Estimation Of GFR Kidney Disease Health And Social Care Essay

AbstractionBackgroundPurpose of our survey was to happen out correlativity between estimated Glomerular Filtration Rate ( eGFR ) by Modification of Diet in Renal Disease ( MDRD ) expression and eGFR by Cockcroft-Gault ( CG ) equations, in patients with chronic kidney disease ( CKD ) , and to see whether they can be used interchangeably.MethodWe conducted a cross subdivision survey of 70 patients presented to the nephrology clinic over a period of one twelvemonth. We compared the eGFR by these two expressions in five phases of CKD. Abbreviated 4 variable MDRD expression was used.ConsequenceMDRD consequences were expressed in ml/min/1.73m2 and CG consequences in ml/min. Age scope was 15 – 79 old ages ; Male 49 % , Female 51 % . The correlativity ( R ) between eGFR by MDRD and eGFR by CG for CKD stages 1 to 5 was 0.64 ; 0.31 ; 0.32 ; 0.67 ; and 0.45 severally. The correlativity ( R ) between creatinine clearance by 24 hr urine aggregation to eGFR by MDRD expression was 0.84 ( P: 0.001 ) and to eGFR by CG expression was and 0.79 ( P: 0.001 ) .DecisionWe conclude that Cockcroft-Gault ( CG ) equation correlates best with MDRD expression at CKD phase 4 followed by phase one. Cockcroft-Gault expression underestimated eGFR in phases 1, 2 and 3. We speculate that standardization of Cockcroft-Gault equation to the organic structure surface country of.73m2 will farther better the correlativity but will diminish its utility on bed side. . There is a demand of a big graduated table population based survey to formalize our consequences.Index WORDSMDRD, Cockcroft-Gault, Chronic kidney diseaseIntroduction:Alteration of Diet in Renal Disease ( MDRD ) and Cockcroft-Gault ( CG ) equations are the most common methods of appraisal of Glomerular Filtration Rate ( GFR ) . Both formulas depend upon serum Creatinine to gauge GFR. Creatinine clearance measuring utilizing 24 hours urine aggregation is mostly abandoned in favour of the MDRD and CG expressions. It is chiefly because of the familial troubles in accurate aggregation of 24 hours urine. Cockcroft-Gault expression remained the most common method of bedside appraisal of GFR. It requires weight in add-on to age but still is really easy to utilize without a reckoner or computing machine. This advantage of CG expression is maintaining it alive in spite the of rapid popularity of MDRD expression. Numerous surveies are done to compare these two equations in assorted scenes. However the information from Asia particularly from Pakistan is bare [ 1 ] . Purpose of our survey was to happen out correlativity between the two equations in patients with chronic kidney disease ( CKD ) and to see whether they can be used interchangeably.MethodsWe conducted a cross subdivision survey of 70 patients presented to the nephrology clinic of a third attention infirmary in Karachi Pakistan over a period of 1 twelvemonth from January 2006 to December 2006. Aim of our survey was to happen out correlativity between estimated Glomerular Filtration Rate ( eGFR ) by Modification of Diet in Renal Disease ( MDRD ) and eGFR by Cockcroft-Gault ( CG ) equations in patients with chronic kidney disease ( CKD ) and to see whether they can be used interchangeably. Age scope was 15 – 79 old ages. Male were 49 % , female were 51 % . Patients with acute nephritic failure were excluded. All the patients in the survey were divided into five groups harmonizing to the kidney disease outcome quality enterprise ( KDOQI ) categorization of chronic kidney disease as follows: Group 1: GFR & gt ; 90 ; Group 2: GFR 90 – 60 ; Group 3: GFR 30 – 59 ; Group 4: GFR 15 – 29 and group 5: GFR & lt ; 15 ml/ min/1.73m2. Abbreviated four variable MDRD expression was used.to estimated GFR ( ml/min per 1.73 M2 ) utilizing the equation:186 x [ serum creatinine ( mg/dl ) ] -1.154 x ( age ) -0.203 x ( 0.742 if female ) . Estimated GFR utilizing the CG equation ml/min ) was calculated as follows: ( 140 – age ) ten ( weight in kilogram ) /serum creatinine ( mg/dl ) x 72 ten ( 0.85 if female ) . Measured creatinine clearance was calculated by 24 hr urine aggregation and utilizing the expression: creatinine elimination ( mg/kg per twenty-four hours ) divided by serum creatinine ( mg/dl ) divided by 14.4 ( min/d per dl/ml ) . Data was analyzed utilizing SPSS package.ConsequencesMDRD consequences were expressed in ml/min/1.73m2 and CG consequences in ml/min. Mean GFR by MDRD expression for CKD stages 1 to 5 was 111AÂ ±30, 77AÂ ±24, 39AÂ ±9, 21AÂ ±6 and 13AÂ ±4 severally. Mean GFR by Cockcroft-Gault equation for CKD phase 1 to 5 was 119AÂ ±28, 78AÂ ±13, 43AÂ ±7, 23AÂ ±3 and 12AÂ ±2 severally ( t able 1 ) . The correlativity coefficient ( R ) between eGFR by MDRD and eGFR by Cockcroft-Gault for CKD phases 1-5 was 0.64 ; 0.31 ; 0.32 ; 0.67 ; and 0.45 severally ( table 2 ) . Mean and average eGFR by MDRD was 48AÂ ±40 and 32 ( 58-7 ) severally for all patients. Mean and average eGFR by Cockcroft-Gault was 52AÂ ±42 and 36 ( 197-7 ) severally for all patients ( table 3 ) . The Cockcroft-Gault equation correlated best with MDRD expression at CKD phase four followed by the phase one. The eGFR by MDRD was lesser as comparison to by CG, in phases 1, 2 and 3. The creatinine clearance by 24 urine aggregation was correlated to the eGFR by MDRD expression. The R value was 0.84 with p value of 0.001. Similarly the creatinine clearance by 24 urine aggregation was correlated to the eGFR by CG expression. The R value was 0.79 with p value of 0.001. ( Table 4 )DiscussionAccurate measuring of GFR in chronic kidney disease can non be overemphasized. It is particularly of import when GFR reaches near phase 3 and 4. The of import determination like doing AV fistulous withers and induction of nephritic replacing therapy are taken at this clip. There were more than eight expressions introduced to gauge GFR but merely two viz. Cockcroft-Gault ( CG ) and MDRD got the credence by the medical community. The CG Formula was proposed every bit early as 1976 [ 2 ] . Because of its simpleness and bedside usage, it was readily accepted by the doctors. The CG expression enjoyed this monopoly till the MDRD equation was introduced in 1999 [ 3 ] . Twenty four hr urine aggregation for Creatinine clearance measuring is non method of pick because of several booby traps. The most of import being the 24 hr urine aggregation is frequently non accurate. In add-on the serum creatinine remains within normal scope in early phases of CKD due to increased cannular secernment ensuing in overestimate of GFR. Using Inulin clearance to mensurate GFR is really cumbrous and non practical for everyday clinical pattern. Alternatively, the radioactive and non-radioactive based markers e.g. Iothalamate, Iohexol, DTPA and EDTA are used. The isotope based GFR measurings are thought to be the most accurate but they are dearly-won and non available in many research labs. Therefore their public-service corporation is confined practically to research. They are used as a gilded criterion to formalize the truth of eGFR by MDRD or CG equations. In our survey we still used the traditional 24 hr urine aggregation to cipher creatinine clearance. We were really peculiar and thorough in giving the direction to the patients. The strong correlativity of 24 hr creatinine clearance to eGFR by CG every bit good as MDRD expression goes in favour of our premise that urine aggregation was accurate. MDRD survey equation originally required six variables viz. Serum Creatinine, Serum Albumin, Serum Urea Nitrogen, Gender, Age and Race. Later a simpler four variable equation was proposed and is considered to be a good as six variable equation [ 3 ] . This brief MDRD equation requires Serum Creatinine, Age, Gender and Race merely. It does non necessitate Serum Albumin and Serum Urea Nitrogen. The usage of standardised serum creatinine in re-expressed 4 variable MDRD expression improves the truth [ 4, 5 ] . Surveies have shown that accommodation for organic structure surface country improves the truth of Cockcroft-Gault expression [ 6,7 ] . The demand of this simpler four variable MDRD equation raised due to trouble of utilizing 6 variable equation on bedside. However still its chief drawback remains the demand of a computing machine. There are a figure of surveies comparing the MDRD to CG expression with variable consequences. Following is the reappraisal of some of import surveies. MDRD equation provides indifferent and moderately accurate estimations across broad scope of subgroups when GFR is less than 60 ( CKD Stage 3, 4 & A ; 5 ) [ 8 ] . They besides proved to be dependable for followup in CKD patients in longitudinal surveies [ 9 ] . MDRD equation performed better than CG equation in CKD, when GFR was less than 60 ml/min/ 1.73 M2. On the other manus CG equation performed better in healthy kidney givers [ 10 ] . CG expression was less precise than MDRD equation in most instances with average GFR of 59.8 ml/ min/ 1.73 M2s [ 11 ] . In another survey appraisal of GFR in older patients with CKD and average GFR of 53 ml/ min/ 1.73 m2. , the CG Formula was more precise than MDR Formula [ 12 ] . In diabetic patients MDRD every bit good as CG expression correlated good with isotopic GFR measurings, but MDRD equation turned-out to be more accurate [ 13 ] . In ill hospitalized patients the public presentation of MDRD and CG equation was compared, utilizing Iodine iothalamate as a control. MDRD equation performed better [ 14 ] . MDRD Formula as comparison to CG expression underestimates GFR in healthy persons [ 15 ] . MDRD expression was more accurate than CG expression in ESRD patients. However MDRD expression underestimated GFR when inulin clearance was more than 8 ml/min/1.73 M2 and overestimated GFR when inulin clearance was less than 8 ml/min/1.73 M2. On the other manus CG expression overestimated GFR when inulin clearance was less than 13 ml/mim/11.73 M2. [ 16 ] . In patients with CKD but normal serum creatinine, CG Formula was found to be more accurate than MDRD Formula. Measurement of GFR by endogenous and exogenic filtration markers might be the most prudent scheme [ 17 ] .DecisionWe conclude that CG Formula correlates with MDRD equation best at CKD stages 4 and overestimated GFR at phases 1, 2, 3. The two expressions may be used interchangeably at phase 4 & A ; 1. Measurement of 24 hr urine creatinine clearance may still be dependable if patients are counseled decently. Standardization of GFR for organic structure surface country of 1.73 m2.improves the truth of Cockcroft Gualt expression. We speculate that this in bend will better its correlativity with MDRD expression. However we suspect that perplexing the Cockcroft Gualt expression by including the organic structure surface country in equation will diminish its utility on bed side. It is improbable that MDRD expression will replace Cockcroft Gualt expression in clinical medical pattern shortly because of its dependence upon a computing machine plan.

The Trip Essays - 9, The Prisoners, Free Essays, Term Papers

The Trip Essays - 9, The Prisoners, Free Essays, Term Papers Ms. Hoogewerf Writing College Success 18 September 2015 The Trip Tomorrow morning! You guys get up bright and early 8 am tomorrow morning and well go. Andrews dad muttered as he staggered out of the kitchen with another beer in his hand. I was at my friend Andrews house with my other friend Ethan. We were in the middle of discussing our plans for jet-skiing the next morning. I knew the plans werent going to go as planned as his dad was obviously drunk as could be. But we eventually decided to go along with it. After forcing ourselves awake the next morning, we walked into the living room to see his dad crashed on the couch. We waited and waited, he didnt budge. Jet skiing was officially out of the picture. I told you guys he was talking nonsense I muttered to my friends as I headed back to bed. I got up early to see your dad fast asleep in front of the TV? my friend Ethan asked Andrew angrily. You guys want to go to Adventure Island instead? said Andrews mom as she walked into the room. We looked at each other hesitantly. A water park full of scre aming kids who use the pools as a toilet? What could be better on a Sunday afternoon? Sure we said shrugging. We would try to make the best out of it. After an hour or so drive later we were walking into the park. None of us had been there in a while so we didnt know quite where to start. Andrews parents found some seats near the wave pool and set all their things down. You guys meet us back here when the park closes. That was 6 hours from then. We didnt think wed need too much time to slide down some slides and splash water in strangers faces. We picked one direction and ran until we came across something interesting. We stumbled upon the entrance to a slide. This looks decent Andrew claimed. We walked through the entrance and started heading up the long spiraled stairs. Excuse me gentlemen, a line is made to wait in, not cut. We turned around to see a short shirtless man with his 2 kids behind him. And then we saw the people behind his kids. And the people behind them. We had walked by a mile long line without even realizing it. This was going to take a while. 45 minutes later, we were getting ready to slide down. It was one pers on at a time so I decided to go first. I slid down into the dark enclosed tube as water rushed by my sides and splashed into my face. The tube open up halfway through the ride and I could finally see where I was. I stuck my arms out to my sides and gripped onto the sides of the slide. With all my strength, I held myself in place from slipping any further and waited for Ethan to slide down behind me. Surely he wouldnt be expecting this. After a few seconds, he rushed up behind me and screamed as he slammed into the back of me. We laughed hysterically as we continued to hold ourselves from sliding any further. Shortly after Andrew slid down and crashed into Ethan. Whats wrong with you guys?! Andrew yelled. If we dont hurry a whole line of people is going to ram into us! he yelled pushing us forward. We finally let go of the sides and continued to slide down. We picked up more and more speed and finally fell into the pool at the end. You guys cant come down at the same time! yelled the lifeguard to the side of the pool. Sorry! We got stuck! Ethan yelled back as he climbed out of the pool. You guys are idiots, we can get kicked out for things like that Andrew said swimming up behind us. I laughed to myself as I heard him say this. Kicked out of Adventure Island? The whole world is over! I screamed sarcastically. Alright fine, act like animals Andrew said letting out a sigh. I knew we wouldnt get kicked out for spicing the experience up a

Sun Bear Facts (Helarctos malayanus)

Sun Bear Facts (Helarctos malayanus) The sun bear (Helarctos malayanus) is the smallest species of bear. It gets its common name for the white or golden bib on its chest, which is said to represent the rising sun. The animal is also known as the honey bear, reflecting its love of honey, or the dog bear, referring to its stocky build and short muzzle. Fast Facts: Sun Bear Scientific Name: Helarctos malayanusCommon Names: Sun bear, honey bear, dog bearBasic Animal Group: MammalSize: 47-59 inchesWeight: 60-176 poundsLifespan: 30 yearsDiet: OmnivoreHabitat: Southeast Asia rainforestsPopulation: DecreasingConservation Status: Vulnerable Description The sun bear has short black fur with a pale crescent-shaped bib that may be white, cream, or golden. It has a short, buff-colored muzzle. The bear has small, round ears; an extremely long tongue; large canine teeth; and large, curved claws. The soles of its feet are hairless, which helps the bear climb trees. Adult male sun bears are 10% to 20% larger than females. Adults average between 47 and 59 inches long and weigh between 60 and 176 pounds. The sun bear has curved claws and an extremely long tongue. Freder / Getty Images Habitat and Distribution Sun bears live in the evergreen tropical rainforests of Southeast Asia. Their habitat includes northeastern India, Bangladesh, Myanmar, Thailand, Malaysia, Cambodia, Vietnam, Laos, southern China, and some Indonesian islands. There are two subspecies of sun bear. The Bornean sun bear only lives on the island of Borneo. The Malayan sun bear occurs in Asia and on the island of Sumatra. Diet Sun bears, like other bears, are omnivores. They feed on bees, hives, honey, termites, ants, insect larvae, nuts, figs and other fruit, and sometimes flowers, plant shoots, and eggs. The bears strong jaws easily crack open nuts. Sun bears are hunted by humans, leopards, tigers, and pythons. Behavior Despite its name, the sun bear is largely nocturnal. It relies on its keen sense of smell to find food at night. The bears long claws help it climb and also tear open termite mounds and trees. The bear uses its extremely long tongue to lap up honey from bee hives. Male bears are more likely than females to be active during the day. Although relatively small, sun bears are known to be fierce and aggressive if disturbed. Because they live in the tropics, the bears are active year-round and do not hibernate. Reproduction and Offspring Sun bears reach sexual maturity around 3 to 4 years of age. They can mate at any time of the year. After a gestation period of 95 to 174 days, the females gives birth to one or two cubs (although twins are uncommon). Newborn cubs are blind and hairless and weigh between 9.9 and 11.5 ounces. Cubs are weaned after 18 months. In captivity, male and female bears socialize and jointly care for young. In other bear species the female raises her cubs on her own. The lifespan of highly reclusive wild sun bears is unknown, but captive bears live up to 30 years. Sun bear cubs are born blind and furless. Christian Aslund / Getty Images Conservation Status The IUCN classifies the sun bears conservation status as vulnerable. Bear populations are decreasing in size. The sun bear has been listed on CITES Appendix I since 1979. Threats While it is illegal to kill sun bears throughout their range, commercial hunting is among the species greatest threats. Sun bears are poached for their meat and gall bladders. Bear bile is used in traditional Chinese medicine and is also an ingredient in soft drinks, shampoo, and cough drops. Despite their temperament, sun bears are also illegally captured for the pet trade. The other significant threat to sun bear survival is habitat loss and fragmentation due to deforestation and human encroachment. Forest fires also affect sun bears, but they tend to recover providing there is a neighboring population. Sun bears are kept in captivity for their commercial value and for conservation. They are farmed for their gall bladders in Vietnam, Laos, and Myanmar. Since 1994, the species has been part of a captive-breeding program with the Association of Zoos and Aquariums and the European breed registry. The Bornean Sun Bear Conservation Centre in Sandakan, Malaysia rehabilitates sun bears and works toward their conservation. Sources Brown, G. Great Bear Almanac. 1996. ISBN:978-1-55821-474-3.Foley, K. E., Stengel, C. J. and Shepherd, C. R. Pills, Powders, Vials and Flakes: The Bear Bile Trade in Asia. Traffic Southeast Asia, Petaling Jaya, Selangor, Malaysia, 2011.Scotson, L., Fredriksson, G., Augeri, D., Cheah, C., Ngoprasert, D. Wai-Ming, W. Helarctos malayanus (errata version published in 2018). The IUCN Red List of Threatened Species 2017: e.T9760A123798233. doi:10.2305/IUCN.UK.2017-3.RLTS.T9760A45033547.enServheen, C.; Salter, R. E. Chapter 11: Sun Bear Conservation Action Plan. In Servheen, C.; Herrero, S.; Peyton, B. (eds.). Bears: Status Survey and Conservation Action Plan. Gland: International Union for Conservation of Nature. pp. 219–224, 1999.Wong, S. T.; Servheen, C. W.; Ambu, L. Home range, movement and activity patterns, and bedding sites of Malayan sun bears Helarctos malayanus in the Rainforest of Borneo. Biological Conservation. 119 (2): 169–181, 2004. doi:10.1016/j.biocon.2003.10. 029

The Highest Quality of Under Armour Case Study Example | Topics and Well Written Essays - 500 words - 95

The Highest Quality of Under Armour - Case Study Example It is not well established as compared to the established competitors like Nike, Puma, and Adidas, Under Armour is gain, ng lead in the industry. The function is in terms of the products abilities to conform to situations and perform as per the expectations. Since the company concentrates on the American domestic market, the information necessary to pinpoint performance is timely. Domestic sales are an indicator that Under Armour has a small sales volume. Apart from using the function system to pinpoint performance results, the company can use the area and unit system to pinpoint performance results. Benchmarking is essential to any organization (Baiman and Joel pp. 201). While aware of the existing competitors who include Nike, Reebok, Puma, and Adidas among others, the Under Armour, through benchmarking has managed to evaluate its performance. An issue of concern is its high dependence on few third-party suppliers. The competitors rely on a variety of third party providers thus easy to counter pricing and ensure efficient product distribution all over the market segments. Under Armour suffers massive losses because of relying on few suppliers who end up demanding high prices. Should the demand for suppliers’ products exceed what the company supplies, it can end up affecting its operations due to reduced access to supplies and raw materials. A key measure and standard that Under Amour upholds is obeying laws and regulations. It is an important element in its code of ethics. Launching of a new product in market demands Under Armour to observe standards of identifiability, accessibility, substantiality, and measurability. It is an indicator to show the company’s ability to assess response patterns and incorporate marketing mix in its standards. Trough this information, Under Armour can segment its market and strive to attain a competitive advantage. The strategy is in line with its recommended strategic plan, which has a passionate taglineâ€Å".

How does globalization affect the environment Essay

How does globalization affect the environment - Essay Example One area of human life that has experienced heavy issues due to globalization is the environment in which human beings live. Policy makers, environmentalist and other stakeholders have attacked globalization for impacting human environment in a negative manner. Body Disadvantages One of the main impacts of globalization is that globalization has led to increase in the spending ability of all individuals and have led to elevation in the consumption levels of human beings and this has impacted the ecological system in a negative manner. Increase in income level have made people demand for more goods and services and this has led to decrease in the natural resources that are offered by the environment. With the increase in demand for goods and services, there has been an increase in the transfer of natural resources from one region to another. Before globalization started spreading, people used to be dependent on their local manufacturers and service providers for goods and services. No w due to decrease in boundaries, people have started demanding for goods and services that are developed in foreign regions. To transfer goods and services, heavy amount of fuel is consumed which has led to degradation of the environment due to increase in pollution. The fuel used in transportation of goods has led to increase in the amount of fossil fuels burned to produce fuel. ... s waste is being dumped in oceans and this dumping process has ruined the underwater life and has led to increase in chemicals being deposited to oceans. For example: during the period of 2010, oil spill from the containers of British Petroleum ended up damaging the ocean in a very negative manner and this happens to be one of the several harmful effects of globalization on the environment (Cook, 2010, p.214). Increase in industrialization along with globalization has led to an increase in the amount of chemicals that are dumped into soil and due to this several plants as well as weeds have been produced. The waste that is toxic in nature and is dumped in soil has severally damaged plant life and had interfered with the natural way of growth of plants. Throughout the world heavy cut down of forests are taking place as wood obtained from forests is used in production of several goods such as furniture and paper. Due to this, carbon dioxide in the environment has increased and release of oxygen by plants has decreased. Similarly, cut down of mountainous regions have even been conducted to create new roads and for real estate purposes and this has long term negative impacts on human health. Plastic is being heavily used throughout that world for several purposes such as packaging and this plastic is not renewable in nature. Plastic is used in then discarded in form of waste which is negatively impacting the environment. Plastic bags tend to enter water lines as well as beaches and as plastic waste is burned, it result in emission of fumes that are toxic in nature and these fumes tend to impact the environment in a negative manner. According to Savedge, more than 100,000 marine animals experience death or are murdered by animals as they dump plastic bags in oceans and

Suatainable Development Essay Example | Topics and Well Written Essays - 1500 words

Suatainable Development - Essay Example limatics to sustainability appraisal, corporate social responsibility, transport or one planet living, sustainable development encompasses umpteenth number of such diverse issues, to make life healthier. According to the World Commission on Environment and Development, â€Å"Sustainable development is the development that meets the needs of the present without compromising the ability of future generations to meet their own needs.† (WCED 1987: 43) This report is also known as the Brundtland Report (WCED 1987). The Brundtland Report puts forward the primary objectives of sustainable development which has been stated as: The World Summit on Sustainable Development (WSSD) conducted in Johannesburg in 2002 was finally able to put sustainable development on the political agenda with the objective of accelerating the environment and development requirement of Africa intensively emphasizing on local issues like household energy, water and sanitation (â€Å"The World Summit†, 2005). More than a hundred Heads of State and Governments discussed the WSSD, the five top spectrums of which encompassed health, water, energy, agriculture and biodiversity (â€Å"The World Summit†, 2005). The UN Summit deserves the credit for bringing together governments in acknowledging a new global deal on sustainable development (â€Å"The World Summit†, 2005). While the WSSD chiefly targeted implementation rather than new visions, treaties and agreements, Rio has been responsible for the exceptionally new paradigm shift in considering sustainable development, as well as the new legally binding agreements particularly those related with biodiversity and climate change (â€Å"The World Summit†, 2005). However, the subsequent years revealed a fall in the high-level political interest and dealing with issues related to sustainable development (â€Å"The World Summit†, 2005). These issues has now been brought back again in the political agenda by the WSSD (â€Å"The World Summit†, 2005). This paved the

Change Management: Carrefour Group

Change Management: Carrefour Group Background to the organization Carrefour is a multinational company which has its retail stores almost all over the world. In the recent past it has expanded the business in the Asian Market. In the year 1995, this company had total of seven stores in Asia but in year 2004, this total went up to 126 stores which was a huge gain for the company. One of the best features of the company was that it was not affected by the economic crisis that happened and this was the biggest reason that company came up with its plan in UAE. Carrefour is an infrastructure group and the real estate was the section which was very much affected by the economic downfall but the company had enough capability to face the risk that it did not get affected (United Arab Emirates: Carrefour expands its services in retail sector). Carrefour is the second largest retail group in the entire world. Carrefour entered into UAE in the year 1995 and till now it has 11 big retail stores around UAE. And soon it will be a famous hypermarket at Dubai Sports City at Emirates Road in Dubai. The company provides as much as 6800 to 14000 sq m of area for a hypermarket in UAE. CEO: Josà ©-Luis Duran (Fortune Globe 500, 2007) Employees: 456,295 Address: 26 Quai Michelet, Levallois-Perret 92695, France (main office) Phone: 33-1-5563-3900 Website: www.carrefour.com Present Rank: 32nd in the World SWOT Analysis Strengths and Weaknesses (Internally COntrolled factors) Strengths One of the major strategic successes of the company is that Carrefour has collaboration with one of the most successful infrastructure company in the world, MAF of Abu Dhabi. This gives the company strength to the company to improve the internal built. The internal reason for the company to collaborate with MAF in UAE because of the restrictions that UAE government put on the foreign companies to start up a business in the country. In order to get the ease, this collaboration has occurred. As far as the industry average in the country in the field of real estate is seen, Carrefour is far above the industry average and the main reason is that it got unaffected at the time of economic crisis. The company is in a phase of a continuous success for the past fourteen years which is easily reflected in the financial ratios of the company which shows a continuous betterment for the past several years. The human resource management of the company is also very strong and it shows the increasing betterment in the performance matrix of the company. This gives the internal support to the company especially in the case of recruitment process. Companys standing at present is at the 32nd place which is really a remarkable success and strength for Carrefour and gives it a motivation to improve its ranking further. Due to the fact that most of the investments done by the company are huge, hence company takes a collaboration of government subsidiaries in UAE which prevent any hindrance in the future. The marketing department of the company is very highly appreciated because of the fact that the company has a huge brand value all around the world and after the success of Hypermarket at Dubai Sports City; it is going to be better and better. The financial department of the company and the research and development section are simultaneously doing a great job of understanding the financial situation of the people living in UAE and accordingly plan the investment. Hypermarket is the best suited for this purpose. Weaknesses The collaboration with MAF is absolutely very helpful for Carrefour in UAE but along with the strengths there are several weaknesses associated with this collaboration. The company does not have full freedom to take the decisions and especially the financial decision. The only area where the company can take the 100 percent decision is the operational department but otherwise there would be several restrictions posed by the collaborated companies. One of the biggest weakness can be that around three fourth of the total profit of the company is in the hands of MAF which means that the investment point of view is really weak because if any person would like to be the part of stakeholder of Carrefour, he would have to worry. There are several social concerns of the company like increasing Emiratization with in the company which means that there is a specific percentage that they have to give to the national employees. This may reduce the output of the company. It is true that economic crisis has not affected Carrefour but under the rules made by the government, there are several restrictions posed on the company which stops the company in its fast expansion. Opportunities and Threats (Externally COntrolled Factors) Opportunities There are several opportunities for the company to expand its business in UAE. The most important factor is its demography. The culture and social aspect of the country is absolutely support the advancement and enhancement of whatever the company is doing. There are several malls and several other locations which are suiting the infrastructure of Carrefour. The financial crisis in 2008 had made the situation worst for the country in the real estate structure. There are several companies which are still lagging because of that crisis. It gives a big opportunity for Carrefour to rapidly enhance the business so that there could be better prospects in the future. Dubai Sports City itself is one of the best opportunities for Carrefour group because of royal crowd and enthusiasm. Threats Of course, if there are so many opportunities for the company in UAE, then threat have to be there. The biggest threat that the company will seek is huge competition in the market. However, it would be lesser because of economic crisis of 2008 but still companies like EMAAR give Carrefour a healthy competition in the country. That too, when the company is foreign based and its major shares are not owned by the company itself. Change Identification This part of the projects deals with the different types of problems related to the identification of changes in the organization: Identification of different kind of changes which can exist Identification for the reason for such changes Identification of scopes and goals for such changes Identification of present part of the changes and comparison with the future prospects Kind of changes This project deals with the parts of the changes which have occurred in Carrefour with its collaboration with MAF in UAE to expand the business. There are several kinds of changes which company has undergone in order to commit this partnership with MAF. Several types of changes which company has seen because of this collaboration are as follows: Change in the working atmosphere in UAE Change in the policies of the company Change in the human resource activities of the company Changes in the process of implementation of work Changes in the roles and responsibilities of employees of the company Changes in the owner ship of the company In order to start for the working progress of Hypermarket in the Dubai Sports City, Carrefour went into collaboration with MAF which has brought about several changes in the organization and its working. This collaboration has affected the atmosphere of the entire organization. Being a French organization, Carrefour has absolutely a different culture and different atmosphere which prevails in the company but entering into UAE was an absolute change for the company. The change in the working process of the company is very high as it does not match to the working standards of Carrefour in other countries. There are several changes in the policies and processes and especially the ownership has a great effect because of such collaboration Reason for changes There are different reasons which have led to the growth of such changes in the organizational structure and its working process. The main of them all is ors collaboration with MAF. Entering into UAE for a foreign based company is not an easy job to do until unless company do not have any partner who is national of UAE and that too with a partnership of more than 50 percent shares of the company. Hence, company entered into the UAE market with its collaboration in MAF for making Hypermarket in the Dubai Sports City. Another reason for changes could be a sense of an easy capture to the market because of its collaboration with MAF because MAF is very well known Construction Company in UAE. Everyone in the country knows this company; it would be very much beneficial for Carrefour to enter into business in UAE having collaborated with MAF. Changes in the scope of the company Carrefour has undergone a change at the entire organizational level. There are some special areas where the company has seen a number of changes. These areas where company has seen a number of changes are as follows: Changes in the types of employees Working process of the company Levels of Departments Business process units Level of systems Above are the main areas which have undergone changes for Carrefour because of the collaboration with MAF. It was quite obvious for these areas to undergo changes because of the reason that there is a huge difference in the culture and the atmosphere of both the companies is entirely difference. One is a France based company and another is a UAE based company. Goals for Changes There are several goals which have been identified to connect them with the changes: Collaboration between Carrefour and MAF For fulfillment of law and order in UAE To benefit the name of MAF to seek the competitive advantage To make people of UAE know about the company Enhance the business Where are you now? GAP Analysis GAP Analysis basically deals with highlighting the difference between the implemented strategies and the expected strategies. There can be two different types of gap may be there, namely Knowledge Gap and Strategic Gap. The exact meaning of Gap analysis is to analyze the difference between the present situations of the company and the future prospects of the company. At the starting, it is necessary to analyze the present condition of the company and in the next situation, the future condition of the company is taken care of. Present and the future condition of the company are necessary to analyze because it gives an indication about the performance of the company. There are different types of analysis takes place in the GAP Analysis of any company. Comparison of organizational performance Comparison of marketing potential of the company Comparison of Business relationships of the company Comparison of operational activities of the company The following diagram shows the gap analysis of Carrefour. Fundamentals Applied for Changes (Kurt Lewin 3 step model) Unfreezing: This corresponds for Carrefour to getting itself ready for desired changes that it going to get in by making collaboration with MAF in UAE. Changes: This corresponds to present situation where the changes are being untaken by the company and making it happening for the customers and the staff. Freezing: This corresponds to the final approval of the changed strategies by Carrefour. Present situation of the company Carrefour is a widely known organization which operates in various countries. It sees different types of organizational culture wherever it starts its operation. This would happen in all the places and same in the case in performing operation in UAE. The culture of UAE is varied. Here, majority of the population is expatriates, which means that in this country there are people from different parts of the world. This is one of the biggest problems that the company is facing. Actually, this is not a problem but it is a concern which is so important to be taken care of by the company. Another concern with Carrefour is the restrictions which are imposed by the culture and the local government of the country on the company. These restrictions stop the company from taking various decisions due to the fact that company has a major share holding with MAF. The root of all such concerns of the company is the strict law which is followed in UAE and high number of expatriates coming in the country. But in another way, for business of Carrefour, this is profitable as well. There are some challenges associated with the present scenario of operational and all around management of Carrefour in UAE. There are several restrictions posed by the government on the foreign based companies to start up businesses in UAE. This is the biggest challenge that the company face and this needs to be soon addressed. Where do you want to be? Future State of the company This will describe the state of the company after little time (at least 5 years after the collaboration between MAF and Carrefour). The future of the company is supposed to be more in favor of MAF rather than Carrefour. The main reason behind this is that the majority of the shares of the company are held by MAF which accounts for more than 50 percent ownership of the company which means that in case of profit to the company, there will be more profit for MAF rather than Carrefour. The future prospects for the company in future are obviously growing as hypermarket in Dubai Sports City is one of the rare infrastructural buildings which are there in the city. This makes this a special place for the local population and the tourist to roam around. But the only problem which the company will have to face is that huge percentage of partnership is taken by MAF which means that huge percentage of profit will go to MAF. Another future prospect which can be helpful in generating more profit is that there is no tax charged by the government which allows the company generate more revenues and earn more money. The organizational culture in the future will be more or what same as the company has its organizational culture in Dubai at present. The organizational culture would be very much diversified. Reason being there are people coming from all over the world to this country. Around 80 percent of the total population of UAE comprises of expatriates. This means that staff in the organization will be of diversified culture. There are several steps which have to be done frequently by Carrefour. These steps are as follows: Company should well regulate its collaboration with MAF so that it can easily operate in the country Company should think of expanding the business and should keep an eye on the total earnings so that it can generate maximum possible profit Company should hire people with in the country and also should call some of the higher authorities from some of the different branches of Carrefour so that it can sustain the culture of the company in the internal matters at least. Company should formulate the strategies according to the marketing potential in the country and according to the diversified public of UAE but along with that company should also keep an eye on the laws, rules and regulations given by UAE. Company should formulate the strategies with in the company in such a manner which would help it to succeed in the plans and should help to generate more and more revenue. Readiness of the organization to undergo the changes This is one of the best possible reasons which could account for change management in the company. Carrefour, being one of the biggest organizations in real estate and infrastructure entered into the business for making hypermarket at Dubai Sports City by collaborating with MAF. There are several changes that company had to face in order to implement their business plan in the country. The biggest change that company had come up with is the organizational culture in the country which is very much different from any other country in the world. There are several restrictions on the business activities imposed on the company by the local government of UAE. The company is ready to adopt these changes in order to generate profit. It might be possible that company do not suit with such an atmosphere of organizational culture but the company is ready to accept the changes because it knows that UAE gives the best possible prospect for their business. Deliverable: To Identify whether the company is ready to adopt the changes Implementation Team Leader: Board of Directors Implementation Sponsor: Strategic Management Team PEOPLE READINESS Action Required When Completed Business Unit / Product Group Actions Were the contracts of business unit notified? Yes Were these contracts briefly explained to the team members? Yes Has the priority of business management unit set? Yes Training Has the identification of training team done? Yes Has the analysis of training been done? Yes Is the Training Information Sheet available? Yes Has the training provider been established? Yes Has all the training details provided by the coordinator? Yes Will the criterions are according to the training rollout? Yes SYSTEMS READINESS Action Required When Completed Information Communications Technology (ICT) Have tools of audit been configured? Yes Content Action Required When Completed Have the procedure published? Yes Is documentation for the procedure necessary? Yes Business Application Does deliverable require software assistance? Yes Does the distribution require any support model? Yes Have IT Business Unit been notified for support? Yes Particulars of the changes (Road Map for Changes) The main objectives which are covered in this part of the plan are: Alternative, methodologies, solutions and different ranges of actions and plans are considered especially or implementation of change Consideration of risk involved in the implementation of plan Consideration of cost to be estimated for the change to be implemented Kotlers 8-Step Change Model Following 8 steps will be used for making a road map for changes in Carrefour for its collaboration with MAF: There is a need to create urgency Formation of a powerful collaboration which the company ahs already done Company has a perfect vision which can lead to changes Communication will be done supporting this vision It is necessary for the company to remove obstacles coming in between Short term profit will be made Changes will be applied for every sector The entire organizational culture will experience the changes How will you get there? There are several changes which will be required by the organization to adopt the business sense according to the culture in the country: There are two types of strategies which will help the company to come up with the changes. These are: Rational This is quite natural that organizational structure of the company has to be changed. It requires changes according to the diversified culture of UAE. New system of workgroup and the human resource is necessary in the company so as to run the business properly in UAE. The main reason behind this is that this will be the first hypermarket in the country which means that the industry and exposure for the company is going to be new. Highly sophisticated system will be required by the company for the process because of the hugeness of the market exposure for the company in UAE Non Rational There will be change in the relationships as well. Carrefour needs to build good relationships with MAF and government of Dubai so as to get the best out of their business techniques in the country. The culture will accept the changes which will be made by Carrefour in UAE. Reason being these changes will be made according to the culture of UAE. Process Change It is required for the company to have process change as well. Process change is necessary. If it would have been a brand of some eatables, clothes, then it would have required that process should have maintained as it is every where but this is an infrastructure company. The structure of the building, shops in the hypermarket and every thing else which is a part of process in the companys operational activities need to be changed according to the destination (change management). Hence all the processes of Carrefour need to be differentiated according to the need in Dubai Sports City. There are some important process changes required by the company: Management process Recruitment process Operational process People Change In order to make changes it might be possible that job roles of the people and their responsibilities change. The biggest problem with the people change result in the de recruitment of some very intelligent people from the company so as to follow the rules and regulations of the company. Roles and responsibilities of the employees will be affected because they will be enforced to follow different prospect Knowledge and training will be entirely different, especially it would required by the employee to learn Arabic in order to work at the ground level Work practices will be entirely be different as a result of the change because these work practices would clearly adopt the culture of UAE. Third party relationships will also be built. This could be done mainly because of the relationships of MAF in the country. The relationships will be built with several agents of MAF. Carrefour will come in contact with these agent companies and will create third party relationships in the market. Information Sharing During the change in the process of Carrefour, there is some information which needs to be shared among the partners of the business. Carrefour and MAF are the two organizations who have collaborated to make hypermarket in Dubai Sports City. There is certain information which has been shared between the two organizations. These are: Financial Information (this needs to be very much critical because MAF has a huge sharing Hypermarket) Some parts of the operational information There are some policies of Carrefour which have changed due to the information sharing. These policies could be: Policies for the implementation of financial plan Policies for fixing up of prices There are several methods which are used for sharing information. These methods are: Direct Conversation In direct conversation There are some processes needed in order to manage the knowledge about the project. These processes are: Knowledge sharing process Internal Managerial Process Cost of Change Financial support is also needed to manage the changes. There are different types of cost which will be required in order to manage the organization. These costs are as follows: Cost of training the new employees in the organization Cost of integration with MAF ( all the legal formalities are included in that) Opportunity cost will also be included. This opportunity cost will be based on the opportunity of the organization to build up a hypermarket in any other country There are different modes of financial support available with the company. These are: Borrowing the money from an external source Issues shares in the share market Investment by the company itself Selling the fixed assets of the company Risk Assessment During the implementation process, it is highly possible that company will be affected by several risks. It is very much necessary that these risks are to be eliminated in order to carry out the work in a smooth manner. Risks that might be involved with the implementation of the project are as follows: Change could lead to incur losses Planning may not be effective Scope for change may not be there It is necessary to minimize the risks as well and hence following steps could be taken. In order to keep the project very much viable for the changes. It is necessary that changes are done with proper planning and keeping in view the culture with the country. For example in UAE, there is a diversified culture and hence accordingly changes should be implemented It could be possible that planning may not work well and hence alternatives should be made so that if one plan fails, company immediately can apply the other one In the case when changes are not adapted by the country and its people then obviously company should keep going with the old policies and old culture. Risk Assessment Matrix Change could lead to incur losses Likelihood Consequences Insignificant Minor Moderate Major Catastrophic Almost certain Likely Possible Unlikely Rare Planning may not be effective Likelihood Consequences Insignificant Minor Moderate Major Catastrophic Almost certain Likely Possible Unlikely Rare Scope for change may not be there Likelihood Consequences Insignificant Minor Moderate Major Catastrophic Almost certain Likely Possible Unlikely Rare Risk Assessment Table Risk no Date of occurrence Risk Description Low Medium High Mitigation action taken Approval of commencement Date 1 Change could lead to incur losses Communication Plan Made 31 August, 2010 4 Planning may not be effective Periodic Review Made 31 August, 2010 2 Scope for change may not be there Periodic Review Made 31 August, 2010 Change Approach (Developing a Critique) Main objectives of this section are: This section finds out the stakeholder of the company and their role in the company What are the barriers that come in between the growth Roles and responsibilities of change management team Stakeholder Analysis Stakeholder is the one on whose stake the company is running. There are different stakeholders of Carrefour in UAE. Strategic management team Project leader Mangers Employees Customer The below stakeholder pyramid will give an indication about the role and the responsibilities of these stakeholder in the working of the company. There are different types of roles and responsibilities described by the below pyramid like driving, active participation, advocacy, willingness and understanding. Resistance to change It is necessary that every individual working in the company is resistance to change. It is required by the organizational growth and its survival. There are some important reasons which lead to resistance among the employees of the organization: This could the feedback given by the employees This could be several inputs given by the supervisor of the company This could be results of the audit Several decisions taken on the issues of various teams Resistance Assessment Survey is taken into care for resolving all the issues related to change. This survey is attached in the appendices Change Management Team Change Management Team is vital for the organization of various activities regarding progress of change in the company. For Carrefour, a committee is formed which analysis the effect of changes which have occurred due to collaboration with MAF in UAE (Majid Al Futtaim Hypermarkets ). There are several roles and responsibilities of this committee which are there for them in order to make the change management not liable for the company. Some of the important decisions taken by the change management team of the company are as follows: Change management team performs gap analysis between the present and future trend of the company. The present trend of the company is researched and the future trend of the company are estimated which means that company a possible gap between the two trends is analyzed by the company so that it can give suggestion for the changes to take place It works for devising the project plan of the company It works for the resistance management plan of the company It works for implementation of changes It see the results of the changes which are implemented on the company and accordingly give the suggestions and the review about the research It works on upgrading the action plans and the change management plan if any flaw is found in the plan (How to write an action plan) Strategies for Implementation There are several strategies implemented for the implementation of the change plan of the company. These strategies are as follows: Action Plan: Action Plan helps in analyzing the overall achievement of the company. The main objective of this is the change management plan and all measures are taken on the basis of percentage of the completed plan Communication Plan: Communication Plan is one of the most important plans of the company because it works for establishing communication between one team member to any other team member of the company Communication Plan Audience Key Communication Delivery Medium Date Length of session (if applicable) Location Leaders of each team, Managers of each Department Action Plan Various meeting, e-mails,etc. 31st August 2010 N/A HO Agents (senders) Operational manager, project