Monday, September 30, 2019
Childcare Level 4 Keeping Children Safe
Unit 4 ââ¬â Keeping children safe E1/D1 Five main laws that underpin the provision of health, safe and secure environments for young children are: Health and Safety at Work Act 1974Under the act 1974, both employers and employees have duties. Employers must produce a written policy explaining how they will ensure the health, safety and welfare of all people who use the premises. Employees must cooperate with these arrangements and take reasonable care of themselves and others. Employers have a duty to display a health and safety law poster.The Reporting of Injuries, Diseases and Dangerous Occurrence Regulation (RIDDOR) 1995This regulation requires accidents, diseases and dangerous occurrence to be recorded. An accident book must be kept in order for staff to record an incidents occurred in the setting. It is very important to record any incidents that have happened in the setting. The purpose of doing this is to attend the child welfare and safeguarding. The records could be used by doctors if the child was to develop any further injury. Settings require parents to inform staff of any illness or allergies their child may have. This protects the child and staff.The Control of Substances Hazardous to Health (COSHH) Regulations 2002This regulation states that substances which can make people ill or injure them must be stored and used appropriately. In a setting substances hazard to health are locked away and out of the reach for children. Only a few members of staff have the key and only they can open the cupboard unless given permission by someone else to. If someone new comes to work in the setting it is the supervisorââ¬â¢s duty to tell them where these substances are kept. Substances accessible to children are generally chemical and toxic free and safe to use.All objects safe to use either have a kite mare, lion mark or CE mark. The marks reassure that the product is safe for the child. Personal Protective Equipment at Work (PPE) Regulations 1992The reg ulation states employers must make sure there is suitable protective equipment available for employers who are exposed to a risk to their health and safety at work. Staff in a childcare setting should be provided with equipment if they are doing any activities that are a risk to there health. It is important that staff wear the protective clothing/equipment to prevent injuries.Equipment such as gloves, goggles, science jackets etc are there to prevent us from haring that part of our body. Gloves are used when handling bodily fluids to protect the hand from burns or reaction to the substance. Food Handling Regulation 1995This regulation states if you are preparing or handling food you must; Wash hands, Make sure the surface is clean and hygienic, Make sure food is stored at the correct temperature, Dispose of waist hygienicallyIn a setting cooks are requires to tie their hair back and wear hair nets and apron. There are different c olour chopping boards for dealing with different kin ds of foods, e. . meat and vegetables. Surfaces are cleaned thoroughly with bacterial sprays to ensure the food is prepared in the cleanest way. Food inspectorââ¬â¢s regularly come in to settings to ensure cooks are storing food correctly and at the right temperature. If everything is done to satisfaction the setting is often awarded with a certificate. In the setting there are labels and signs to show what goes where and how they should be used. Children are encouraged to abide by this regulation as well, when they do cooking activities. Children are told to wash their hands when handling and consuming food.Staff will plan activates that will teach children how to safely prepare food. Staff ma organise with the cook to have the children watch how they prepare their food in the kitchen. E2 Bump on head ââ¬âa bump on the head is a common injury in young children. If it happens in the setting it should be noted down in the accident book which every childcare setting must have. Then the injury should be treated with an ice pack. The child should be closely supervised as the injury could cause them to become drowsy. Parents should be given a copy of the accident form or a letter must be sent home.It depends on the procedure of the setting. The parent should always be informed of the accident when they come to collect their child. Asthma attack ââ¬âa child having an asthma attack needs to be comforted and taken to a quiet place away from the other children. The child is then given an inhaler. Staff must call the parent/career straight away informing them about what has happened to their child. Staff should reassure the child by telling them every thing is going to be ok and try to steady the child breathing by breathing with them slowly which will allow air to get to their lungs. The child should never be left alone.Sickness and Diarrhoea ââ¬â if a child has diarrhoea the parent/ career must be informed and ask to pick up the child immediately. If th e child has vomited then children should be moved away from the area and staff must clean it up, wearing protective clothing such as gloves which must be disposed after as it will protect them from infection or catching the illness. Personal Protective Equipment at Work (PPE) Regulations 1992. A child with diarrhoea should be given plenty of fluid; if the child cannot keep the fluid down then the child should be taken to the hospital as soon as possible.It is best the child stays of school for at least two days before returning. This is normally a health and safety procedure in a setting. E3 11 year old 9:00am The children are dropped of and say goodbye to parent. 9:15am A register is taken. This is done so that staffs are aware of all children who are in the setting on that day. 9:30am Children have social time. They play with each other and with activities set out for them in the baby room. 10:15am Children have their nappy change, their hands get washed and prepare them for snack time. 0:30am put the children in their baby chairs and give them milk, water, fruit or a snack to eat and drink. assist any child who needs help with feeding. 11:00am The children are taken out side for some fresh air. put the children in their buggies or if the weather is good they can crawl around and play in the sand pit. It is important staff check the outside area every day. 11:30am The children return back to the baby room. Change of nappies and clothing is done if needed and wash the face and hands of the child. 11:45am: Children are put in their baby chairs and are told what they are going to have for lunch.Staff in the kitchen should follow the Food Handling Regulation 1995, to make sure food is prepared safely. It is very important to check that the food prepared will not affect children with allergies. 12:00pm Lunch Time ââ¬â Children eat their lunch and when they are finished they are put back in the baby room to play with resources around them. 1:00pm: nap time 2:3 0pm: The children have their nappies changed and their face cleaned. Staff must were protective clothing such as disposable aprons and gloves. 2:45pm Staff and children bonding time.Sing songs play with instruments, read books, plays with toys and communicate with them. 3:15pm: We prepare the children for home time. It is important staffs are aware of who is collecting the children. Parents who normally collect their child should inform the setting that someone else will be collecting their child. The setting should never give the child to anyone else if not permitted by the parent. E4 ââ¬â Routine for a child age 39:00am Children arrives at nursery and is greeted by the teacher. 9:15am Children sit down on the carpet and the morning register is taken. Then issue each group their activity. :30am Children go off in their groups and do there activity each group has 30 minutes to do their activity before having to move on to do another activity. 10:00am Groups change to do a new ac tivity 10:30am Children tidy up there activity 10:45am Children put on their coats if needed collect fruit, snacks and drinks and go outside to play11:00am Children return back to the classroom and groups are change so their doing a different activity. 11:30am Groups change for the last time12:00pm Children are sent off to wash their hands and line up for lunch. Posters are placed in toilets on how to wash hands to promote hygiene.Washing hands prevents the children from infection and disease. 12:15pm Children eat their lunch. Staff are supervising the children at their table Meals are nutritional and should follow the health eating regulations. Once they have finished they go outside to play. 1:00pm Children return back to the classroom and an afternoon register is taken. 1:15pm Depending on which day of the week it is children will either have a music lesson or a P. E lesson or art lesson. A P. E lesson will allow the children to take risk and do challenging activities. It is impo rtant staff do risk assessment of any activities they have planned. :00pm Children go out to play to get fresh air and exercise. Children can explore the setting. There must be at least two members of staff supervising the children. 2:15pm Children return back to the classroom and either have golden time or free play. 3:00pm story or song time 3:30pm Children collect their jackets. Staff should only give the child to the parent or anyone given permission by the parent to collect the child. E5 In a setting staff try to offer an exciting range of experiences to the children which will stimulate and extend their skills in all areas of development.Child Care and Education. Tina Bruce. Pg 273in a setting staff should supervise the children; there must be enough staff to look after the children. All care in the setting should avoid danger in order to maintain the safety and security of the child. Children need challenging play in order to develop, risk taking will occur in these types of activities so staff must supervise these areas for the health and safety of the child. ââ¬Å"Close supervision is the most effective way of ensuring childrenââ¬â¢s safetyâ⬠. Care and Education. Tina Bruce.Pg 273Staff should always remember it is their responsibility to keep children safe in the childcare setting. Children are individuals and develop at different stages so we must have in mind all children may not be able to do the same thing at the same time. Children with special needs may need special equipment and playing resources in order to participate safely in activities in any setting. It is important we make all children feel included when panning activities in challenging environments at no time should a child feel different due to their needs or abilities.The weather can be an issue for planning. Before outdoor play, the area must be checked. Icy or slippery surfaces are dangerous for all activities planned for the children. If staffs do decide to let children p lay outside despite any weather children should be suitably clothed and equipped for it. Children should always be dressed according to the weather. A challenging environment will always involve risk and this is why staff should risk assess. Risk assessment is important however we need to create and enabling environment whilst thinking about the childââ¬â¢s safety.Before planning we need to think and asses the possible outcomes. An activity can be well planned but if a child get injured from it then the activity is worthless. There should always be a record of safety issues that occur E6/C1 Forest SchoolsChildren seem to thrive and their minds and bodies develop best when they accessible to stimulating outdoor environments for learning through play. A forest school is a unique educational experience. The purpose of it is to adapt an education curriculum to a participants learning style.The philosophy is to inspire individuals through achievable goals and make them independent. Th e benefit of a forest school are:à * that its child led and initiated à * it helps to work towards goals in the Early Years Foundation stage (EYFs)à * beneficial to children with emotional and behavioural difficultiesà * encourages creativity and self awarenessà * uses the child centred approachà * child need an interested is always catered toââ¬Å"It is important that childrenââ¬â¢s basic needs are met before higher learning can take placeâ⬠. Maslow Hierarchy of Needs.Forest schools are a unique way of building independence and self-esteem in young children. They originated in Sweden in the 1950s as a way of teaching children about the natural world. Children with challenging behaviour or identified as having additional or specific needs tend to develop control over behaviour, improved concentration and independence and develop their social and emotional skills. Children who are shy and timid and lack in confidence in a normal nursery environment become c onfident in their own abilities within the forest and lessen to rely on adults.Being in a forest school allows children to freedom, oxygen and space. Children can explore wildlife and the growth of things in the outside world. Children should learn and develop on first hand experience. Children are more social as they interact with the other children more. They become more confident in what they do and may speak to other children. The can explore together and discuss things they find. This can not necessarily be done in a classroom. Children respond to the sense of freedom given to them in the forest school.Children are encouraged to move away from adult interaction and become more responsible for themselves and others. Children take manageable risk in a forest school they use full size adult tools, light fires, and build dens and plenty more other challenging activities. The child knowledge and understanding of the world, language, mathematics, creative, physical, personal and soci al development underpins the whole forest school philosophy. Learning Outside the Classroom (LOtC)In November 2006 the government launched the Learning Outside the Classroom Manifesto.It was made so that children have a variety of high quality learning experiences outside the classroom. Learning outside the classroom thrives to:à * develop children learning in the environmentà * nurture creativity à * provide opportunities for informal learning through playà * reduce behaviour problems an improve attendanceà * stimulate, inspire and improve motivationà * provide challenging the opportunity to take acceptable levels of riskà * improves young children attitude to learning à * improves academic levels achievementsà * develops skills and independence in a widening range of environment ( Tasoni, 2007. The government believes children should learn and experiment the world beyond the classroom. Children construct their own learning in the world around them. Learn ing is more engaging and relevant to the children. E7 Risk taking benefits the development of children as it influences their perception of themselves and self ââ¬âesteem, it provides excitement and pleasure for the child. A child needs to take risk in order to develop risk competence.Children seem to have fewer accidents when they are more risk taking as they are more knowledgeable and skilled in assessing risk and can takes risks more safely. Panic ZoneLearning ZoneComfort ZoneOnce the appropriate risk assessments have been carried out in the setting, activities can be planned to enable children to learn from their environment while taking managed risks. Children must have the opportunity to explore their physical environment. By making children take risk we are playing an important role in developing their independence.It helps children to develop their physical development and social development as they can help other children to keep themselves safe. If we do not allow chil dren to take risk then they will not develop to the next stage of development. A child who is not allowed to take risk will not enjoy the thrill of achieving or try new challenges. The opportunity to play in and experience different environments is important in allowing children to experience challenges. If children are helped to take risk then they will develop their skill and confidence in what they do.Many settings thrive to manage risk and challenges and allow children to take risk by providing them with challenging play, experience and activities. Children learn through play. Climbing, building dens and tree housed, gardening, cooking, science experiment, bonfires etc allows the child to develop their control and coordination of their bodies. When you implement all these health and safety restrictions children will stop learning. Some parents may not allow their child to take risk as they are far too protective or scared of their childââ¬â¢s safety.This can prevent the child from having no independence and they will not be aware of their own danger when unsupervised and the risk they can actually manage, which may result to the child seriously hurting themselves. Children should have some awareness of the risk and challenges they can take. Being oblivious to risk is worse than a child taking risk, they can put themselves in serious danger as they donââ¬â¢t know the different levels of risk they can and cannot take. Parents should be the once to reinforce this. Children need to be supported by the adults to take risk.Children need to be told about any accidents that could happen so that when they are playing they are responsive of this. We as the adult in the setting should think about:à * talking to children about the potential risk in the environmentà * encouraging children to think of ways to manage the risk the may come across. This can be done by making the child take upon some responsibility and indentifying and reporting hazards. * encou raging older children to take acre of younger ones where there are potential risks à * agreeing appropriate behaviour.Child Care and Education 4th edition, Penny Tasoni, 2007. Pg 195Children should always be reassured by the adult that they are here to help as this boost the child confident in what ever they do. If a child is scared to do something the adult should provide support and encourage the child to do it. The child then know they can do it and that the adult is their to help if something goes wrong. E8 D2 Each setting should have a Health and Safety policy. It should contain the overall guideline for employers, employees and any other staff.It should state the values of the setting regarding health and safety. It should state the procedures that are regarded to be followed in the setting. All procedures should be names in the Health and Safety policy. They should be regularly revised and all staff should be advised of the procedure of the setting before starting work. Ev ery childcare setting is required by law to have an accident book in a safe place in the setting and to maintain a record of accidents init.This makes the parents and staff aware of about any accidents that have happed. The book requires the following informationName of person injured: Date and time of injury:Where the accident took place:What exactly happened:What injury occurred:What treatment was given: Name and signature of person dealing with accident:Signature of witness to the report:Signature of parent:If an accident happens to the child you should call or send for first aide. He or she will provide the best care for the injury. If needed call for the supervisor as well.If the accident is serious parent/career must be informed immediately or if less serious inform them at the end of the day when they come to pick up their child. Record the accident in the accident book and ensure the parent signs it. The accident book should be kept in safe place where it is easy to access. Children contacts numbers should assessable in alphabetical order so any member of staff can find who the want quickly. In a setting there should normally be pictures of staff who are first aiders.The setting should be kept tidy so visitors and parents know there child is being left in a safe environment and staff should encourage children to tidy up after themselves as well. If a child is ill whilst in the setting the child should be removed from the classroom and taken to the first aider where the parents should be informed immediately and told to come and collect their child. If needed the child should be cleaned and changed and a member of staff should comfort him or her, until the parent comes for them. First aider should advice the parent to take the child to the family doctor if necessary.Signs of serious illness includes:à * High temperatureà * Continual vomiting à * Unexplained painà * Unusual crying in a babyChild Care and Education 4th edition, 2007, Pg 182Thi s is when a child should be taken to see a doctor. If a child has a contagious illness, e. g. swine flu, parents and local authorities must be notified that the illness is in there setting. Children who have on going illness e. g. have allergic reactions, should be kept a record of. Staff must have a have a note of all medication the child needs including how much the child needs to intake and how frequently the child needs it.All setting should have a policy of parents informing them of all the illnesses and medical attentions their child needs. Posters of the child should be made including information of what the child is allergic to, and should put up in staff rooms and places visible for all staff to see and be aware of. Children in the setting should be encouraged to keep hygienic therefore washing hands before meals and after play. The must know about germs and bacteria and how they spread and cause infections and illnesses if they donââ¬â¢t hygienically maintain there body as child like to but the hands in their mouth and dig their noises.If an emergency happens, e. g. a fire in kitchen, the fire alarm must be raised and everyone must evacuate the building immediately. Keeping the environment safe to support the procedure means keeping corridors clear and fire exits, ensuring everyone in the setting is aware of the assembly point childrenââ¬â¢s contact details are up t date and that it is always kept the same. It important that in the setting all staff know what to do in an emergency, practices need to be held regularly and signs and notices must be kept in visible places.Drills and practices should be taken seriously, as if it is really happening and should be recorded as the Early Years Foundation stage (EYF) statesâ⬠¦http://www. eriding. net/resources/fndtn/management/101125_sclark_eyfs_safeguarding. pdf B1 There are many ways to maintain the safety and privacy of children. ââ¬Å"Supervision is the most effective way of ensuring childrenâ â¬â¢s safety. â⬠Child Care and Education, 2007, Pg 273Children should be treated as individuals as they have their own individual needs.Babies have no awareness of their danger and are totally dependant on their parent/carer for protection and safety. In a setting children are to be changed in a separate section in the setting and the practitioners should also be accompanied by another person just to protect themselves. When changing a child it should never be done in a place where the child is not exposed to other people and children, or where the other children are playing. Doing this is respecting the privacy of children, as the UN Convention states that all children have the right to privacy.All settings will have information about each child stating where they live and parent/career phone number etc this information should be kept in a secure place, insured to protect it from being disclosed to anyone other that member of staff in that setting. Doing this is respecting their confidential needs. Parents will inform staff about illnesses or personal information about their child and family this should not be shared with friends or other member of staff unnecessarily. Children have rights as the Children Act clearly states and it is important that we value and respect them and put them into practice in the setting.Practitioners must be aware of the policies and procedures in their setting as it inform staff how to keep the children safe. Abraham Maslow developed the Hierarchy of Needs theory. Safety needs is one on the five stages a human needs in order to for fill their full potential (self-actualisation) therefore; if a child does not feel safe they will not reach their full potential (self-actualisation) where personal growth and fulfilment takes place. The setting should always provide a safe and secure environment for the children meaning, ensuring the environment and equipment is checked and safe to use.Staff should check the outside area every day before the children arrive as needles, sharp objects and other harmful object can fall into the setting. Equipment in the setting should be tested if needed to make sure it work properly and in no way may harm the child using it. Toys in the setting should have a water mark on it clearly indicating that the toy has been tested and is safe to use. Special needed children may need special equipment and play resources in the setting, in order to participate safely in the daily activities or just need to have changes made to the environments to suit their need.However they should never be made to feel they canââ¬â¢t do things by themselves and they donââ¬â¢t always need assistance. We have to be careful not to scaffold the child to much as they can make choices for themselves. Staff in the setting or on duty can only deal with and watch over a certain amount of children at a time. It would be a good idea for staff to encourage children to be aware of their own safety and the s afety of others. So lessons on why and how to keep your self safe would be beneficial for the staff and more importantly the children. As they can use their own initiative and indentify what is and what is not safe to do.They become more self aware. There should be a time where staffs have one to one time with children in the setting. This time could be where children tell you how thy feel or about something that may be bothering them. What ever has been said in that conversation should only stay between you and that child as they choice to tell you because they knew that they can confide and trust you. If the child has told you something that is putting them in danger then that is the only time matter must be taken into someone elseââ¬â¢s hands and it would be best to tell the child before doing so, just so that they are aware. A When working with children, a practitioner can have both negative and positive effect. Negatively the demands of a childcare job can seem extremely cha llenging. Tiredness, stressed, boredom, all factors that canââ¬â¢t be avoided in this type of job. Working hours are generally from 8:00am to 3:30pm and staffââ¬â¢s are always on their feet as children need consistent supervision. Children need routine and staff must stick to itâ⬠¦doing the same thing everyday becomes very boring. ââ¬Å"Boredom is the deadliest poison. â⬠William F. Buckley, JR.Stress can be caused by this type of work as practitioners have to maintain and work at high standards. ââ¬Å"Stressed caused by work is the second biggest occupational health problem in the UK,â⬠Child Care and Education, 2007, Pg 329. This is because staffs are unable to cope. The work load may interfere with private, social or family life, too much to do or simply believing childcare isnââ¬â¢t the right job for them. As well as the above, practitioners can be physically affected. Back problem is the biggest occupational health problem in the UK. Childcare involves picking up children.Continuously bending over and stooping to the childââ¬â¢s level. Children at a young age are not yet independently hygienic and are vulnerable to colds becoming ill and picking up infections. These things can easily be passed on to practitioners. Parents/careers put their childââ¬â¢s safety in the practitionerââ¬â¢s hands as they are mostly with the child during the settings hours. So a lot of pressure is on the practitioner, if any thing happens to the child accidentally or not they feel as if they where the one to blame and some parents are not very reasonable or understanding.Practitioners could become too attached to the child involving themselves in things that do not really concern them. This could be difficult for some. Some children in the setting may tell practitioners moving information. That their being abused, have difficulties, etc and they could then become emotionally attached to the child, showing love to the chid, love they may not recei ve at home or from their parents. Positively there are joys and happiness to the job. When children achieve and do well in things it makes the practitioner feel happy as they helped the child to achieve that goal.Learning new things from the children and putting it into practice. Bonding with the child finding out what they like and dislike show the practitioner that the child can confide in them and feels safe around them. Set routines will eventually develop the child to know what is coming next and they will independently get ready for it putting least pressure on the practitioner to have to run after them. Practitionerââ¬â¢s in the setting do all they can to support and care for the child that is why routines and doing things at certain time are in place.However some people may agree with the way the setting does things due to their own views and beliefs. Comparatively, all children need similar care but when working with different children who come from different background whose parents have different religious requirements or do not want their child eating certain foods; it can be difficult for the practitioner. Practitioners will have parents that will not agree with everything they have to say or made to feel uncomfortable with what is happening in a setting. If this happens the supervisor or tutors are there to support and discuss how you will need to deal with the ituation. The practitioner should keep themselves up to date with any changes in practices and legislations. Practitioners should not put themselves in risky situation e. g. being left alone with a child. Just to avoid accusations being made as ââ¬Å"The number of children contacting a sexual abuse helpline service has increased by almost 50% in three yearsâ⬠. http://news. bbc. co. uk/1/hi/scotland/7877823. stm. There are websites and books available to practitioners that can support them and give information about how to deal with problems they have.In all setting there are polic ies and guidelines to help them meet the care needs of children such as health and safety, confidentiality and protection polices. It is vital that procedures are followed to protect themselves. This in itself causes fewer problems. E9 Booksà * Bruce, T ,( 2007) Child Care and Education, * Pound L, (2005) How children learn, Step Forward Publishing Ltd (United Kingdom) * Tasoni P , (2007) Child Care and Education 4th edition, Websites http://news. bbc. co. uk/1/hi/scotland/7877823. stmhttp://www. eriding. net/resources/fndtn/management/101125_sclark_eyfs_safeguarding. pdf
Sunday, September 29, 2019
Six Sigma for Sustainability in Multinational Organizations
Six Sigma For Sustainability In Multinational Organizations Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 Six Sigma For Sustainability In Multinational Organizations Abdullah AlSagheer, Hamdan Bin Mohammed e-University, Dubai UAE ABSTRACT The Six Sigma model provides various kinds of sustainability to companies in terms of quality enhancement, zero defect level, market share enhancement, optimal production level and financial returns. Multinational companies are more orientated toward impl ementation of Six Sigma than small scale locally held companies.Numerous larger companies have so far implemented Six Sigma including 3M, Caterpillar, Merrill Lynch, Bank of America, Amazon. com, DHL, SGL group, Dell, Ford Motor Company, DuPont, McGraw Hi ll Companies and HSBC group. Implementation of Six Sigma requires considerable cost and effort in terms of human resource training and reformulation of business processes. This study is an attempt to find what kind of sustainability motivates multinational companies to invest in Six Sigma. Sustainability identified includes social sustainability, environmental sustainability, and economic sustainability.With the aid of interviews, a constant comparison study is conducted in order to find the most preva lent type of sustainability offered by Six Sigma. A sample is drawn from multinational companies which have already implemented Six Sigma in their operations. The findings suggest that multinational companies implement Six Sigma in order to attain econom ic sustainability through various means such as market share, customer base, and social sustainability. Keywords: Six Sigma; sustainability; multinationals; economic sustainability; zero defect level; financial sustainabilityINTRODUCTION T he world is witnessing a reformed shape of business, an approach more focused on quality and customer care. The traditional concept of supplier orientation has shifted to customer orientation and traditional mean ing of quality has also changed. Quality management, total quality management, zero defect level, lean management, continuous improvement and Six Sigma have evolved over the period of time to meet quality requirements of customers. Each having a slighter different and updated focus of quality, Six S igma is the most advance approach.Six Sigma is a quality management initiative that takes the methodological approach based on data attempting to eliminate the defects to minimize standard deviation to desired level of quality (Six Sigma, 2010). The study is focused to find sustainability that Six Sigma brings in multinationals. Small businesses, due to their small scale and low organized processes confront difficulties while implementing six sigma processes. Present study finds the sustainability that six sigma provides to larger multinational organizations in terms of society, environment and financial return.Background Of Study Initiated by Motorola, Six Sigma has largely been adopted by number of multinational, larger scale companies. A few to mentioned includes 3M, Merrill Lynch, Bank of America, Amazon. com, DHL, SGL group, Dell, Ford Motor company, DuPont, McGraw Hill Companies, HSBC group, United States Army and many others (Gupta, 2005). It is pertinent to notice that mostly multinational an d larger companies have adopted Six Sigma (Wiele, Iwaarden and Power, 2010).Literature and actual implementation of Six Sigma largely reflects the fact that multinational companies are more inclined towards adoption of Six Sigma as it produces multifacete d sustainability. Core reasons of this adoption is that multinational afford higher cost of training, higher technical expertise requirement and more advance processes (Gupta, 2005). à © 2011 The Clute Institute 7 Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 Statement Of The Research ProblemMultinational organizations adopts six sigma as it offer them sustainability and diversity however , it is important to learn what type of sustainability does six sigma provide to the companies. The core research question to be addressed is what kind of sustainability is largely provided by S ix Sigma in multinational companies. The core question is supported by several secondary questions such as is it in terms of financial success, corporate social responsibility, market share or business? s repute for best practices? Does the core objective of Six Sigma is to bring financial success?How companies define sustainability and what do they want to achieve through Six Sigma? Purpose And Significance Of The Study The study is aimed to drill down into concept of sustainability provided by Six Sig ma. It is important to learn how quality management and advanced quality approaches are helping companies to improve their performance and efficiency. The study is a guideline for companies that have not ventured for Six Sigma. Many multinational companies such as IBM, Microsoft and Royal Dut ch Shell are using their customized quality approach (Schwandt and Marquardt, 2000).The study will ardently provide a basis of comparison between Six Sigma companies and customized quality approaches for future researc h. Moreover, it is significant from Six Sigma companies view point by looking into possible sustainability that Six Sigma can add to their businesses. Review Of The Literature A wide variety of literature is present which draws on Six Sigma, sustainabil ity and sustainability brought by Six Sigma in multinational companies in different perspectives. Six Sigma has a history of twenty four years and theorists have widely discussed its different aspects.The literature initially defines how Six Sigma works f or multinational companies and what the term sustainability ideally reflects. In later part, the literature reviews the sustainability actually brought by Six Sigma in companies and the core aim of adopting Six Sigma in different companies. Six Sigma For Quality Manag ement Six Sigma is highly effective implementation of proven quality principles and techniques. The approach works for virtually error free business performance. In Six Sigma, the company? s performance is measured by the sigma level of businesses process (Pyzdek and Keller, 2009).An approach focused on establishing world class performance bench marks provides road map for attaining zero error level. Apparently Six Sigma is associated with the enhancing quality of good and services, nevertheless, it brings efficiency and effectiveness in processes throughout the organization (Truscott, 2003). Six Sigma approach marvelously improves quality as it objectively looks into quality measurement. Henderson and Evans (2000) McCarty and Fisher (2007) stated that Six Sigma make measurement possible through its multi dimensional statistical model.The model is primarily focused on three aspects i -e sigma statistics, sigma measure and performance benchmark however no element specifically identif ies the le vel of sustainability (Truscott, 2009). Turscott (2009) further exemplifies the Six Sigma implementation by looking at following daily life examples: Process sigma value 2 3 4 5 6 Source: Truscott (2009) 8 Table 1: Six Sigma Implementation from Daily Life Expectation of Time without electricity 207 h 45 h 4h 9 min 8 sec Aircraft accidents 8 per 10 flights 24 per 100 flights 25 per 1000 flights 9 per 10,000 flights 12 per million flights 2011 The Clute Institute Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 Six Sigma works on principles of continuous improvement; Coronado and Antony (2002) resembles the Six Sigma as a loop which begins with defining the goals of improvement activity i -e benchmarking of quality services and leads to measuring of existing syste m. In Six Sigma, measuring the existing system is often termed as gap analysis (Antony, 2006). The next component of Six Sigma loop works with identifying the ways to remove the gap and i mproving the present system (Thareja, 2006).If Six Sigma loop stops at continuous improvement, it will more likely consider as total quality management (Khan, 2003). Sustainability The other core element of Six Sigma implementation is the sustainability which it brings to the organization. Generally understanding sustainability, sustainability is best defined by world commission on environment and development (1987) stating that sustainable development is development that meets the need of present without compromising the ability of future generation to meet their own n eeds.Fricker (1998) defined sustainability as vision of future that provides a road map while focusing on certain set of ethical and moral values which may guide the actions of an entity. Looking sustainability in details, it mainly focuses on three aspec ts i-e economic growth, social progress and environmental protection (Munier, 2006). Sustainability involves people, capital resources, natural resources, environme nt and institution. Fricker (1998) further added that sustainability is not merely an end result of processes rather it continuous seeking of quality behavior.An organization is said to be sustainable if its people are willing to bring a change and embrace the change ultimately leading toward sustainable organizational design (Shrivastava and Director, 1995). In an organizational perspective particularly, sustainability refers to the value addition from Six Sigma. The dimension of sustainability includes variation elimination, control on new processes, statistical controls, reduced complexity, precision, accuracy and effectiveness in business process (Giardina, 2006).An addition in traditional Six Sigma is lean Six Sigma which primarily focuses on improved process flow (Reiling, 2008). Due to difference of focus, the perspective for sustainability also varies. In Six Sigma, the sustainability refers to utmost standardization with zero defects whereas lean Six Sigma emphasize sustain ability as identification of value, defining value stream, determining flow, defining pull and improving process in every business function such as marketing, finance and management (Taghizadegan, 2006). Sustainability Achieved Through Six SigmaMultinational companies have adopted Six Sigma for variety of purposes however, the core goal was to attain financial sustainability through improved processes and better work flow (Poudlove, Moxham and Boaden, 2008) however, the financial success is achieved through multidimensional quality improvements (Mahadevan, 2010). General Motors reduced its disposal costs by $12 million through kanban system; an integral part of Six Sigma. Similar to this, Robins Air Force Base, C -130 paint shop reduced tools material and equipment by 39% and $373,800 in direct operating savings (Giardina, 2006). M was among few companies which initiated to adopt Six Sigma. 3M upgraded to lean Six Sigma and its purpose was to attain environmental stability. The comp any is pioneer in use of lean Six Sigma methods and tools to improve operations and quality. In first step, the company trained it s 100,000 employees for Six Sigma in order to attain the operational sustainability. 3M achieved multi facet results such as improvement in energy efficiency from 20% to 27% and reduction in waste index to net sales from 25% to 30%.All these achievements are aimed toward attaining environmental sustainability and operational sustainability. Till 2005, savings from the lean Six Sigma project was amounted to $1 billion which was made possible by reducing pollution, improving workflow, equipment redesign, process ramification and product reformulation (3M Lean Six-Sigma and Sustainability, 2010). Byrne (2007) also asserts that companies implement Six Sigma to drive the innovation. The first five years of lean Six Sigma helped many companies to improve their results such as attained by Caterpillar.Weber (2004) also quotes Caterpillar as achiever from Six Sig ma. In September 2004, Caterpillar was $20 billion Company and Caterpillar was aimed to increase the revenues by $10 billion in first decade of lean Six Sigma implementation. Weber (2004) contrasts with Byrne (2007) in the context that caterpillar wanted to attain the innovation à © 2011 The Clute Institute 9 Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 sustainability. According to Weber (2004), caterpillar was focused on achieving financial stability. The company? top management has highlighted that Caterpillar management such as CEO has claimed that Six Sigma was the important contribution toward increase in sales of caterpillar. Six Sigma is also driving the continuous improvement culture in the company and business is gaining efficiency in all respects (Weber, 2004). Hilton (2008) identifies several companies such as Motorola, General Electric, Dell Computer, Dow Chemicals, Wal-Mart and Honeywell who implemented Six Sigma and attained measurable re sults. General electric saved $8 billion after mplementing Six Sigma in three years and Wall -Marts is looking for savings of $1 billion from lean Six Sigma (Leahy, 2000). RESEARCH METHODOLOGY Study Design Decision to implement of Six Sigma comes from organizational leaders. Since every organization is unique and has its own requirements, therefore company? s internal management can determine the potential benefits to be achieved by the Six Sigma (Bertels, Rath & Strong, 2003). Defining objectives for the company and preparing employees to accept change occurred through Six Sigma is responsibility of top management and leaders.According to Pande (2003), Six Sigma lies in the vision of top management and only they can decide what sustainability they want from Six Sigma. On these grounds, the study seeks direct interaction with top management about sustainability desired from Six Sigma. The survey method provides researcher with an ease of open communication and allows sharing of idea s and thoughts. Surveys are considered best when opinion and ideas of people are important in shaping a conclusion (Groves, Fowler, Couper, Lepkowski and Eleanor, 2009). The study adopted cross section survey method as its core research methodology.In survey, interview tool was used to collect data directly from top management of multinational companies. Cross sectional survey are used to collect information at a single point in time and helps to establish the relationship between two entities (Babbie, 1990). Brief structured interviews were conduct ed to collect the data from participants. Participants Participants were selected using purposive sampling. Purposive sampling provides an opportunity to select participants on a specific criterion which fits to the purpose of study (Teddlie and Tashakkori, 2009).For present study, interviewees were selected on number of criteria such as listed below: ? ? ? The participants belong to a multinational company which has already implemented Six Sigma. The participant works on multinational on any key managerial position directly associated with decision making. Such participants include chief operating officers, chief executive officers, senior finance managers, chief information manager, information technology head, information technology specialist and senior management.Participant has been working in the organization before the Six Sigma was implemented in the company. Data Collection And Data Analysis Since it was difficult to visit such participants personally due to geographical constraints, int erviews were conducted on telephone where personal visit was not possible. After getting the list of multinational companies who have implemented the Six Sigma, the information tentative participants were collected using official websites and Chamber of Commerce websites. The contact information, permission and appointment for an interview were also obtained via telephone.The interviews could not be recorded as permission was not granted however; notes were taken during the interview and were later converted into text manually. The text was later analyzed using software Weft QDA and patterns were obtained. Constant comparison approach was used to compare the interview transcript and to obtain the patterns. According to Glaser and Strauss (1967), constant c omparison approach helps to develop a 10 à © 2011 The Clute Institute Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 theory about the phenomenon.The constant comparison is made through development of codes and subsequently, a theory is developed. The interviews were structured and comprised of 15 -20 twenty minute each. In all, forty two participants from different companies were interviewed. The participants includes senior finance managers, chief executive officers, IT managers, chief operating officers and in some cases directors of companies also. The participants companies include Maple Lead Foods, Pakistan Intern ational Airlines, Pakistan State Oil, Starwood Hotels and Resorts Worldwide, Deere and Company, Bank of Montreal, McGraw Hill Companies and Vodafone.Findings And Analysis Telephonic and face to face interviews were conducted to collect the data from participants. In all forty two participants were interviewed which included executives and managers. The stratification of participants on basis of their designation is provided below: Senior Finance Managers Chief Executive Officers IT Managers Chief Operating Officers Directors Total Table 2: Stratification of Participants on Designation Participants 12 7 14 5 4 42 %age Participation 29% 17% 33% 12% 10% 100% The interviews were brief and structured (Appendix A).Primarily the interviews were focused to know what type of sustainability motivates the multinational companies to invest in Six Sigma. Using the constant comparison approach, the interviews text was a nalyzed for patterns. Two level coding was performed using Weft QDA as the pu rpose was to find which type of sustainability is acquired through Six Sigma. Several codes were found which were emerged. Redundant codes were merged to derive constant flow of i nformation. Primary and secondary research questions are addressed through several themes discussed heere Core Objective Of Six SigmaSecondary research questions inquiring core objectives of Six Sigma were addressed through themes such as competition, zero defect level and financial success. As reflected by most of the, Six Sigma is implemented to stay competitive with other companies. Participants concluded that multinational companies needs to build corporate repute which increases their market share and Six Sigma is nowadays used as tool to reflect that company is taking endeavors for improving quality. This at first hands improves the competitive position of the company.Regional Finance Manager of Vodafone asserted that ââ¬Å"The impacts of Six Sigma are long term and may be seen afterwards however; t he company instantly start attaining repute after implementation of advance quality model â⬠. COO of Maple Lead Foods was also of the view that ââ¬Å"To remain competitive in market, continuous improvement in every aspect is necessary. Six-Sigma is also aimed to help us in enhancement in our market image in eyes of competitorsâ⬠Vice President (Finance) of Bank of Montreal endorsed the same by stating ââ¬Å"Other larger banks have already implemented similar models which has raised customersââ¬â¢ expectation.We are aimed to attain better market position by implementing an optimal service quality modelâ⬠. Second prevailing theme for core objectives of Six Sigma was quality improvement. ââ¬Å" Six-Sigma really helps to improve quality, we can see the difference. Processes are now more efficient and speedyâ⬠stated by IT manager of Starwood Hotels. CEO of Pakistan International Airlines asserted that ââ¬Å"The model has helped to stay efficient and had reduce d our effort in day to day activities. We are now more competent for offering quality solutions to our passengers and to our suppliersâ⬠.COO of Pakistan State Oil stated the fact ââ¬Å"Six Sigma has reduce our effective time to market and we had a desire to attain so from this model implementa tionâ⬠. à © 2011 The Clute Institute 11 Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 Third objective as extracted from most of interviews was the ability of Six Sigma to improve financial position of the company. It is evolved from the interviews that almost all companies are highly profit oriented and Six Sigma is adopted as a tool to attain financial success. Most of the company? executives reflected that Six Sigma is not merely adopted for financial success however, the responses can be considered as attempt to act in socially desirable manner. Executives of large multinational companies may not always admit that their specific endeavor is merely fo r profits. Reflection about company? s high concern toward profits can harm its repute as socially responsible company (Stocke, 2003). CEO of Pakistan State Oil endorsed that â⬠We understand Six-Sigma reduces material wastage and improves supply chain activities.Ultimately, it leads to overall cost reductionâ⬠. COO of Maple Leaf Foods also asserted that ââ¬Å"Six-Sigma do cost to use however, we expect a positive return in terms of market repute ultimately translated in financial successâ⬠. Senior Vice President (Finance) of Deere and Company stated, ââ¬Å"It is important to look all projects from financial perspective. We considered the cost and benefit analysis of Six Sigma as fundamental step for deciding on the projectâ⬠. How Companies Understand Sustainability Secondary question pertaining to sustainability was explained with themes uch as financial stability, improvement in quality, optimal productivity, social responsibility, environmental protection a nd value addition to the company. The most prevalent theme emerged for sustainability is financial success and optimal productivity. As reflected by all participants, the primary meaning of sustainability is financial success and optimal produc tion with minimum defects. Multinational companies consider financial success as the foremost sustainability to be achieved through zero defect level.In opinion of CEO of Pakistan International Airline ââ¬Å"A company can only be socially responsible when it is financial sustainable. For me, sustainability is the financial success which enables PIA to be sustainable in other areas tooâ⬠. IT Manager of McGraw Hill Companies highlighted the fact that ââ¬Å"when I think of sustainability, I think of higher financial return earned on investments of shareholders. Finance manger of John Deer and Company however, considered value addition as true sustainability by stating ââ¬Å"We are sustainable when our products are able to generate value for our companyâ⬠.Endorsed by director of Starwood Hotels, ââ¬Å"We are sustainable when are able to offer highest with the lowest sources, this means Starwood is sustainable in terms of services and in its corporate frameworkâ⬠. The other prevalent theme about sustainability was environmental protection and corporate social responsibility. Director of Deere and Company defined sustainability as ââ¬Å" We are sustainable when we are harmless to society and its stakeholdersâ⬠. IT manager of Bank of Montreal highlighted the same fact ââ¬Å"Sustainability is an attempt to be productive for the society and for its membersâ⬠. Sustainability Attained Through Six SigmaThe literal meaning of sustainability identified by participants is different from the sustainability desired to be attained through Six Sigma. While analyzing the interviews, the most prevalent theme of sustainability attained through Six Sigma was zero defect level, optimal production and financial su ccess. The primary research questions of study i-e what kind of sustainability is largely provided by Six Sigma in multinational companies. The multinational companies mostly reflected that Six Sigma has helped them in improving production and services ultimately translated into financial success.The primary research question was aimed to find what kind of sustainability has actually been provided by implementing Six Sigma. This has further been identified by secondary research question about core aim of Six Sigma and understanding of sustainability by multinational companies. ââ¬Å"Six Sigma has helped us achieve financial successâ⬠identified by CEO of Deere and Company. Further elaborated by CEO of Deere and Company, Six Sigma has helped us in improving human resource functions, customer services and low cost.Ultimately, all these types of sustainability are translated into financial success. ââ¬Å"Our employee satisfaction has increases which have helped to reduce materia l wastage and become process efficient. Reduced employee turnover and reduced manufacturing cost. Due to Six -Sigma implementation has considerably helped out to increase financial viabilityâ⬠. Finance Manger of Vodafone highlights the sustainability achieved through implementation of Six Sigma ââ¬Å"Vodafone market share has increased as well as its financial returns.Six-Sigma has offered us financial sustainability as well as market sustainabilityâ⬠. 12 à © 2011 The Clute Institute Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 As revealed in the present study, Six Sigma sustainability bears a multifaceted concept for organizations. Sustainability is primarily offered by Six Sigma however, every company takes the Six Sigma fr om a different perspective. It is not only the perspective which differs, rather the organizations adopts several ways to reach to a single sustainable point which is common in all organizations.Organizations? understan ding of sustainability is contrasting with the requirements of Commission on Environment and Development (1987) definition of sustainability. Multinational organizations are working for material sustainability instead of focusing on developing sustainability for creating conductive environment for future changes (Ethier, 1986). Sustainability as defined by Shrivastava and Director (1995) has not been addressed by multinational companies in its fullest. Multinational organizations? ore aim to adopt Six Sigma was either to remain competitive with the other companies or to attain zero defect level along with financial sustainability. In addition, the sustainability is taken by multinational companies in terms of effectiveness in business process which are capable enough to be translated into fi nancial success (Giardina, 2006). The concept of Giardina (2006) and Taghizadegan (2006) are closely aligned and both fit to the present understanding of organizational sustainability to be achi eved through Six Sigma.Sustainability as identified by organizations holds multiple meaning and multinational organization use Six Sigma to escalate from one sustainability to other such as optimal production to higher market share and ultimately into financial success (Muneir 2006). Actual sustainability as reflected by 3M experience and Robins Air Force Base attained financial sustainability through Six Sigma. 3M saved $1 billion by implementing Six Sigma by the way of product reformulation, process ramification and equipment redesign (Giardina, 2006).Amalgamating secondary and prime research question about sustainability provided by Six Sigma, it is evident from the study that multinational companies are more concerned with multidimensional sustainability however; the financial sustainability is mostly desired sustainability. Multinational companies are focused on achieving financial stability using different sustainability routes such as value addition, process improvement, huma n resource process improvement and market sustainability. The financial sustainabili ty is the ultimate goal however, achieved through various type of sustainability.SUMMARY AND CONCLUSIONS Six Sigma is a multidimensional approach for improving process efficiency and attaining sustainability. Six Sigma has traditionally been adopted by multinational companies due to several reasons such as higher concern for quality, higher availability to resources and competitive business environment. Initially Six Sigma was introduced by Motorola however; soon it became an advance model for improvi ng quality. Larger companies such as 3M, Deere and Company, Caterpillar, Bank of America and McGraw Hill Companies are already sustainability through Six Sigma.The study has an aim to find what kind of sustainability is being obtained by implementation of Six Sigma. Several theorists have identified several types of sustainability few including process improvement, financial sustainability, market shar e, value addition, corporate reputation ââ¬â all broadly covered under social repute, environment protection and economic growth. The study directly interacts with participants and adopts qualitative research methodology to address the subject matter. Under qualitative study, survey design and interview tools are used for making constant comparison analysis of all interviews.With constant comparison, several themes were emerged to address the primary and secondary research question. Primarily, Six Sigma is multifaceted and holds several aspects variably been considered by multinational companies. Organizations are less concerned with environment protection, moderately concerned with social repute such as competitive position in eyes o f competitors and highly concerned with economic growth. The economic growth widely covers financial returns attained through different routes such as increase in market share, economies of scale production, minimum input cost and low employee turn over.Mu ltinational companies? ultimate objective is to increase financial returns by identifying market share increase, customer base enhancement, zero defect level and competition as secondary objectives. For multinational companies, aim and sustainability of Si x Sigma varies as most of companies considers Six Sigma as a way to meet competition however, sustainability is associated with financial success. The combination of sustainability and Six Sigma ultimately translated into sustainable financial return which helps the company to increase its market competitiveness. à © 2011 The Clute Institute 13Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 Implications For Future Research Six Sigma is not a new issue nevertheless; the issue has mainly been addressed by developed counties. Mostly, the organizations that have implemented Six Sigma belong to developed nations. In few cases, companies of small underdeveloped countries have implemented Six Sigma and have reaped significant benefits from implementation of Six Sigma. The study identifies such companies and reflects on sustainability provided such as financial returns; markets share increase, environmental protection, zero defect level and o thers.In this way, it is a guide for small companies which have still not implemented Six Sigma considering it as an expensive way to quality. The study provides a guide to companies about the benefits attained through Six Sigma and serve as guidelines for companies who have not yet implemented Six Sigma. Present study is an initial research on sustainability provided to multinational companies. The study is under limited scope as it collects data from CEOs of only few companies. A large number of compa nies and their top executives are still untapped to describe several types of sustainability provided.In addition to this, sustainability with respect to industry and type of business can also be identified to customize the Six Sigma for speci fic businesses. The study is a subject measurement of sustainability generally drawn on all type nevertheless, leaving a significant margin to calculate financial sustainability provided to these companies. The study is a base for future studies as first step of id entification of top most sustainability provided by Six Sigma has been completed.The base study can be utilized for identification and statically measurement of market, financial, environmental and social sustainability provided. In addition, a comparison can be made between multinational and domestic or small vs. larger scale companies for the financial return improvement or customer base enhancement. AUTHOR BIOGRAPHY Dr. Abdullah AlSagheer is an Assistant Professor of Management at the e -School of Quality and Business Management at the Hamdan Bin Mohammed e-University. He is teaching undergraduate courses level such as TQM Implementation, Capstone Project.In addition, he is teaching graduate courses level such as Strat egic Management of Innovation and Technological change. Dr. AlSagheer has PhD in Education and Human Resource Studies specialized in Interdisciplinary Studies (Industrial and Human Recourse Management Engineering) and M. Ed Education and Human Resource Studies specialized in Interdisciplinary Studies (Industrial and Human Recourse Management Engineering) from Colorado State University (CSU). He received Master of Science in Electrical Engineering specialized in Integrated Systems & Strategic Project Management.His undergraduate degrees wer e Bachelor of Science in Computer Engineering and a double major in Bachelor of Science in Electrical Engineering from California State University Long Beach (CSULB). Dr. AlSagheer research focuses in strategic management, capstone courses, entrepreneurship and leadership, total quality management, ergonomics and human factor engineering, curriculum development, human resource management, management training, teamwork, innovation strategies, engin eering management, and industrial engineering. REFERENCES 1. 2. 3. 4. 5. 6. 7. 14 3M Lean Six Sigma and Sustainability. 2010.United Stated Environmental Protection Agency. Available [Online] http://www. epa. gov/lean/studies/3m. htm [Accessed December 08, 2010]. Antony, J. 2006. ââ¬Å¾Six sigma for service processes? , Business Process Management Journal, Vol. 12 No. 2, pp. 234 ââ¬â 248 Babbie, E. 1990. Survey research methods. Wadsworth Pub. Co. Bertels, T. , Rath & Strong. 2003. Rath & Strong's six sigma leadership handbo ok. John Wiley and Sons. Byrne, G. , Lubowe, F. , and Blitz, A. 2007. ââ¬Å¾Using a Lean Six Sigma approach to drive innovation? , Strategy & Leadership, Vol. 35 No. 2, pp. 5 ââ¬â 10 Coronado, R. B. and Antony, J. 2002. Critical success factors for the successful im plementation of six sigma projects in organizations? , The TQM Magazine, Vol. 14 No. 2, pp 92 ââ¬â 99 Ethier, W. 1986. ââ¬Å¾The Multinational Firm? , The Quarterly Journal of Economics , Vol 101 No. 4, pp- 805834 à © 2011 The Clute Institute Journal of Business Case Studies ââ¬â May/June 2011 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. Volume 7, Number 3 Fricker, A. 1998. ââ¬Å¾Measuring up to sustainability? , Futures, Vol 30 No. 4. pp-367-3 Giardina, A. 2006. Sustainability and Lean Six Sigma. Available [Online] http://proceedings. dia. org/JSEM2006/Wednesday/Giardina. pdf [Accessed December 10, 2010]. Gupta, P. 2005. The Six Sigma performance handbook: a statistical guide to optimizing results, McGraw Hill Professional, pp- 15-19 Glaser, B. G. , & Strauss, A. L. 1967. The discovery of grounded th eory: Strategies for qualitative research. Chicago: Aldine Groves, R. , Fowler, F. , Couper, M. , Lepkowski, K. , and Singer, E. 2009. Survey methodology: Volume 561 of Wiley series in survey methodology. John Wiley and Sons. Henderson, K. H. and Evans, J. R. 2000, ââ¬Å¾Successful implementation of six s igma: benchmarking General Electric company? Benchmarking: An International Journal, Vol. 7 No. 4, pp 260ââ¬â 281 Hilton, H. 2008. Managerial Accounting, 7th ed. Tata McGraw-Hil. Khan, J. 2003. ââ¬Å¾Impact of total quality management on productivity? , The TQM Magazine, Vol. 15 No. 6, pp. 374 ââ¬â 380 Leahy, T. 2000. ââ¬Å¾In search of perfection with Six Sigma? , Business Finance, Vol. 5 No. 1, pp -72-74. Mahadevan, B. 2010. Operations Management: Theory and Practice. Pearson Ed ucation India. McCarty, T. , and Fisher, K. 2007. ââ¬Å¾Six sigma: it is not what you think? , Journal of Corporate Real Estate, Vol. 9 No. 3, pp. 187 ââ¬â 196 Munier, N. 2006.Introduction to Sustainability: Road to a Better Future, Springer, pp -10-15 Our Common Future: Report of the World Commission on Environment and Development, Our Common Future, Chapter 2: Towards Sustainable Development. 1987. UN Documents. Available [Online] on http://www. un-documents. net/ocf-02. htm [Accessed Nove mber 28, 2010]. Pande, K. 2003. The Six Sigma Way. Tata McGraw-Hill. Proudlove, N. , Moxham, C. , and Boaden, R. 2008. ââ¬Å¾Lessons for Lean in Healthcare from Using Six Sigma in the NHS,? Public Money & Management, Vol. 28 No. 1, pp. 27-34, Pyzdek, T. , and Keller, P. 2009.The Six Sigma handbook: a complete guide for green belts, black belts, and managers at all levels, McGraw Hill Professional, pp -34-38 Reiling, J. 2008. Lean Versus Six Sigma: What's the Controversy? What the Differ ence? Available [Online] http://www. articlesbase. com/business-articles/lean-versus-six-sigma-whats-the-controversy-whatthe-difference-595677. html#ixzz17Y3zDWRW [Accessed December 20, 2010]. Schwandt, D. , and Marquardt, M. 2000. Organizational learning: from world -class theories to global best practices, St. Lucie Press, pp-120-31 Six Sigma. 2010 Available [Online] on http://www. managementhelp. rg/quality/sixsigma/six-sigma. htm [Accessed November 27, 2010]. Shrivastava, P. , and Director, S. 1 995. ââ¬Å¾Creating sustainable corporations? , Business Strategy and the Environment, Vol. 4 No. 3, pp-154ââ¬â165. Stocke, V. 2001. Socially desirable response behavior as rational choice: the case of attitudes towards foreigners. Sonderforschungsbereich. Taghizadegan, S. 2006. Essentials of lean Six Sigma. Butterworth -Heineman. Teddlie, C. , and Tashakkori, A. 2009. Foundations of mixed methods research: integrating quantitative and qualitative approaches in the social and behavioral scie nces. SAGE Publications Inc. Thareja P, 2006. A Total Quality Organization through People; Part 5, People as Change Agents? , Foundry, A Journal of Progressive Metal Casters, Vol. 18 No. 5, Sept/Oct. Truscott, W. 2003. Six sigma: continual improvement fo r business: a practical guide Referex Engineering, Butterworth-Heinemann, pp-15-35 Wiele, T. , Iwaarden, J. , and Power, D. 2010. ââ¬Å¾Six Sigma implementation in Ireland: the role of multinational firms? , International Journal of Qualit y & Reliability Management, Vol. 27 No. 9, pp- 1054 ââ¬â 66. à © 2011 The Clute Institute 15 Journal of Business Case Studies ââ¬â May/June 2011 Volume 7, Number 3 NOTES 16 à © 2011 The Clute Institute
Saturday, September 28, 2019
Maximizing Revenues in Minor Leagues Case Study
Maximizing Revenues in Minor Leagues - Case Study Example He carried out a research to plan on how he would come up with a ticketing system that was convenient for sports fans in Springfield. The Customer Profiles The association found out that most of the people in Springfield were not fans of professional sporting events, despite the fact that the neighboring Boston city is home to some of the worldââ¬â¢s best professional sport teams such as basketballââ¬â¢s Celtics and baseballââ¬â¢s Red Sox. Residents attended sporting events at local schools and college events. This is surprising considering the fact that Springfield is the worldwide basketball hall of fame and the birthplace of basketball. It has no professional basketball club and only one ice hockey team. Most of the diehard sports fans go to Boston to watch their favorite sport clubs playing. so for a fact Buckingham knew that there were sports fans in Springfield only that there were no enough sporting events for them to watch in Springfield so they opted for Boston. There were also the college students and little leaguers who were eager to experience professional sporting events in Springfield hence would attend matches to experience the thrill. Buckingham learnt from the general managers of sport teams in other small cities that the keys to selling the Norââ¬â¢easters to Springfield residents were professionalism, fun, simplicity, and flexibility. One of the general managers called it a family fun business since it aims at both entertaining and generating enough income to maintain the teams and to pay the players. This is as opposed to how he had thought, that games won and lost would affect the attendance of the next matches, as was the case in Major League Baseball. He also knew that the reason why most of Springfieldââ¬â¢s college populations do not attend professional sporting events is due to the pricing of the tickets, since large populations of Springfieldââ¬â¢s residents live below the average standards of living. He then had to know the charges that would be affordable to the local baseball fans. Pricing In the survey, he realized most of the MDs in other cities prefer the pricing to be like that of other entertainment events like movies, bowling and other sporting events, it should not be so high because most of the residents mind about their usage of money and would rarely pay for expensive tickets. Buckingham also got the idea of season tickets, group sales, and individual tickets. He learnt that the three helped balance the ticket revenue. Group tickets made the most sales if they priced reasonably lower than individual tickets hence the need for prompting them with little promotions to attract local customers. The promotions would include summer camp programs and family days out. One way of keeping the ticket prices low was securing corporate sponsorship to sell stadium banner ads. Another way of increasing revenue and profits was by the use of concession sales, this include snack sales, souvenirs and arcade games, though he was not quite convinced with this offer so he decided to shed more light on it in his research. By the time, Buckingham was through with the questionnaire, there were two categories of information he decided to major on. These are price sensitivity, and sports attendance. These were the key factors that would determine the success of the ticketing process. The pricing that he would come up with would determine the attendance, which is a key issue in getting revenue. There should be keenness in setting the ticket prices to suit all the target audience. Single Tickets and Season Ticket Packages Single tickets are those which sell for every
Friday, September 27, 2019
Finance & Investment Essay Example | Topics and Well Written Essays - 3250 words
Finance & Investment - Essay Example when the share is underpriced. The valuation model used to estimate the intrinsic value of a share is the present value model. Constant Growth Model is also known as Gordonââ¬â¢s Share Valuation model. It is assumed that dividends will grow at the same rate (g) into the indefinite future and that the discount rate (r) is greater than the dividend growth rate (g). The constant growth assumption may not be realistic in many situations. The growth is dividends may be at varying rates. In this model, the future time period is divided into two different growth segments such as the initial extraordinary growth period and the subsequent constant growth period. That is the flow from period 1 to N which will call V1, and the flow from period N+1 to infinity referred to as V2. Freehold property is an asset, the owners of such property require appropriate evidence about their ownership of the property. The freehold property is a fixed asset held by the owner itself. In this context, it is viewed that whenever the portion of assets increases, then the profitability of the company also goes on increasing. If there is an appreciation in assets, it will automatically lead to increases in profitability of the company as a whole; as a result, increase in profit leads to increase in dividend also. So, it is very clear that there is a direct relation between the increment of assets and thereby a corresponding increment of profits, and finally in dividend also. Moreover, whenever a person becomes the real owner of a freehold property, such a person has the right to undertake either to sell or to provide a lease of such property. ââ¬Å"Taxpayers may seek to infer that the wording "holding investments" connotes passive ownership and argue that extensive personal involvement by the deceased/transferor in the business cannot be classed as "holding investmentâ⬠. (SVM27580 - Share Valuation Manual: Business Property Relief and Agricultural Property Relief)
Thursday, September 26, 2019
Strategy Implementation - Smart Water Research Paper
Strategy Implementation - Smart Water - Research Paper Example This brand is targeted to replace carbonated soft drinks, which are believed to have high calorie intake (Griffin & Moorhead 321). Smart Water is designed to address the needs of the customers who are concerned with their health status. This ââ¬Å"Nutrient enhanced waterâ⬠has imposed strong competition, not only against other bottled water, but also against other carbonated soft drinks, of which it acts as a perfect substitute (Griffin & Moorhead 322). The Smart Water packaging is designed to conform to the companyââ¬â¢s policies and practices. The packaging is made out of sustainable and recyclable materials, which is consistence with the companyââ¬â¢s sustainable packaging policy. Key performance indicators are often used to monitor sustainable packaging (Griffin & Moorhead 323). One of the companyââ¬â¢s policies is to disclose the use of recycled materials in its products: a strategy that was successfully implemented in the production and packaging of Smart Water. Some of the companyââ¬â¢s policies and practices that relate to the packaged water include; water recycling initiatives, water efficiency targets, water efficiency process, disclosed water conserved, reveal water use at Non-US Facilities, disclose normalized water use, policies to improve the efficiency of water use, and climate change policies that address water conservation and use (Griffin & Moorhead
Wednesday, September 25, 2019
Incarceration Essay Example | Topics and Well Written Essays - 250 words
Incarceration - Essay Example The eye of the world is presently fixed on the myriad sentencing policies undertaken by different nations of the world. Also, the rate of crime is directly proportional to the incarceration for a nation. More the rates of crimes, it becomes evident for the occurrence of higher rate of incarceration. This is not the end as the remedy is to find out that why are the nations incurring higher rate of crimes. The factors like political instability, uncertainty of economic future and few other transitory factors leading to an instable society have resulted in the increase of the organised crime. Incarceration for all kinds of organised crimes also increases the cost for it. United States nationally estimates $ 26.8 billion annually for the purpose of incarceration. The third world nations are the worst victims of the incarceration. In Zaire, e.g. 7.5% of the inmates pertaining to the prison system die out of poor health, disease and mal-nutrition.
Tuesday, September 24, 2019
Project Management for Information Technology Assignment
Project Management for Information Technology - Assignment Example The applications as well as the limitations of these two models in the aspect of information technology project management are also considered. The examples of information technology projects are taken from two companies, namely Google Inc. and Microsoft Corporation and the role of culture in the success or failure of these projects are discussed and analysed. It is identified that both Google Inc. and Microsoft Corporation are extremely mature companies in terms of project management as well as in the use of information technology systems. The analysis of the examples of information technology projects in these two organizations establish that culture plays an important role in the management of different types of information technology projects. The analysis also indicates that a supportive culture is necessary for the short term as well as the long term success of these kinds of projects. The examples show that the complexity associated with the information technology projects can be managed to a high degree through the development of an appropriate culture within the organization and among its members. The report is concluded by summarizing the overall findings from the analysis of the theories and examples. Organizational culture has emerged as an important perspective in the modern business world. The role of organizational culture has been highlighted in the recent years due to many organizations experiencing issues and fallouts due to discrepancies in their project management and their respective cultures. On the other hand, a majority of the successful companies across the world are identified to have focused extensively on integrating culture in their organizational functions and capabilities. Corporate culture is also an important influencing factor in the way in which information technology projects are managed in a company. It has been identified that when an information technology project fails,
Monday, September 23, 2019
Analysis of the Article Written by Deepak Lal for the Business Research Paper
Analysis of the Article Written by Deepak Lal for the Business Standard Regarding Global Financial Crisis - Research Paper Example The savings are recycled through the international banking system on a regular basis to fuel demand. Second, cheap credit given by banks without checking the creditworthiness of the borrowers. Thirdly, the rise in the commodity prices also contributed a lot to the financial crisis and Lastly, according to him is the bailout sought by some irresponsible banks from the taxpayers telling them otherwise it will lead to the complete wiping of the financial institution. He says that the 1980 crisis was resolved when the banks hugely wrote off their Third World debt, sacked their reckless managers and shareholders also suffered large losses. But, eventually, it all came under control without threatening the world economy on a large scale. Whereas, in the current times the global financial system is sinking and bailouts are no longer an exception but have become a routine affair. The difference in outcome is because that even in the 1970s surplus money was recycled but it was done by the off -shore branches of the Parent Bank, bringing no risk to the Western Banking system, even if there was a default. Whereas, the current crisis stems from UK's financial liberalisation in the 1980s, and the Clinton era abolition of the Glass-Steagall Act, which had kept a firewall between the commercial and investment banking parts of the financial system since the 1930s. In these times no difference was kept between the Payments/deposit system of the banks and the investment banking.Ã
Sunday, September 22, 2019
Soviet Sports and the relation to politics in the cold war Research Paper
Soviet Sports and the relation to politics in the cold war - Research Paper Example Similarly, this spirit of competition was not merely limited to those states/actors that supported the West/NATO with reference to capitalism over communism. Instead, the Soviet Union actively sought to promote the superiority of its system of government through the use of its various techniques to include: the arms race, the space race, advances in technology, and prowess displayed through expertise in sporting events. This analysis will work to research the level and extent to which the Soviet Union promoted sport as a means of spreading ideology throughout the world.1 Furthermore, the analysis will seek to answer the question of how this ââ¬Å"threatâ⬠was understood by the United States and its allies. Similarly, the understanding of sport as a means towards a political end will be examined as a function of how the Soviet Union viewed these activities. However, before such an analysis is thoroughly performed, it is necessary to delve into an explanation of how the Soviet Un ion developed and fielded some of the most talented athletes that the 21st century has had to offer. Similarly, the research will work to show how the Soviet Union used sport as a means to domestically foster ideas relating to Communism, teamwork, collectivism, physical education, resourcefulness, as well as encouraging elements of national pride and patriotism. In this way, the paper will analyze the extent to which Soviet policies and ideologies directly affected the cultivation and development of the raw talent that it subsequently introduced to the world. Similarly, the scope of desired outcomes that the Soviet Union hoped to achieve from the implementation of such a broad and overarching commitment to sports will be analyzed. Development, Ideology and Vision Prior to the end of the Second World War, the Soviet Union was only represented in two international sporting unions. This was mainly due to the fact that the Soviet Union had been dedicating all its resources to marshal ac tivities involving preparing troops for the front lines. However, the arrival of peace after 1945 allowed the Soviet Union to continue to focus on building up their armed forces while fostering a robust sporting and physical fitness culture. These activities were noticed by the remainder of the world and many American observers of the time noted the rapid growth and dynamism that was portrayed by the Soviet sporting teams. One observer noted, ââ¬Å" The Central Committee of the Soviet Union had the following to say with regards to the role that sport should play in the lives of the citizen, ââ¬Å"Physical culture must be considered not only from the standpoint of physical education and health and as an aspect of the cultural, economic and military training of youth (the sport of rifle marksmanship and others), but also as one of the methods of educating the masses (in as much as physical culture develops will power and builds up endurance, teamwork, and resourcefulness and other v aluable qualities), and in addition, as means of rallying the broad masses of workers and peasants around the various Party, soviet, and trade union organizations, through which the masses of workers and peasants are to be drawn into social and political activityââ¬
Saturday, September 21, 2019
The Truman Show Essay Example for Free
The Truman Show Essay The Truman Show is a film directed by Peter Weir. It is all about how the public spend too much of their time watching television and how we also like the idea of voyeurism. The film has two main characters Christof and Truman Burbank, the latter being the star of the show, which charters Trumans life, twenty four hours a day, seven days a week, all year round. Christof has been filming Truman ever since conception. Truman doesnt know this, and in fact he knows nothing about his real family. Everything around him has been scripted and he is on a film set all the time. He is like Christofs pet, he controls everything Truman does. He controls whom Truman meets and talks to e. g. when Truman sees his father again in the streets and from out of nowhere some people come and take him away, preventing Truman from talking to him. Even the weather is controlled in the Truman Show when Truman attempts to leave the island a storm conveniently starts and only affects his boat and not the island, but when he reaches the end of the shows set the storm comes to a sudden end. The set in question is the second only manmade structure completely visible from space. He chose to pick Truman instead of the other babies in the ward, purely on the basis that Truman was born on the day of the shows launch. This was the first time in history that a television corporation has been able to adopt a baby. Because of this fact the viewers who have watched the programme since then in a way regard Truman as a surrogate child, they eagerly follow his every move. The affection the audience feel for Truman has helped the show to attract billions of viewers worldwide. This is kind of a similar affection as to that of the affection the viewers of the 7 Up television series felt towards the children who starred in the series. This programmes is a good comparison to make to The Truman Show because we follow a group of random seven year olds and every few years we return to the same group and see how they have changed in the way they think and feel, a fly on the wall programme if you will. Also The Truman Show is like a soap opera were we are familiar with all the characters but are also the cliff hangers at end of each programme are interlinked in to the next programme and help to keep the continuous flow of the series. Due to the fact that the show does not sleep. Also we finish this hybrid of modern television with an element of reality T.V. For example the Big Brother series, a show where a group of television producers headhunt the nation for an elite group of contestants to compete for a cash prize. The contestants normally consist of a funny person, a beautiful person, a homosexual, someone of different race to the rest of the group and someone who they know will act as a catalyst in the whole situation, some to upset all the other characters. There is also a connection to The Truman Show because there are multiple camera angles to let the viewer see the contestants every move. Its other appeal is that the environment is that of the classic 1950s America, Everyone knows everyone, everyone likes everyone. Everything about this small fictional town of Seahaven, a small picturesque island an island so perfect that no one has yet found reason to leave. This town is perfect for multiple reasons it could be perfect due to the perfectly manicured lawns, the white clapperboard houses or the picket fences. There is the classic old style grocery store on the corner with its brown paper bag and every worker from the shop assistant to the newspaper retailer quite often gives the American trademark phrase of Have a nice day! Which, quite honestly everyday is perfect in the sense of weather anyway. The parks and public space in this town are also super clean, there is always someone cleaning up these public areas, especially when Truman is around, all the cleaners all have earpieces on, the audience know they have earpieces to keep in contact with the shows headquarters so they can make sure Truman is still following routine, but Truman may believe they are deaf or something. But if this was 1950s America there should be no black Americans socialising with the whites due to integration. This is a sign to the audience that there are modern aspects to this classic 1950s seaside town. The Truman Show has some amazing technology going on, with over 5000 cameras constantly beaming out to the world. These cameras have multiple angles, which allow them to follow Trumans every single move, the camera loves him. These cameras are able to follow his every move thanks to the multiple places were they are hidden. They are hidden for example in the bathroom cabinet when we see him grooming himself every morning, in his mums necklace she moves it to show us what Trumans up to on several occasions, in the cars dashboard we see Truman every morning driving to work, in the bin at work we see him piecing together his first love Lauren Garlands face back together as a collage of articles from beauty magazines for the wife, also last of all we see the cameras in his boat in the mast and boats main cabin watching Christofs attempted assassination on Truman when he tries to sail away to from the island. The camera also seems to cut frequently to the shows viewers, for example, the man who always seems to be in the bath watching The Truman Show, the old ladies with their Truman show cushions and blankets who have to reassure each other that Truman is going to be OK when sailing away to freedom, the security guards eagerly watching the show in anticipation of the first televised conception. There is even a mother who leaves her baby crying in the back room just so she doesnt miss out on any of the programmes. Also, the Truman Show cut to various Truman Show bars around the world, bars that are covered in Truman memorabilia and were Truman Show fans can socialise with other Truman Show fans. These people appear to spend all their time watching the Truman Show, there is a certain sense of privileged voyeurism. They can watch other peoples lives on television without having their lives watched and interfered with, they also may be a little nosey and like to know all about other peoples lives. But with all this technology and overheads you may wonder how the Truman Show manages to cover their finances the answer to this question is answered throughout the film. At the start of the film the director informs us that the show generates the Gross.
Friday, September 20, 2019
Parkinsons Disease | Case Study Essay
Parkinsons Disease | Case Study Essay This case is about a headmaster, Mr Boddy, who was experiencing a variety of problems that increased in severity and had an ever-increasing impact on his life. The symptoms were becoming increasingly obvious to both Mr Boddy and his children which lead to him going to see his GP who referred him to a specialist. The specialist started him on a course of drug but decided to change it within less than a year. From the symptoms described in the case, it is obvious that Mr Boddy has Parkinsons Disease. The issues presented in this case were discussed and learning objectives were produced which will be explored in this essay. Anatomy and function of the basal ganglia The basal ganglia are a group of deep nuclei that are located at the base of the forebrain and are linked to the thalamus. The deep nuclei that make up the basal ganglia are the caudate nucleus, the putamen, the globus pallidus, the substantia nigra and the subthalamic nucleus. (Michael-Titus, et al., 2010)The main function of the basal ganglia is to start and maintain motor actions and they play a vital role in the decision-making processes in the brain by processing cognitive and emotional information from the environment. They also communicate with the supplementary motor cortex to organise the correct excitation of the primary motor cortex as well as scaling the strength of the response. Another function is that they adjust movement on a minute by minute basis by communicating with the cerebellum. (Buot Yelnik, 2012) The nuclei of the basal ganglia can be classified as either input nuclei or output nuclei. The input nuclei are made up of the caudate and the putamen and as they are functionally similar they are known together as the striatum. They can be seen in Figure 1 where they are coloured purple. Most of its input comes from the cerebral cortex, however it also receives some input from the other basal ganglia nuclei. (Rolls, 1994) The output nuclei are the globus pallidus, substantia nigra and subthalamic nuclei. They can also be seen in Figure 1 and are in very close proximity to the striatum. The substantia nigra is split into two parts, the pars compacta(SNpc) and the pars reticulata (SNpr). The SNpc are the cells that produce dopamine and are damaged in parkinsons which is what happened to Mr Boddy. The SNpr receives input from the striatum and sends it to the ventral anterior, ventral lateral, and mediodorsal thalamic nuclei to control head and eye movements as well as carry out other f unctions. The globus pallidus is split into the internal (GPi) and external (GPe). The function of internal part of the nucleus is to send outputs to the thalamus. However, the function of the external portion of the nucleus is not fully understood but it appears to regulate and focus activity in the rest of the basal ganglia. (Hanna, et al., 2011) Damage to the basal ganglia is what caused Mr Boddys Parkinsons disease. Neurological pathway of dopamine and neurotransmitters involved in basal ganglia pathway One of the main effects of Parkinsons is on movement and this is true with Mr Boddy as he developed a lot of movement problems. Thus, there must be a problem with the basal ganglias modulation of movement. The normal modulation of movement can be explained in terms of a brake theory. In essence, to start one movement the brakes must be applied to other movements. So damage to the basal ganglia will result in an inability to stop current movements as well as difficulty initiating movement. (Rhoades Bell, 2009) The initiation of a motor programme and the maintenance of a motor programme are respectively controlled by the dopaminergic direct and indirect pathways. Whether a motor programme is going to start or be maintained is determined by the interaction of the two pathways. So damage to the substantia nigra pars reticulata which produces dopamine has adverse effects on these two pathways and alters their function thus altering their combined effect which manifests as the symptoms of Parkinsons. The direct pathway is excitatory and the indirect pathway is inhibitory. (Lenglet, et al., 2012) The direct pathway is activated via excitatory glutamatergic neurones from the cortex. This combined with the dopamine being released from the substantia nigra pars compacta causes inhibition, via GABAergic neurones, of the internal globus pallidus which then causes the net reduction of the inhibition, via GABAergic neurones, of the thalamus. This ultimately results in the increased excitation of the cortex via glutamatergic neurones which then causes increased excitatory output from the cortex to the muscle fibres via the lateral corticospinal tract. The excitatory direct pathway can be seen in Figure 2. The indirect pathway is very similar to the direct pathway. Once stimulated by the cortex, the neurones from the striatum project onto the external globus pallidus nuclei which causes inhibition. This inhibition results in the net reduction in the inhibition of the subthalamic nucleus. This results in the subthalamic nucleus projection of excitatory, glutamatergic, inputs into the i nternal globus pallidus which causes inhibition of the thalamus and this decreases stimulation of the motor cortex. Which then results in reduced muscle activity. As with the direct pathway, the indirect pathway is illustrated in Figure 2. The reason why dopamine released from the substantia nigra can have both excitatory and inhibitory affects is because of the dopamine receptors. The dopamine receptors D1 and D5 are found in the internal globus pallidus and are excitatory. The dopamine receptors D2-D4 are found in the external globus pallidus and are inhibitory. (Lenglet, et al., 2012) In Parkinsons disease substantia nigra pars compacta have degenerated and thus are producing less dopamine. This affects the D1-D5 receptors which results in less stimulation of the direct pathway and release of the inhibition of the indirect pathway. This means that the indirect pathway becomes the dominant one which inhibits the thalamus and thus will reduce motor activity in the motor cortex. This results in the characteristic symptoms of parkinsons. A diagram of the changes can be seen in Figure 3.These changes are what caused the problems that Mr Boddy was experiencing and the increasing severity of his symptoms was most likely caused by the continuing degeneration of his substantia nigra pars compacta cells. (Wu, et al., 2012) Symptoms of Parkinsons The symptoms that Mr Boddy experienced are mainly caused by the lack of dopamine resulting in the dominance of the indirect pathway. The first symptom that he developed was sleeping problems and this was most probably caused because the body has trouble initiating a sleep cycle. So once he wakes up in the middle of the night to go to the toilet for example, then he will not be able to go back to sleep because of the under activity of the direct pathway. The loss of the sense of humour and the tremors are also caused by Mr Boddy becoming stuck in a motor programme. The pill-rolling tremor is characteristic of Parkinsons. The clumsiness and falling over occur because the basal ganglia damage means that it cannot communicate normally with the cerebellum. There are also a number of other symptoms that present in patients with parkinsons disease. Even though everyone presents with Parkinsons differently, there are a number of symptoms that are present in everyone. They are listed in Table 1. Diagnosis of Parkinsons Diagnosis of Parkinsons is made from a medical history and neurological examinations alone. This is because the only test for Parkinsons at the present time can only be performed during a post mortem. After the neurological tests and the history have been taken the NICE guidelines (Table 2) have to be applied to the finding. In Mr Boddys case, he had two of the three criteria in Step 1 as well as four of the criteria that had to be met in Step 3 to make a definite diagnosis. Lewy bodies can be found during a post-mortem of a patient with Parkinsons. They appear as spherical masses which contain abnormal alpha synuclein protein deposits and are found on the brainstem. An example of a Lewy body can be seen in Figure 4. Treatment of Parkinsons There are a number of treatments for Parkinsons disease, each with their own side effects which means that their use must be strictly controlled and monitored. The most effective class of drug at elevating the symptoms of Parkinsons is L- dopa. L-dopa is the precursor for dopamine and it can cross the blood brain barrier where it is converted to dopamine by dopa decarboxylase to restore the dopamine levels in the brain to a normal level. Dopamine itself cannot be given as it cannot cross the blood brain barrier. However, if L-dopa is given on its own it will breakdown in the body and activate the vomiting centre in the brain and cause vomiting. So to counteract this problem, it is given with a dopa decarboxylase inhibitor which stops the conversion to dopamine in the body. As it cannot cross the blood brain barrier dopamine can still be produced in the brain. The main side effect is that after a long period of use side effects known as on-off phenomenon develop. Which is where there are periods of activity (on) followed by a state of being immobile (off). The patient can suddenly switch between these two states. Another side effect is dyski nesia. (Goetz, 2007) To avoid the end of dose side effects of L-dopa other drugs that are less effective are given first to prolong the time before L-dopa has to be given and the on-off effect starts happening. One type is a dopamine agonist. They work by binding to the post-synaptic receptors in the brain and have similar effects to L-dopa. However possible side effects include nausea, vomiting and fatigue. An example is bromocriptine or rotigotine. Another class of drug that is used is Monoamine oxidase inhibitors. They work by preventing the breakdown of dopamine. Their side effects include; headache, joint pain and depression. Catechol-O-methyl transferase (COMT) inhibitor works by preventing the breakdown of L-Dopa and the adverse effects are nausea, vomiting, diahorrea and abdominal pain. An example of a COMT inhibitor is entacapone. Mr Boddy was given Rasagiline to start with which is a monoamine oxidase inhibitor. And then he was switched to L-Dopa which had a marked effect. (Longmore, 2007) Deep brain stimulation is another option for the treatment of Parkinsons. It cannot cure Parkinsons but by firing high frequency impulses into the brain it can reduce the symptoms of Parkinsons as well as reducing the adverse effects of the drugs which improves the patients quality of life. It could be suggested to Mr Boddy that he tries this option when the on-off effects start happening. (Rodriguez-Oroz, et al., 2005) Prognosis of Parkinsons If Parkinsons isnt treated then patients will be bedridden after 10 years of onset of the disease. The symptoms will advance rapidly. In people taking drugs the time taken for the disease to reach a stage where they are bed ridden is well over 15 years. (Poewe, 2006) However, the course of the disease is different in every individual with the disease progression being faster in people who are older. (Obeso, et al., 2010) Disability is linked to motor symptoms at the start of the disease but as it advances they are linked to motor symptoms that dont respond to medicine. Life expectancy for people with PD is also reduced. (Poewe, 2006) The advice that can be given to Mr Boddy is that there is no way of knowing for certain how Parkinsons will affect his future. However, the best case scenario is that he can carry on as normal for another 7 to 10 years before his symptoms greatly affect his job and family life. Conclusion In conclusion, this was a very interesting subject to look into and it made me realise how complex the disease is and how much of an impact it has on a persons life. If I had more time I would like to look further into the genetic links behind Parkinsons as well as looking into new methods of diagnosis that are being developed as I didnt have the time to do so.
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