribute to why many firms prefer non-fihancial performance measures. In view of this, some researchers suggest that the preference for these measures on a large scale is related to the enterprises operational and competitive structure (Said, et. l. , 2003: 193-223), others suggest that this preference can be related to the JIT, TQM and CAM structure (Hoque, et. al 2001: 23-45). Similarly, while many reported that the use of multiple performance measures is relevant only to the strategic preference of managers (Malina and Selto, 2001:48; Govindarajan and performance, reward short-term or incorr ect behaviour, provide little information on root causes or solutions to problems, and give inadequate consideration to difficult to quantify intangible assets such as intellectual capital. 38 Melek Eker Fikri Pala Gupta, 1985: 51-66), some reports demonstrate that an enterprises environmental conditions affect this preference. On this subject, for example. Hoque (2004) found that there was a meaningful relationship between environmental uncertainties and the preference for these measures. Chenhall and Morris (1986: 16-35) found that organizations prefer nonfmancial management accounting systems to cope with high environmental uncertainties effectively. The use of multiple performance measures and its positive effect on production performance are demonstrated in another section of the literature. For example. Banker, Potter and Schroeder (1993: 33-55) stated that multidimensional performance measurement system reports presented to the personnel in production line was positively associated with the implementation of modem management techniques such as JIT, Team Work and TQM. However, Chenhall (1997: 187-206), Callen, et al. (2005: 271309), Itner and Larcker (1995: 1-34) examined the use of BSC together with the aforementioned modem techniques and argued that enterprises using the TQM/JIT and non-financial (production performance) measurements together have reached a higher performance than other firms without these measurements. Additionally, many studies examine the positive contribution of multiple performance measures on the general enterprise performance from the fmancial perspective. For example, Davies Albright (2004: 135-153) and Dilber et al (2005: 220) argued that there is a meaningful positive relationship between the use of BSC and high-level fmancial performance. In an empirical study by James, Hoque (2000: 1-17) demonstrates that the use of BSC increases general enterprise performance, but this increase is not associated with organization size, product life circle, or market position. Lingle and Schiemann (1996: 56-61) found that enterprises managed by measurements reached a higher fmancial performance level, a higher industrial position and a higher level in the management process relative to enterprises that are not managed by measurements. Ittnera, Larckera and Randalb (2003: 715-741) indicated that the enterprises placing more emphasis on measurement and variety have acquired a much higher stock exchange income. Perera, Harrison and Poole (1997: 557-572) argue that the use of non-financial measures show significant associations with customer focused strategy, but not the link to organizational performance. Apart from studies examining BSC effects on general enterprise performance, other studies have examined the enterprises suitable working The Effect of Competition, Just In Time Production and Total Quality 39 Management on the Use of Multiple Performance Measures: An Empirical Study conditions as an effective performance measurement tool in BSC. For instance, Cavalluzzo and Ittnera (2004: 243-267) state that organizational factors such as willingness in the top management directed at the use of performance knowledge, decision making and training in the subject of performance measurement techniques have a positive effect on measurement system development and usage. Also, Moers (2005: 67-80) called significant attention to the positive relationship between the variety of performance measures and the degree of perfection with bias during the performance evaluation. It is clear that the bias mentioned here indicates a pre-cognitive accumulation directed at performance measurement. On the other hand, Krumwiede (1998: 239-278) suggested that organizations with higher quality information systems could implement new measurement systems comfortably relative to companies with less sophisticated information systems. Thus, he suggests that this highlights the linear relationship between opportunities for existing information systems and the success of implementation. In addition, he draws attention to managers^ who are satisfied with information from the existing system that might not be willing to invest in new systems. This will give way to the development of a negative relationship between the system and its implementation. Briefly, these studies, within a framework related to literature conceming multidimensional performance measurement system, draw attention to the use of multiple performance measures by enterprises associated with the anagers preference, specifically, the enterprise managers scientific level, organizational culture, environmental conditions, technological developments, new management techniques, enterprise performance and indirectly, stock exchange incomes. Our study considers the relationship between the four dimensions that occur in BSC (financial, customer, internal business processes, learning and growth); a) with the enterprises position in the market, b) with the level of competition in the market, c) with the JIT pra ctices and d) with the TQM practices. 2. 2. Variables and Hypotheses 2. . 1. Balanced Scorecard BSC created firstly by Kaplan and Norton in 1992 at the end of pursuits on altemative planning, control and performance measurement system in 40 Melek Eker Fikri Pala management accounting, is an efficient management tool (Kaplan and Norton: 1992). The target is to enable managers to obtain comprehensive viewpoint about overall business and in this way help them focus more on critical activities that are supposed to improve the organizational strategy of the firm (Wongrassamee, et. al. 2003: 18). In that way, BSC undertakes two crucial functions. First is being a strategic guide for department managers. Second is being communication and strategic planning tool describing the link between financial and nonfinancial criteria as a guide for firms (Kaplan and Norton 1996; Kaplan and Atkinson, 1998: 367-375; Atkinson, Kaplan and Young: 2004; Simons: 2000). Using BSC provides some opportunities to managers on subjects like ability to evaluate changes around a firm, to determine and evaluate the processes of the aims of a firm, to check whether internal performance targets are achieved or not and sustaining the continuation of improvements, in the final analysis. Four dimensions of BSC and derived indicators have created these opportunities. These four dimensions or perspectives will be explained briefiy. Financial performance measures; they are the focal point for the target and measures of other three perspectives in BSC. In this sense, financial performance measures can be considered as the outcome of operational activities (Rao: 2000). Therefore, each selected measure should be a part of the cause-and-effect relationship leading to an improvement in financial performance. These measures are items such as sales amount, market share, new customers, new markets, cash now, return on capital, etc. (Morrow, 1992: 145). Customer performance measures; today, being customer-focused is one of important items for firms, so at the same time its a kind of important expression of vision and mission. In this sense specific measures reflecting critical factors like time, quality, cost should be determined. Customer satisfaction, improving costumer loyalty, gaining new customers, customer profitability, and market and customer shares in targeted scope are basic measures. Internal operation measures; these are obtained from critical success factors which are effective on providing shareholder and customer satisfaction by focusing on work processes and activities (Keegan, Eiler and The Effect of Competition, Just In Time Production and Total Quality 41 Management on the Use of Multiple Performance Measures: An Empirical Study Jones, 1989: 45-49). But, the most important point here is that to create value for both customer and shareholder, it is necessary to define and measure an exact intemal operation value chain at the designing and development stage, production and commercializing (Eker, 2004:128). These measures include the duration of presenting new product to the market, number of new products, sales percentage of new products, rate of defect, duration of production, production cost, just-in-time delivery, etc. Leaming and growth measures; making real the ideals related with financial, customer and intemal operations highly depend on the learning and growth capacity of an organization. In leaming and growth measures especially, it investigates and measures what sort of methods to be followed for increasing the growth of intemal operation methods, which measures are employee satisfaction, productivity and sustainability ofthe employees. 2. 2. 2. Market Competition One of the distinguishing factors of the use of multiple performance measures by the firms is the competition environment in the market. As the market competition increases, the firms are likely to need multidimensional performance measurement system more than before in rder not to lose their power and market share. Also, the measures included in multidimensional performance measurement system (BSC) are known to increase the level of competitiveness by monitoring the static and dynamic capabilities of the firms (Hoque, Mia and Alam, 2001: 26). If its considered that the world has become a single market in global scale, in such a condition, its necessary for a firm to have the capability of offering speedy customer service (reliability), high quality and low cost, different and new product/service in order to be dominant in its own sector. Furthermore, all these need to be supported by total and coordinated organization efforts and also by performance measurement systems serving the same objectives within the organization. BSC is not only satisfied with following the financial performance of the firm, but it could also be functional by monitoring non-financial performances like customer satisfaction, renewal via quality production, which are essential to sustaining the competitive advantage (Otiey, 1999: 363-382; Howell and Soucy, 1987: 27; Trussel and Bitnet, 1998:441). 2 Melek Eker Fikri Pala 2. 2. 3 Just-In-Time Production It is possible to observe that traditional performance measurement system is inconsistent with JIT system benefiting from technological innovations at a maximum level and also that it prevents or hides broadbased effectiveness of new production methods. In this sense, the restrictions of traditional measurement system in JIT environment might be listed as follows: Continuous development in produc tion process is basic element in JIT manufacturing environment. To reach this aim easily, its intended to make flow of production possible with minimal parties and decreasing stock levels to a minimum. Yet, production and productivity measures of traditional understanding have reported that the productivity is low when small-lot production is made (Drury, 1990: 40-41). For this reason, traditional accounting system suggests increasing batch capacity rather than decreasing lot size, which leads to raising stock levels, long supply process, ihcreasing cost and declining customer satisfaction (DonoVah, 2-3; Mcnair, Lynch and Cross, 1990: 29). As in standard costing, appropriate operational control of traditional accounting system cannot be carried out in todays production environment (Allott, 2000: 54-56; Cheatham and Cheatham: 1996; Ezzamel, 1992: 117). Besides, due to the reliability and consistency of manufacturing processes in JIT environment, deviations do not exist or exist in quite low level and it also leads to less use of deviation analyses. JIT manufacturing system changes will bring about changes in information requirements (Upton, 1998:110). As it is known, normally traditional performance reporting is prepared monthly or weekly and cannot detect on time real reasons of processes that are not realized as expected. Yet, in JIT production system there is a possibility of short production cycle, so it requires information for the problems coming out in accordance with one-day or real time principal. In current production environment, direct labor cost is between 5%15% of total product cost. In this sense, traditional accounting system is likely to exaggerate the importance of labor cost and The Effect of Competition, Just In Time Production and Total Quality 43 Management on the Use of Multiple Performance Measures: An Empirical Study ignores the control and measurement methods of increasing general production costs. Another limitation of traditional accounting system is its failure in reporting the criteria such as quality, reliability, supply duration, flexibility, and customer satisfaction (Johnson, 1990:63). As a result of this, management and the employees are encouraged to focus only on costs rather than those critical success factors. Consequently, JIT production system is in need of a performance measurement system that will follow, measure and report critical success factors such as production and delivery time, quality, flexibility, cost efficiency and continuous development(Fullerton, 2003: 40; Mcllhattan, 1987: 25-26). In current environment, which is dominated by a flexible, dynamic, and process-oriented roduction understanding, JIT production system cannot perform its functions including result-focused traditional performance measurement system, measuring, evaluating and reporting of operational actions in order to be successful. Therefore, performance measurement system of a corporate using Just-in-time production system should support basic variations such as increasing product or service quality, continuous development and reducing the losses (Hendricks, 1994: 27). BSC meets the new management requirements because of its following qualifications: (1) focusing long term perspective instead of short term perspective; (2) performing data both in fmancial and non-financial/operational dimensions; (3) being timely and ready for usage instead of being prepared for terms; (4) being easy to understand and apply; (5) immediately answering/adapting the changes in the production process, (6) transforming the firm strategy to operational measures (Santari, 1987: 27). 2. 2. Total Quality Management TQM does produce value, through a variety of benefits: improved understanding of customers needs; improved customer satisfaction; improved intemal communication; better problem-solving; greater employee commitment and motivation; stronger relationships with suppliers; fewer errors; and reduced waste (Powell, 1995: 15-37). In order to get this value and to ensure the success of the system, the features of the performance measurement system of the businesses applyi ng the system should be: (Kaydos, 1999: 150) 44 Melek Eker Fikri Pala to focus the attention of managers on the satisfaction of foreign and domestic customers to produce assumptions on strategy to detect the unforeseen quality and wasting problems to provide objective information for priority-setting to receive support from managers and employees for further changes when they see concrete improvements in performance to increase the loyalty of employees by encouraging managers to delegate their authority Taking all these features into account, it is seen that BSC is in compliance with what is expected from a performance measurement system in the context of TQM. Because there is a reciprocal relationship between BSC and TQM as the former makes the latter more efficient through its applications. Accordingly, BSC makes TQM more efficient in the following matters: (Kaplan and Norton, 2001:376) Firstly, it complements the intemal processes where the progressive elements with critical importance for the strategic success are found. TQM is implemented in many businesses; however, the effects of its implementation can be determined neither in financial terms nor in terms of the performance with respect to the customer, and the implementation remains limited to the department or unit level. BSC, on the other hand, identifies the processes that are important for the strategy as well as the priorities in these processes. Moreover, it also determines whether the process developments focus on such important issues as cost-cutting, quality improvement and shortening of production cycle, or not. Secondly, BSC identifies the non-financial quality measures regarding the quality costs and prepares reports on a daily or real-time basis, and it can find out the real causes of the unfulfilled transactions (Sinclair and Zairi, 2000: 156-157). Therefore, BSC proves to be a crucial resource, which provides continuous and acctirate feedback to managers and employees, in meeting customer expectations, improvement of processes and reporting of quality performance measures. Thirdly, BSC urges managers to develop business processes in order to achieve successful outputs for customers and shareholders, and to create value. Within this framework, a perpetual relationship between quality and the financial outputs is made possible. Based on the above studies, we posit that increasing application of JIT and TQM, as well as intense market competition, would prompt greater The Effect of Competition, Just In Time Production and Total Quality 45 Management on the Use of Multiple Performance Measures: An Empirical Study multiple performance measures usage. Therefore, the following hypotheses are proposed: Hypothesis 1 : The greater emphasis on the use of multidimensional performance measurements by the management will be associated with a more intensely competitive environment. Hypothesis 2: The greater emphasis on the use of multidimensional performance measurements by the management will be related to a greater application of JIT. Hypothesis 3: The greater emphasis on the use of multidimensional performance measurements by the management will be associated with a greater application of TQM. 3. Research Methodology 3. 1. The Nature of the Research This study depends on the data related to 430 manufacture firms of the top 500 in Turkey. The data forms were delivered between the dates of 01 January- 30 June by post and mailed to the top managers (general manager or vice general managers) of manufacture firms that participated in this study. The survey forms return rate was 28. 3% (122). The manufacturing activity of the firms is depicted in Table 1. 6 Melek Eker Fikri Pala Table 1: Profile of respondents by manufacturing activity Manufacturing Activity Frequency 25 15 1 10 12 6 6 13 7 20 1 6 121 Percent 20,5 12,3 ,8 8,2 9,8 4,9 4,9 10,7 5,7 16,4 ,8 4,9 99,2 Valid Percent 20,7 12,4 ,8 8,3 . 9,1 5,0 5,0 10,7 Cumulative Percent 20,7 33,1 33,9 42,1 51,2 56,2 61,2 71,9 77,7 94,2 95,0 100,0 1 Textile, clothing and foo twear 2 Food and allied products 3 Drink and tobacco 4 Construction 5 Petroleum and chemicals 6 Plastic products 7 Metal Wares 8 Machinery 9 Wood and paper products 10 Automotive and spare part 11 Glass products 12 Electronic products TOTAL 5,8 6,5 ,8 5,0 100,0 As can be seen from the table, manufacturing activity distribution was realised in the following order, 20,7% textile, clothing and footwear, 16,5% automotive and spare parts, 12,4% food and allied products and 10. 7% machinery sector. 3. 2. Data Collection Tools The survey form, which was developed to collect the research data, was comprised of three parts. In the first part, it is aimed at defining the usage level of JIT and TQM practices. Within this framework, participants were requested to designate their choose not used, partly used, used, rather used and used at high level. The second part consisted of 5 questions, which were directed at defining the firms market situation and the competition level in the market. Within this framework, participants were requested to mark each term very bad, bad, average, good and very good for each denotation which occurred between 1 and 5. In the last section, the diversity of measurement is measured with an adapted version of the instrument used by Hoque and James (2000) and Hoque et al. (2001). The aforementioned BSC approach was comprised of four sub-dimensions, such as financial, customer, intemal business processes and leaming and growth and a total of 20 items. The participants were requested to designate whether their firms used the aforementioned measures. For this, the likert scale, in which the choices between 1 and 5 were not used at all. The Effect of Competition, Just In Time Production and Total Quality 47 Management on the Use of Multiple Performance Measures: An Empirical Study partly used, used, used rather a lot, and used very much. The reliability analysis was performed to test the consistency of BSC s survey results. The alpha coefficient was found to be 90%. No variable was negatively associated with the . total correlation. The data showed strong internal consistency. 3. 3. Data Analysis In this study, the data was entered into SPSS 13 for data analysis. Factor analysis, descriptive statistics, multi- correlation and multinomial logistic regression analysis were performed. 3. 3. 1 Factor Analysis Exploratory factor analysis was used to designate the factors which form the sub dimensions of BSC. Firstly, KMO (Kaiser-Meyer-Olkin) sampling adequacy measure was calculated for determining the convenience of data for factor analysis. KMO varies from 0 to 1. This measure shows that sampling is convenient for factor analysis when it is close to 1 and it shows that sampling is not convenient for factor analysis when it is under 0. 50. In the analysis the KMO sampling sufficiency has been calculated as 0. 803, this shows that this sampling has sufficient size. We use basic components and varimax rotating technique to carry out factor analysis. The obtained factor analysis results were examined, because the factor burden related to the market share measure in the second and third factors and the factor burden related to the employees satisfaction measure in the second and fourth factors that have almost the same burdens, analysis has been done again excluding these two variables. At the end of the analysis 5 factors have been determined whose Eigen value is above 1. Five factors explained 69. 857 % of the total variance. Factor 1 explained most proportion of the total variance (17. 098 %) and consisted of variables which contained internal business processes measures. Factor 2 explained 14. 381% of the total variance and consisted of variables, which were related to customer performance measures-I. Factor 3 explained . 13. 582% of the total variance and consisted of variables, which were related to financial performance measures. Factor 4 explained 13. 495% of the total variance and factor 5 explained 11. 301% of the total variance and they consisted of variables, which were related to learning and 48 Melek Eker Fikri Pala growth measures and customer performance measures-II, respectively. Table 2 shows groups of questions. Table 2: Rotated Component Matrix Factor Factor Factor Performance Measurement 1 3 2 Items Internal Business Measures ,839 Rate of material scrap loss Ratio of good output to total ,748 output at each Production process ,667 Manufacturing lead time ,613 Materials efficiency variance ,546 Labour efficiency variance Customer Performance Measures-I ,745 Customer response time ,694 Number of warranty claims ,662 On-time delivery ,609 Survey of customer satisfaction ,562 Number of customer complains Financial Performance Measures ,873 Sales growth ,827 Operating income ,576 Return-on-investment Learning and Growth Measures Number of new product launches Time-to-market new products Number of new patents Customer Performance Measures -II Percentage of shipments returned Due to poor quality Number of overdue deliveries Factor 4 Factor 5 ,831 ,824 ,736 ,774 ,742 The analysis carried out on performance measures was also performed respectively on competitive factors. According to this, alpha co efficient was calculated as 58% for competitive factors. KMO sampling adequacy measure was 0,561 therefore sampling was convenient for factor The Effect of Competition, Just In Time Production and Total Quality 49 Management on the Use of Multiple Performance Measures: An Empirical Study analysis. Also, significant level of Bartlett test was calculated as 0,00. Consequently, both tests showed that factor analysis could be applied to data. In the factor analysis, principal component analysis and none rotation technique were used. At the end of the analysis 2 factors have been determined which have Eigen value above 1. Two factors explained 65. 972% of the total variance. Factor 1 explained most proportion of the total variance 38. 186% and Factor 2 explained 27. 786% of the total variance. In the results of factor analysis the first factor is named firms market situation and the second factor as market competitive density level. Table 3: Rotated Component Matrix 1. Factor ,867 ,824 ,683 ,820 ,810 2. Factor Competition for Marketing Competition for Market Share Competition for New Product Development Competitors Power Number of Competitors in the Industry 3. 3. 2. Descriptive Statistics related to the Variables and Correlation Analysis In Table 4, the BSC and sub-dimension averages, minimum, maximum values and standard deviations of the firms are presented. The firms usage points of overall multidimensional performance measures are between 38 and 100; the average usage point was 74. 751. When the BSC subdimensions were analysed, the financial measures were between 6 and 15 and the average was 12. 8525. The customer measures usage points were between 17 and 40 and the average was 30. 5656. The intemal business process measures usage points varied between 7 and 25 and the average was 18. 9174. The learning and growth measures usage points were between 4 and 20 and the average was 12. 6148. These average figures show us that the firms use the financial performance measures (86%), customer performance measures (76%), and intemal business processes measures (75%) at a rather high level and teaming and growth measures at a medium level. 50 Melek Eker Fikri Pala Table 4 : BSC and Sub Dimensions Averages, Minimum, Maximum Values Mean Standard Cronbach N Theoretical Minimum Maximum No deviation alpha of range items ,572 18,3639 2,40303 2,2 21,2 Competition 122 5 5-25 Factors 3,57 1,191 1 1 5 JIT 117 1-5 1,144 1 1 4,08 TQM 121 1-5 5 74,7951 12,64842 ,905 20-100 38 100 Overall 122 20 Multidimensional Performance Measures ,762 15 12,8525 2,07970 122 3 3-15 6 Financial Performance Measures 40 30,5656 5,46361 ,787 Customer 122 8-40 8 17 Performance Measures 18,9174 4,23396 ,849 Intemal Business 121 5-25 25 5 7 Measures 4 122 4 20 12,6148 3,88352 ,813 Learning and 4-20 Growth Measures Variable Table 5 shows a correlation matrix for all variables. As proposed, the overall use of multiple performance measures is positively and significantly correlated with firms market situation, market competitive density level, JIT and TQM practices and the correlations were 0,425 (p

The Young Offenders Act essays

The Young Offenders Act essays This essay was written to show the advantages and disadvantages of the Young Offenders Act over the previous Juvenile Delinquents Act. Also it should give a theoretical understanding of the current Canadian Juvenile-Justice system, the act and it's implications and the effects of the young offenders needs and mental health on the outcome of the trials. In the interest of society the young offenders act was brought forth on april second 1984. This act was created to ensure the rights and the needs of a young person. Alan W. Leshied says "On one hand the justice and legal objectives of the act are being effectively realized while on the other hand the needs and treatment aspects of it leave much to be desired." The research of the Young offenders act is still ongoing but Leshied says that it is becoming clear that the custody positions have been in dispute since the act came into effect. The old Juvenile delinquency act states in section 38 "The care and custody and discipline of a juvenile delinquent shall approximate as nearly as maybe that which should be given by his parents, and... as far as practability every juvenile delinquent shall be treated, not as a criminal, but as a misguided and misdirected child . . . needing aid, encouragement, help and assistance."(Page 72) If a youth is close to the adult age of 18 years they could be transfered to the adult justice system. This means that they would be given the same sentences as an adult including and up to life in prison. Many people have tried to correct this problem that they see as a weakness. Yet, so far their attempts have failed. Another weakness they find, is that the courts are expensive and unsatisfactory methods of dealing with crime that is not very serious. Before the fabrication of legal aid most young offenders were ...

The Science Behind Fog

The Science Behind Fog Fog is considered a low cloud that is either close to ground level or in contact with it. As such, it is made up of water droplets that are in the air like a cloud. Unlike a cloud, however, the water vapor in fog comes from sources close to the fog like a large water body or a moist ground. For example, fog usually forms over the city of San Francisco, California during the summer months and the moisture for that fog is produced by the cool ocean waters that are nearby. By contrast, moisture in a cloud is gathered from large distances that are not necessarily near where the cloud forms. Formation of Fog Like a cloud, fog forms when water evaporates from a surface or is added to the air. This evaporation can be from the ocean or another body of water or moist ground like a marsh or a farm field, depending on the type and location of the fog. As the water begins to evaporate from these sources and turn into water vapor it rises into the air. As the water vapor rises, it bonds with aerosols called ​condensation nuclei (i.e. small dust particles in the air) to form water droplets. These droplets then condense to form fog when the process occurs close to the ground. There are, however, several conditions that need to first occur before the process of fog formation can be complete. Fog usually develops when relative humidity is near 100% and when the air temperature and dew point temperature are close to one another or less than 4ËšF (2.5ËšC). When air reaches 100% relative humidity and its dew point  it is said to be saturated and can thus hold no more water vapor. As a result, the water vapor condenses to form water droplets and fog. Types of Fog There are various types of fog that are categorized based on how they form. The two main types though are radiation fog and advection fog. According to the National Weather Service, radiation fog forms at night in areas with clear skies and calm winds. It is caused by the rapid loss of heat from the Earths surface at night after it was gathered during the day. As the Earths surface cools, a layer of moist air develops near the ground. Over time the relative humidity near the ground will reach 100% and fog, sometimes very dense forms. Radiation fog is common in valleys and often when the fog forms it remains for long periods when winds are calm. This is a common pattern seen in Californias Central Valley. Another major type of fog is advection fog. This type of fog is caused by the movement of moist warm over a cool surface like the ocean. Advection fog is common in San Francisco and it forms in the summer when warm air from the Central Valley moves out of the valley at night and over the cooler air over the San Francisco Bay. As this process occurs, the water vapor in the warm air condenses and forms fog. Other types of fog identified by the National Weather Service include upslope fog, ice fog, freezing fog,​ and evaporation fog. Upslope fog occurs when warm moist air is pushed up a mountain to a place where the air is cooler, causing it to reach saturation and the water vapor to condense to form fog. Ice fog develops in the Arctic or Polar air masses where the air temperature is below freezing and is composed of ice crystals suspended in the air. Freezing fog forms when the water droplets in the air mass become supercooled. These drops remain liquid in the fog and immediately freeze if they come into contact with a surface. Finally, evaporation fog forms when large amounts of water vapor are added to the air through evaporation and mixes with cool, dry air to form fog. Foggy Locations Because certain conditions must be met for the fog to form, it does not occur everywhere, however, ​there are some locations where fog is very common. The San Francisco Bay Area and Central Valley in California are two such places, but the foggiest place in the world is near Newfoundland. Near Grand Banks, Newfoundland a cold ocean current, the Labrador Current, meets the warm Gulf Stream and fog develops as the cold air causes the water vapor in the moist air to condense and form fog. In addition, southern Europe and places like Ireland are foggy as is Argentina, the Pacific Northwest, and coastal Chile.

Medical seizures Essay Example | Topics and Well Written Essays - 1000 words

Medical seizures - Essay Example Seizures are temporary phenomena; some individuals have got repeated episodes of seizures. These repeated episodes have been given a medical name of epilepsy. Individuals with seizures may present in different ways depending upon the level of and number of neurons involved. In a number of individuals, it is just a jerky movement involving one or more limbs or other areas with conscious level maintained while in others the movements may involve whole body and individual may loose her/his consciousness. So, seizures have been classified according to the level of complexity and consciousness. When some parts of the body are involved, seizures are called as partial otherwise they are generalized. If consciousness is lost which usually occurs with generalized seizures then these are called complex, if consciousness is present, these are simple seizures. Generalized seizures may affect body in a variety of ways and they have been further divided based on the types of movements they are pro ducing: absence, myoclonic, clonic and atonic seizures. In contrast, there are some situations in which these seizures may be single, for example: trauma or head injury, high grade fever especially in children, a symptom of other diseases including tumor and reactions to some drugs. At times, a partial seizure may spread in the brain when it is called secondary generalization. A persistent state of seizures for more than 5 minutes or by other doctors for 30 minutes is called status epilepticus. It is a real emergency state, which needs urgent measures to bring the patient out of the condition (Wikipedia, Carpenter ch:125). Current Treatment Treatment is required when seizures become recurrent. If the cause of the seizure is removed then there is no need of use of epileptic drugs; this occurs in situations like febrile conditions in children or seizures due to electrolytes imbalance. Main purpose of these drugs is to stop seizures because in addition to the direct effects of seizures there are chances of more severe complications, for example accidents resulting from seizures while driving, to arise if these seizures are not treated effectively. The criteria for starting anti-epileptic drugs are: evidence of focal neurological lesion based on clinical examination, radiological findings or EEG interpretations. If seizures occur once and there are no other findings especially in adults then there is no need of epileptic drugs. These drugs have been classified and prioritised for various types of seizures: Partial - simple and complex: carbamazepin,phenytoin, valproate, gabapentin, lamotrigine, topiramate Secondary generalized: carbamazepin, phenytoin, valproate, gabapentin, lamotrigine, topiramate Primary Generalized - absence: ethosuximide, valproate, lamotrigine Primary Generalized - tonic-clonic: valproate, carbamazepin, phenytoin, lamotrigine Primary Generalized - myoclonic and tonic: valproate, clonazepam Some of the patients do not get benefits from the medical treatment. The only option left for them is surgical resection of the hyperactive area in the brain. This is a very sophisticated procedure, which requires exact location of the area of brain with abnormal hyper excitability (Carpenter ch:125). Treatment of choice for status epilepticus has been diazepam even in the presence

Pseudomonas Essay Example | Topics and Well Written Essays - 500 words

Pseudomonas - Essay Example The problems associated with this type of transient bacteria include infections such as Pseudomonas infections, especially those caused by Pseudomonas aeruginosa. The bacteria also cause infections of the blood, pneumonia and post surgery infections, which may cause death. In addition, mild infections occur, especially after exposure to water, such as infections of the ear and the eye in children, skin rashes. These infections occur after exposure to water, which is inadequately chlorinated (CDC, 2013). The methods that are used to effectively remove this type of transient bacteria from hands include effective hand washing using soap and water because they act as emulsifying agents that dissolve grease and oils on the hands to remove transient bacteria. One should also dry hands after washing them with proper towels. Alternatively, alcohol-based instant hand sanitizers may be used after hand washing. Antiseptic lotions or creams soaps can be used when cleaning hands. Antiseptic soaps or detergents remove surface bacteria, and may have a residual effect while instant hand sanitizers do not have a residual effect (Marriott & Gravani, 2006). Aseptic hand wash and hand sanitizers can be used to prevent the spread of transient bacteria. Aseptic hand wash method involves the use of antiseptic soap and special techniques to cleanse the hands and forearms aseptically. It reduces bioload of bacteria on the skin surface to prevent transmission to the patient (Mulder, 1999). Hand sanitizers are made of chemicals such as alcohol. These chemicals kill pathogens, thus preventing disease transmission. Some of the diseases that are caused by bacteria include Acne, Pneumonia, Whooping Cough and Tuberculosis. Viruses cause mumps, AIDS and yellow fever while parasites cause diseases like amebiasis. Fungi cause candidemia while protozoa amebiasis. Among these diseases, AIDS can be detected with approved CLIA-waved testing (Parmet,

Rohingya Refugees Health Problems and Health Seeking

Rohingya Refugees Health Problems and Health Seeking Title: HEALTH PROBLEMS HEALTH CARE SEEKING BEHAVIOR OF ROHINGYA REFUGEES Abstract Background:  Rohingya refugees are the most vulnerable group due to lack of health care system, personal hygiene, shelter, sanitation and violence. In this study the main aim to find out the health problems health care seeking behavior of rohingya refugee peoples, to identify the socio-demographic information for such exposure group in relation to age, sex, occupation, living areas, to explore the patients physical, emotional, perceptions, attitudes and environmental health problems and to bring out health care seeking behavior of refugees. Methodology: This was a cross-sectional study. Total 149 samples were selected conveniently for this study from the refugee camps. Data was collected by using mixed type of questionnaire. Descriptive statistic was used for data analysis which focused through table, pie chart and bar chart. Results: The finding of the study showed that 45.6% participants had multiple problems followed by 16.8% participants had other specific problems like muscul oskeletal pain, visual problems and peptic ulcer. Urinary tract infection is the leading individual health problems, among the participants 11.4% had this problem, 10.7% participants had hypertension, 6% had respiratory tract infection, 3.4% had nutrition deficiency, 4.75% had diabetes mellitus and 1.3% had sanitation hygiene problems. Among the participants the middle age people had mostly health problems, 68.4% age range between 15-59 years. The study showed that, only 16.1% participants were satisfied with the quality of service they received, among the participants 37.6% participants said that they were need better services such as more laboratory test, radiological imaging, more medicine more doctors. Conclusion:  It is clear that refugee peoples suffered from lots of health problems, because there living condition, environmental situation not similar like an independent nations, from being their expectation there was not sufficient enough medicine other services were avai lable, they deserve better services. Keywords:Health problems, Rohingya refugee, Health seeking behaviour, Bangladesh. Introduction: Rohingyas are an ethnic, linguistic and religious minority group of Northern Rakhine State (NRS) of Myanmar. Myanmar government categorized them as illegal immigrants from Bangladesh and excluded them from citizenship and basic human rights (1). From 1991-1992 a mass exodus of more than 250,000 Rohingya refugees fled persecution in the Union of Myanmar and arrived in Bangladesh, living in temporary camps and completely dependent on outside support from the United Nations (UN), the Government of Bangladesh (GOB) and numerous non-governmental organizations (NGOs) (2,3,4). Globally, the total population of refugees is about 9.9 million. The general health status of refugees in various countries is reported to be poor with malnutrition being the major health problem due to lack of access to sufficient food and nutrient intakes. Other health problems among refugees include mental illnesses, intestinal parasites, hepatitis B, tuberculosis, sexually transmitted diseases, HIV/ AIDS, malaria and anemia (2, 5). Infants and young children are often the earliest and most frequent victims of violence, disease, and malnutrition which accompany population displacement and refugee outflows. Rohingyas are spending long period of time in Bangladesh as refugees My life is over. All I want is for my children to have a chance at a better life. Two generations of the Rohingya have said this. The vast majority of their community suffers the same neglect and lack of opportunity that their parents faced at present, there are no specific services available to refugee children with special needs or disabilities. With regards to cases of sexual exploitation of children, there have been reports and cases of refugee minors (females) being harassed, abused or raped by local villagers. A survey found that out of 508 children of under 5 years of age, 65% were anemic and therefore, chronically malnourished (4, 6, 7). Rohingya is a generic term referring to the Sunni Muslim inhabitants of Arakan , the historical name of a Myanmar border region which has a long history of isolation from the rest of the country. It is thought that the Rohingya are of mixed ancestry, tracing their origins both to outsiders (Arabs, Moors, Turks, Persians, Moguls and Pathans) and to local Bengali and Rakhine. They speak a version of Chittagonian, a regional dialect of Bengali which is also used extensively throughout south-eastern Bangladesh (8). Syrian refugees are in need of basic services such as shelter, nutrition, education, medication and health care services. Approximately 1.4 million Syrian refugees are children and the United Nations Childrens Fund has reported that these children are at risk of being a lost generation. Syrian refugees are enduring daily challenges to physical and mental survival. In addition to the extreme needs for physical and nutritional interventions, mental health professionals recognize the urgent need for counseling services based on widespread documented report s of refugees (9, 10). Three meals a day are served in camps, but refugees are not satisfied with the quality of what is served. There are occasional cases of food intoxication. Refugees are not allowed to cook their food in tents because of the risk of fire. Out of camps, the nutritional status of refugees is mostly bad, only limited number of them can have 3 meals a day. In general, they feed on bread and vegetables. A survey conducted at a provincial centre found, among women in the age group 15-49, iron (by 50%) and B12 vitamin deficiency (by 46%) (11). Some of the countries in the region (notably Pakistan, Bangladesh, and Nepal) are host to refugee and displaced populations from neighbouring states, a circumstance that in itself merits attention since it has the potential to cause major political unrest (12). Bangladesh is surrounded by a high HIV prevalence neighboring country at southern part, Myanmar. Teknaf is a small town in the Chittagong Division at the southern tip of B angladesh, separated from Myanmar on the eastern side by the river Naf. This border area is unique for many reasons, including the history of the tens of thousands of refugees that are currently living in squalid conditions on the Bangladeshi side (13). A 19 years old refugee at Nayapara camp sayed that I was born in Burma, but the Burmese government says I dont belong there. I grew up in Bangladesh, but the Bangladesh government says I cannot stay here. As a Rohingya, I feel I am caught between a crocodile and a snake (14). The population of Bangladesh is growing at approximately the rate of l.59 percent per annum the percentage of urban population is 27% while that of rural is 73%. Bangladeshs population growth rate was among the highest in the world in the 1960s and 1970s, when the country swelled from 65 to 110 million (15). The Rohingya refugee problem has been a longstanding issue and involves the question of an ethnic minoritys identity. The Rohingyas are an ethnic minority group in the northern Arakan (currently Rakhine) state of Myanmar. Commonly known as Muslim Arakanese, the Rohingyas trace their historical roots in the Arakan region from the eleventh century to 1962 (16). Hundreds more Rohingya have been the victims of torture, arbitrary detention, rape, and other forms of serious physical and mental harm. Whether confined to the three townships in northern Rakhine State or to one of dozens of internally displaced persons camps throughout the state, Rohingya have been deprived of freedom of movement and access to food, clean drinking water, sanitation, medical care, work opportunities, and education (17). There is no domestic law in Bangladesh to regulate the administration of refugee affairs or to guarantee refugee rights. New refugees have difficulties accessing health care, their health proble ms may worsen with time.5 Social isolation and disconnection have been shown to contribute to premature death among members of isolated communities (18). In refugee camps medical services are mostly crippled, there is no examination and with the exception of some community health centers (RHU) there is no pregnant women and infant monitoring either, since family planning services for refugees are not available, there are unwanted births and increase in infant mortality, women additionally face risks of gender discrimination, sexual violence, early marriage and miscarriage and birth complications (19). The government of Bangladesh welcomed the Rohingyas and made substantial efforts to accommodate them but the GOB had clearly maintained from the beginning that asylum for the refugees was temporary and encouraged their immediate return, of the original 20 refugee camps that were constructed in 1992 in south -western Bangladesh, among them only two are remain near Nayapara refugee camp at Teknaf and Kutupalong refugee camp near Ukhia, giving shelter to 21,621 refugees, Kutupalong camp officially houses 8,216 refugees and Nayapara 13,405 a s of December 2001(20). Methods: Study Place: The study was conducted at the refugee camp in Coxs Bazar in Bangladesh. Data Collection, Management Analysis The data was collect from the refugee camp in Coxs Bazar in Bangladesh through a standard mixed type questionnaire. The study was conducted at the Nayapara refugee camp at teknaf in Coxs Bazar. About 149 samples were collected from July 2016 to October 2016 in Nayapara refugee camp. After collecting the data analysis is done by SPSS (Statistical Package of Social Science) software version 16.0. Ethical consideration A research proposal was submitted to the public health department of ASA University for approval and the proposal was approved by the faculty members and gave permission initially from the supervisor of the research project and from the academic coordinator before conducting the study. The necessary information has been approved by the ethical committee of public health department and was permitted to do this research. Also the necessary permission was taken from the Camp In charge (CIC), health coordinator medical team leader of the refugee health unit (RHU). The participants were explained about the purpose and goal of the study before collecting data from the participants. Pseudonyms were used in the notes, transcripts and throughout the study. It was ensured to the participants that the entire field notes, transcripts and all the necessary information was kept in a locker to maintain confidentiality and all information was destroyed after completion of the study. The participant s were also assured that their comments will not affect them about any bad thing. Result: Table 1: Distribution of demographic variables among the respondents (n=149) Demographic Variable Gender Gender Frequency Percent Male Female 67 82 45 55 Age Age Frequency Percent 01-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 101-110 06 10 14 35 29 23 18 10 2 1 1 4.0 6.7 9.3 23.5 19.5 15.4 12.1 6.7 1.4 0.7 0.7 Educational Status Educational level Frequency Percent Illiterate Literate 112 37 75.2 24.8 Marital Status Marital Status Frequency Percent Married Unmarried Widow 105 20 24 70.5 13.4 16.1 Occupations of the Participants Occupation Frequency Percent Fisher Man 1 .7 Agriculture 3 2.0 Driver 2 1.3 Day laborer 11 7.4 unemployed 42 28.2 Housewife 61 40.9 Student 13 8.7 other (Specify) 16 10.7 Among 149 participants 82 (55%) were female and 67 (45%) were male. Female were predominantly higher than male. Mean age of the participants was 45.52 ( ±19.28) years, mode was 35. The range is 100 with minimum age 02 years and maximum 102 years. Among the participants the higher numbers of the participants were at the age of 35 years and the numbers were 13 (8.7%). The number of à ¢Ã¢â‚¬ °Ã‚ ¤ 18 years were 15 (10.1%), à ¢Ã¢â‚¬ °Ã‚ ¤60 years were 102 (68.4%) and à ¢Ã¢â‚¬ °Ã‚ ¥60 were 32 (21.5%). Majority of the participants were illiterate the numbers were 112 (75.2%) and 37 (24.8%) participants were literate those who complete their primary education. Majority of the participants were married the numbers were 105 (70.5%) followed by those who are widow the numbers were 24 (16.1%) and 20 (13.4%) participants were married. Nuclear family were 76 (51%) whereas 72 (49.0%) participants were in extended family. Among total particepants housewife were 61(40.9%), Unemployed were 42 (28.2%), others 16 (10.7%), student 13(8.7%), Day labour 11(7.4%), Agriculture 3(2%) Driver2 (1.3%) and Fisher man1 (.7%). Figure -1: Health problems among the participants (n=149)    In this study 149 participants are gathered as sample, where there mean is 7.39 with standard deviation ( ± 3.28), median 9.0 and the mode was 10. Out of the 149 participants, 68 participants (45.6%) were had multiple problems followed by those had other specific problems 25 participants (16.8%) like musculoskeletal pain, visual problems and peptic ulcer. Urinary tract infection is the leading individual health problems among 17 participants (11.4%) had this problem, 16 (10.7%) participants had hypertension, 9 (6%) had respiratory tract infection, 5 (3.4%) had nutrition deficiency, 7 (4.75%) had diabetes mellitus and 2 (1.3%) had sanitation hygiene problems. Table 2: Type of health care and health care receive organization (n=149) Type of health care Frequency Percentage Medicine Counseling Laboratory test Referral Nothing Multiple Services 82 2 5 5 6 49 55.0 1.3 3.4 3.4 4.0 32.9 Health care receive organization Frequency Percentage Refugee Health unit (RHU) 75 50.3 Handicap International (HI) 1 0.7 Others 6 4.0 Multiple Organizations (RHU, HI, ACF, RTMI) 67 45 In this study among the 149 participants, 82 (55%) participants took medicine from RHU, 49 (32.9%) received multiple services like medicine, referral, laboratory test others, 5 (3.4%) received both laboratory test referral to other organizations 6 (4%) participants said that they didnt received any treatment from health center And majority of the participants said that they receive health services from RHU, the number was 75 (50.3%) followed by they received health services from multiple organizations like RHU, HI, ACF RTMI and 6 (4%) said that they receive services from others like MSF, health complexes. Table 3: Health care services that meet the demands and the reason for not fulfill the demands (n=149) Health care services that meet the demands Frequency Percent Yes 17 11.4 No 45 30.2 Sometimes 87 58.4 Reason that not fulfill the demands Frequency Percent Not enough medicine supply in the camps 47 31.4 Narrow space in health unit 5 3.4 Lack of doctors 25 16.8 Other 5 3.4 Not enough medicine Lack of doctors 50 33.6 Among the 149 participants, only 11.4% (n=17) participants said they have enough health services to meet their needs, 58.4% (n=87) said that sometimes they have enough health services to meet their needs and 30.2% (n=45) said that they have not enough health services to meet their needs and majority of the participants said they didnt meet needs because there is a lack of medicine supply doctors in the camps the number was 50 (33.6%) and 47 (31.4%) patients said that they didnt meet needs because there is a lack of medicine supply in camps. Figure 2: Expectation among the participants (n=149) Among the 149 participants, 56 (37.6%) participants said that they were need better services, majority of the participants said that they need multiple services includes more laboratory test, radiological imaging, more medicine more doctors, 17 (11.4%) participants said that they need more medicine and 3 (2%) said that they require more referral, laboratory test radiological imaging. Figure 3: Satisfaction level among the participants (n=149) Among the 149 participants, only 16.1% (n=24) participants were satisfied with the quality of service received, 56.4% (n=84) said that they were sometimes satisfied after received services and 27.5% (n=41) said that they were not satisfied after received services. Discussion: The result of this study showed that 45.6% participants were had multiple problems followed by 16.8% participants had other specific problems like musculoskeletal pain, visual problems and peptic ulcer. Urinary tract infection is the leading individual health problems, among the participants 11.4% had this problem, 10.7% participants had hypertension, 6% had respiratory tract infection, 3.4% had nutrition deficiency, 4.75% had diabetes mellitus and 1.3% had sanitation hygiene problems during the course of the study and also in this study it was found that among the participants the mean age of the participants was 45.52 ( ±19.28) years. The range is 100 with minimum age 02 years and maximum 102 years. Among the participants the higher numbers of the participants were at the age of 35 years 8.7%. The numbers of à ¢Ã¢â‚¬ °Ã‚ ¤ 18 years were 10.1%, à ¢Ã¢â‚¬ °Ã‚ ¤60 years were 68.4% and à ¢Ã¢â‚¬ °Ã‚ ¥60 were 21.5%, the middle age people had mostly health problems. ÃÆ'-nen C e t al stated that health problems among refugees were frequently seen mostly at the early childhood in adult aged problems, a community based study was carried out by Turkish medical association stated that 25.0%   children had sleeping disorder at the of below 18 years 24.0% have adult persons with the same problems (22). The study showed that, majority of the participants said that they receive health services from RHU, the number was 75 (50.3%) followed by they received health services from multiple organizations like RHU, HI, ACF RTMI and 6 (4%) said that they receive services from others like MSF, health complexes. The study showed that, only 16.1% participants were satisfied with the quality of service they received, 56.4% said that they were sometimes satisfied after received services and 27.5% said that they were not satisfied after received services, Among the 149 participants, 32.9% participants said that they were not satisfied because there is a lack of medicine supply in RHU, 13.4% participants were not satisfied because there is a lack of qualified doctor in RHU 38.9% participants stated that in RHU there is a lack of budget, lack of doctor, lack of medicine supply, lack of referral to other organization in timely, not gave proper medicine treatment lack of serial maintain during medicine collection thats why they were not satisfied. Conclusion From the above discussion it can be said that Rohingya refugees are not having rights to live as human being. Considering the importance of nationality crisis of the Rohingya and problems associated with these following steps can be taken: Supplies of adequate Medicine, Increase Doctors and Nurse, Modernized treatment, Increase Childcare hospital, Decrease pollution, Mass awareness of life threatening disease. Acknowledgement: Author acknowledges the Kauvery Research Group for necessary support. Funding: Self funded Conflict of Interest: None References: Azad A, Jasmin F. Durable solutions to the protracted refugee situation: The case of Rohingyas in Bangladesh. J Indian Res. 2013;1(4):25-35. Teng TS, Zalilah MS. Nutritional status of rohingya children in kuala lumpur. Malaysian J Med Heal Sci. 2011;7(1):41-9. The Rohingya Refugee Situation in Bangladesh Evan Coutts American International School / Dhaka Senior Project 2005. 2013;1-37. UNHCR WFP. Report of the WFP-UNHCR Joint Assessment Mission, Bangladesh. Assessment. 2010;(June). Kemmer TM, Bovill ME, Kongsomboon W, Hansch SJ, Geisler KL, Cheney C, et al. Iron deficiency is unacceptably high in refugee children from Burma. J Nutr. 2003;133(12):4143-9 Department of Sociology University of Dhaka Nationality crisis and Rights of Rohingya Refugee Childrenà ¢Ã¢â€š ¬Ã‚ ¯: A Sociological Analysis of Children s Rights in Bangladesh. 2014;2011-2. UNHCR. Bangladesh: Analysis of Gaps in the Protection of Rohingya Refugees. 2007;(May). Kiragu Angela Li Rosi Tim Morris E. UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES States of denial A review of UNHCRs response to the protracted situation of stateless Rohingya refugees in Bangladesh. 2011;(December). Karaman MA, Ricard RJ. Meeting the Mental Health Needs of Syrian Refugees in Turkey. 2016;6(4):318-27. Eastern M, Studies S. OrtadoÄÅ ¸uStratejiÃÅ'†¡k AraÃ…Å ¸tirmalarMerkeziÃÅ'†¡ Center for Middle Eastern Strategic Studies. 2015. TTB. War, Migration and Health; Experience of Turkey. Red Cross. Children affected by armed conflict (CABAC). 2000;(September):48-51. Gazi R, Mercer A, Wansom T, Kabir H, Saha NC, Azim T. An assessment of vulnerability to HIV infection of boatmen in Teknaf, Bangladesh. Confl Health. 2008;2:5. Holland MSF, Fronti S, March H. 10 Years for the Rohingya Refugees in Bangladeshà ¢Ã¢â€š ¬Ã‚ ¯: Past , Present and Future. 2002;(March):1-45. Socio-economic and family planning aspects of rural people in Bangladeshà ¢Ã¢â€š ¬Ã‚ ¯: A case study of Comilla District. 2014;6(10):348580. Farzana KF. Music and Artistic Artefacts: Symbols of Rohingya Identity and Everyday Resistance in Borderlands. Austrian J South East Asian Stud [Internet]. 2011;4(2):215-36. Genocide IS, In O. Persecution of the Rohingya Muslimsà ¢Ã¢â€š ¬Ã‚ ¯: Persecution of the Rohingya Muslims. 2015;(October). Herald M. Refugee Health- Research Barriers to access to health care for newly resettled Refugee Health Research. 2006;185(11). Sharara SL, Kanj SS. War and infectious diseases: challenges of the Syrian civil war. PLoS Pathog. 2014;10(10):e1004438. Cheung S. Migration control and the solutions impasse in South and Southeast Asia: Implications from the Rohingya experience. J Refug Stud. 2012;25(1):50-70. AFAD. Population influx from Syria to Turkey life in Turkey as a Syrian guest. 2014. 2014;(1):152. ÃÆ'-nen C, Gà ¼neÃ…Å ¸ G, Tà ¼reme A, AÄÅ ¸aà § P. Depression and Anxiety Case among in Syrians that Live in a Refugee Camp. The Journal of Academic Social Science. 2014;2(6):223-30.

Safety Program Development

Effective evaluation of the safety program. Increase employers and employees' involvement in worksheet hazard assessment and control by 25%. Reduce accident rate by 25% Pages Appendix 01 â€Å"Safety & health program responsibilities† Appendix 02 â€Å"Job Safety Analysis OSHA)† 12 Appendix 03 â€Å"Sample form for correction tracking† 15 Appendix 04 â€Å"Rout cause analysis† 18 I. Chapter 01 : Management & Employee involvement The overall safety in a workplace is a responsibility of both the employers and employees. The employers need to work together with their employees toward safety improvements.Management must encourage employees' involvement in improving safety. Employees need to inform and communicate with management to what is needed to be done to improve safety. L. A. Being a visible management and taking charge Management must prove their commitment and detection toward achieving a safer environment for their workers. Management musts make thems elves visible by being out there in the working area inspecting how to improve safety. Getting where you can be seen: Be visible when taking parts in any operation in order to be more aware of the working environment and the employees.This way the workers feel appreciated and aware of management good intentions for improving safety. This method can be done formally or informally depending on management participation levels. 0 Being Accessible: Employees need to have chances to communicate to management when necessary without going through complicated procedures. The employers must give the employees an easy two way communication process for reporting situations, comments or any work related issue regarding safety. Sacrificing or cutting authority to obtain accessibility between management and workers is not necessary.Adequate accessibility is as simple as having an open door policy or skipping large formal meeting. Being an example: When rules and regulation are issue management sho uld be the first to follow it showing the workers their participation and dedication. Rules must apply to everyone in the workplace with no exception. Following rules can be as simple as wearing safety equipment, such as, safety glasses. Taking charge: Management must be clear on what is required by their workers. Rules, regulations and polices must be officially stated and written in a clear easy to understand language.In addition, rules and regulation must be enforced with no exception. Management must follow on safety processes and make sure that individuals are performing their responsibilities. Management must not neglect employee involvement regarding safety issues. Workers are the first to be exposed to potential hazards. Workers are the ones who understand what must be done to reduce hazards associate with working procedures. Management need to encourage and increase worker precipitations, making them more aware of their safety roles and expectations.Employees can help manag ement in safety issues by: Participating in Joint labor-management committees and other advisory or specific purpose committees. Conducting site inspections. Analyzing routine hazards in each step of a Job and/or a process and preparing safe work practices or controls or eliminate or reduce exposure. Developing and revising the site safety and health rules. Providing program and presentations at safety and health meetings. Training of both current and newly haired employees. Conducting accident or incident investigations.Management can increase employees' precipitation in safety by: Showing workers management's detection to make the workplace safer and healthier. Adequate leadership from management that leads to employees' commitment. Management must not refuse any worker involvement; get as many help as you can. Reward and recognize workers for their efforts and accomplishments in achieving safety or following rules. Be clear on want you need workers to do (good communication). Giv e workers the resources necessary to perform the Job with the adequate training. Show your seriousness in their work toward safety.II. Chapter 02: Supervision and responsibility to the safety program All personal and acknowledge and understand their responsibilities toward safety. The employer has a responsibility to his/her workers, making sure that they are not exposed to any potential hazards and work in a safe environment. In addition, employers must clearly communicate with workers about their responsibilities toward safety, making ere that no confusion occurs. II. A. Reviewing existing organization Management must understand and be well inform of each individual safety roles in the workplace.Employees' roles in any safety and health program can be identified by using a specific worksheet (Appendix OLL- Page 04). Organizational structure and Job titles vary from one company to the next, but they include general assignments of health responsibilities. Some examples Job titles an d job decryption include: President/owner/site manager: Establish policies – provide leadership & resources – set objectives – assign susceptibilities – hold people accountable – interact with employees – set a good example – review accident reports – provide medical programs – establish safety training programs.Safety and health director/coordinator: Maintain safety & health – familiar with safety laws – aware of all presented hazards and their preventions – evaluation of the workplace' safety – design control & preventive procedures – assist & support supervisors & employees regarding safety – communicate safety rules – review hazard reports – evaluate emergency drills. Plant superintendents/division managers/directors:Provide leadership – maintain accountability – follow up on employees' suggestions analyze the facility for potential hazards  œ follow up on periodic hazards analysis encourage reporting hazards by employees – provide the necessary PEP (Personal Protective Equipment) – maintain safety meetings – help develop emergency procedures. Supervisors: Evaluate worker's performances – encourage precipitation in safety and health programs follow up on preventive maintenance – investigate accidents – discourage short cuts follow safety rules – familiarize everyone with emergency procedures. Employees' responsibilities:Understand all safety rules – responsible for your safety and the safety of other employees – offer safety and health suggestions – get involve in safety – be aware of your responsibilities in an emergency – know where the first aid kit is – report all accidents. II. B. Assigning & determining responsibilities Corporate management roles in safety: Management is responsible to their employees for providing a working area free of any recognized hazards that can causes injury or death. Managements must establish specific goals and objectives that aim to reduce injuries caused by specific unsafe behaviors.Any safety and health program will not be able to go very far without management support. Management must hold employees accountable for their actions. This can be done by rewarding workers for following safety and taking the necessary disciplinary action when they fail to follow safety rules. Management need to obtain constant feedback for determining the effectiveness of the safety program. In addition, management must get involve in the safety program, through attention to workers, precipitation in investigations and following safety rules. The facility manager roles in safety:The facility manager must acknowledge his or her responsibilities to maintain adequate house keeping, establishing safe working procedures and making sure that employees follow them. The shape and physical condition of the facility also plays an important role in achieving safety. The facility manager must make sure that everything is in good condition, taking employees suggestions into active consideration. Workers must obtain adequate training in using PEP and machines operations. Also, the facility manger must educate the employees about the areas' safety rules and polices, making sure that they are followed correctly.The facility manager is accountable to both upper management and his or her employees. The facility mangers must also have significant involvement in communications, obtaining feedback and performing tours around the working area (formal & informal) making any necessary corrections. First line supervisor roles in safety and health: The first line supervisor has more specific goals and objectives compare to other managers. The first line supervisor has various roles regarding safety, since he or she is in first contact with the employees.He or she need to set the necessary standard or achieving safety through good housekeeping and desired safety conditions. The first line supervisor must determine the employees understanding and practice of safety rules and regulation in the work area. Effective safety training of employees and continuous observation from the first line supervisor is essential. Employees' level of safety awareness can be increased by: Setting specific working standards and following them through. Employees' precipitation in safety meeting with their superiors. Following up on safety inspection and making all the necessary corrections.Management recognizes employees' outstanding achievements toward safety. Supervisors must sincerely listen to employees' complaints and suggestions. The employer must provide an adequate Hazard (Hazard Communication Standers) to his or her employees. Information on all the chemicals in the workplace must be easily accessible to workers in case of an emergency. In addition, proper training for chemical handling, s torage and transportation is necessary as part of an ongoing process. Ill. A. Chemical overview, communication standards & hazards Chemical overview: Chemicals can be either in a solid, liquid or gaseous state.Chemicals can be found in drums, tanks, pressure vessels and process systems. Responses to spills or exposure depend on the chemical properties. Material Safety Data Sheets (MASS) and labels on the chemical containers are essential for determining how workers must respond. Hazard communication standards: Chemical handling requires adequate training before any initiations are taken. The training and education must include the following: Knowledge about Occupational Safety & Health Administration (OSHA) standards. Knowledge on all chemicals in the workplace and hazards associate with them.Informing workers of the facility written plan to deal with chemical hazards. How to use MASS and labels. How can workers protect themselves and others. Hazards: Physical Hazards: Physical haza rds includes, a sudden violent reaction involving flammable, explosive or reactive materials. Proper handling is the key to deal with physical hazards. Information from MASS can be obtained about storing, mixing or moving chemicals. Physical hazards can be identified as: Oxidized Water reactive Organic peroxide Combustible Health Hazards: Chemicals can cause adverse health effects if workers became over exposed.There are two types of health effects: Acute health effects: occurs over short periods of time due to immediate exposure, they can be minor or serious. Some examples include burning or irritation. Chronic health effects: occurs over long periods of time due to prolong exposure in small amounts. Some examples include cancer, liver disease or lead poisoning. Ill. B. Exposure limits, controlling exposure & Safety on the Job Exposure limits: Exposure limits are governmental standards indicating when overexposure occurs. PEEL – Permissible Exposure Limit: Must not be exceed ed, over an our average rookery.TTL – Threshold Limit Value: Must not be exceeded, over an our average workday. STEEL – Short-Term Exposure Limit: can be safety exposed to over 1 5-minute period. IDLE – Immediately Dangerous to Life or Health: very hazardous, must not be exposed to. Controlling exposures: There are several methods used to control exposures to chemicals. Engineering controls can be use to keep exposures below PEEL and TTL levels. Also, maintaining adequate ventilation system can reduce exposure to hazardous chemicals. When exposure can not be avoided, using proper PEP depending on the chemical is essential.PEP are used to prevent exposure through skin absorption, inhalation, ingestion and injection. Chemical safety on the Job: Identify all chemical hazards in the workplace. Know how to deal with chemical in both regular and emergency operations. Treat unknown chemical as hazardous ones. Make sure to use the appropriate PEP by looking at MASS. Ins pect your PEP before and after use. Know the workplace emergency procedures. Know location of emergency showers, first aid kits, fire extinguishers and eyewash. Always secure the exposed area and ask for help. Maintain good hygiene to prevent outside exposures. IV. Chapter 04: Lockout / DugoutThere are energies in the workplace that might be accidentally released and cause serious injuries or death. The employers, with the proper training of workers, must prevent the accidental release of these hazardous energies. This can be achieved through using lockout/dugouts. ‘V. A. What is lockout/dugout & when they must be perform What is lockout/dugout? Lockouts: The employer places a lock on any energy isolating device, making sure it cannot be removed from the closed position. Such devices include circuit breaker or valve handle. Dugout: The employer attaches a written note (warring tag) on the equipment or device that