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Digitalization and emerging business models Risk description Missed opportunities in digitalization and emerging business models Context and potential impact Organizational menstruation lupus 2.5mg femara otc, structural and cultural transformations Risk description Failure to successfully achieve our organizational womens health center xenia ohio order femara on line, structural and cultural transformations Context and potential impact From time to time we reassess our business organization to ensure we have the optimal structure with which Rapid progress in medical and digital technologies and in the development of new business models is substantially transforming our industry and is creating new businesses and new opportunities for improving patient care and increasing revenue and profit womens health yahoo answers order cheapest femara and femara, while sometimes quickly rendering established businesses uncompetitive or obsolete menstrual vomiting remedy buy 2.5 mg femara overnight delivery. For example, numerous technology companies are seeking to enter the healthcare field, which generates opportunities for partnerships and alliances for us that may accelerate innovation and complement our current capabilities, although we also may be impacted by potential innovative technological advances among our existing competitors, through partnerships and alliances with technology companies or otherwise. To take advantage of these opportunities, we are implementing a digital transformation strategy, with the goal of becoming an industry leader in leveraging advanced analytics and digital technologies. We expect to invest substantial resources into efforts to improve the way we use data in drug discovery and development; to improve the ways we engage with patients, doctors and other stakeholders; and to automate business processes. Key Information factors, including data quality, technology architecture, entering into successful partnerships and alliances with technology companies, a cultural change among our employees, attracting and retaining employees with appropriate skills and mindsets, and successfully innovating across a variety of technology fields. Our digital transformation efforts have started to gain significant traction, but we do not yet know whether they will be sustainable as they are scaled and made a part of our normal business operations. There is also no guarantee that these efforts will succeed, that we will successfully implement our digital transformation strategy, or that we will be able to do so within our budget or in the expected time frame. At the same time, other technology companies with specialized expertise or business models and substantial resources are entering the healthcare field, from research and development to pharmaceutical distribution and delivery of care. These new entrants could disrupt our relationships with patients, healthcare professionals, customers, distributors and suppliers, with unknown potential consequences for us. Such new competitors may impact our share of the healthcare value chain, or successfully develop products or technologies that could make our products or business models uncompetitive or obsolete. The risks described above may result in our business being supplanted in whole or in part by new competitors with disruptive new technologies or business models. We are therefore vulnerable to cybersecurity attacks and incidents on such networks and systems, whether our own or those of the third-party providers we contract, and we have experienced and may in the future experience such cybersecurity threats and attacks. Interruptions in the service provided by these third parties could affect our ability to perform critical tasks. Although we have experienced some of the events described above, to date they have not had a material impact on our operations. Nonetheless, the occurrence of any of the events described above in the future could disrupt our business operations and result in enforcement actions or liability, including potential government fines and penalties, claims for damages, and shareholder litigation or allegations that the public health, or the health of individuals, has been harmed. Any significant events of this type could require us to expend significant resources beyond those we already invest to remediate any damage, to further modify or enhance our protective measures, and to enable the continuity of our business. Third-party management Risk description Failure to maintain adequate governance and oversight over third-party relationships, and failure of third parties to meet their contractual, regulatory or other obligations Context and potential impact We outsource the performance of certain key business functions to third parties, and invest a significant amount of effort and resources into doing so, including to manage and oversee such third parties. Key Information functions include research and development collaborations, manufacturing operations, warehousing and distribution activities, certain finance functions, sales and marketing activities, data management and others. Some of these third parties, particularly those in developing countries, do not have internal compliance systems comparable to those within our organization. Our reliance on outsourcing and third parties for the research and development, sales or manufacturing of our products poses certain risks, including misappropriation of our intellectual property, failure of the third party to comply with regulatory and quality assurance requirements, unexpected supply disruptions, breach of the research and development or manufacturing agreement by the third party, and the unexpected termination or nonrenewal of the agreement by the third party. In addition, governments and the public expect companies like Novartis to take responsibility for and report on compliance with various human rights, responsible sourcing and environmental practices, as well as other actions of their third-party contractors around the world. Ultimately, if third parties fail to meet their obligations to us, we may lose our investment in the collaborations or fail to receive the expected benefits of our agreements with such third parties. In addition, should any of these third parties fail to comply with the law or our standards, or should they otherwise act inappropriately in the course of their performance of services for us, there is a risk that we could be held responsible for their acts, that our reputation may suffer, and that penalties may be imposed upon us. Talent management Risk description Inability to attract, integrate and retain key personnel and qualified individuals Context and potential impact Manufacturing and product quality Risk description Inability to ensure proper controls in product development and product manufacturing, and failure to comply with applicable regulations and standards Context and potential impact the development and manufacture of our products is complex and heavily regulated by governmental health authorities around the world. Whether or not our products and the related raw materials are developed and manufactured at our own manufacturing sites or by third parties, we must ensure that all development and manufacturing processes comply with regulatory requirements as well as our own quality standards. Failure to comply with regulatory requirements has resulted in, and may in the future result in, warning letters, suspension of manufacturing, seizure of products, injunctions, product recalls, failure to secure product approvals, or debarment. A failure to fully comply with regulatory requirements could also lead to a delay in the approval of new products, an inability to ship or We rely on a diverse, capable workforce across our businesses and functions. Novartis invests in attracting, recruiting, developing and retaining highly skilled individuals to achieve our business objectives. The loss of key personnel ­ including senior members of our scientific and management teams, high-quality researchers and development specialists, and skilled personnel in key markets ­ could delay or prevent the achievement of our major business objectives.

A rule of thumb is that equipment maintenance is approximately 10% of the purchase cost per year women's health center bismarck north dakota purchase femara 2.5mg overnight delivery. Another 10% per year should be saved as amortization to replace the equipment in 10­15 years women's health big book of exercises itunes purchase femara without prescription. The other components are salaries atraso menstrual 02 dias buy generic femara 2.5 mg, 497 consumables breast cancer month 2014 order femara online from canada, and building maintenance and amortization. Thus, the initial price of equipment should be multiplied by 2 in a ten year period to cover maintenance and amortization [29. A programme to encourage development and continuous education of professional staff should be part of the retention policy mentioned above. This should be based on the establishment of training programmes at the national level [29. In many ways, the process will replicate everything that happened when establishing the first facility in terms of timeline, training, selection of equipment, buildings, etc. The experience in many projects has been that adequate expansion of the radiotherapy facility was not taken into account at the time of the initial design, making it very difficult to carry out expansion. More detailed costing analysis and examples are addressed in Chapter 18 on costing in radiotherapy. The documents for tender and equipment specifications should be carefully prepared. Petereit Unforeseen developments and discoveries notwithstanding, a prediction regarding the future of radiotherapy must be based on a careful observation and analysis of current trends. In general terms, future developments in radiation oncology relate to two broad categories: developments in technology that will improve the accuracy of physical dose delivery, and developments in biology that will enhance the selectivity of cell kill by radiation, thus improving the therapeutic index. The same source predicts a total of 17 113 588 cancer cases for 2020 and 21 645 658 for 2030. The second radiotherapy course may be directed to the same previously irradiated volume (true re-irradiation), to a metastatic site or to a second primary tumour. The retreatment rate appears to be different for developed and developing countries. In developing countries, the retreatment rate tends to be lower since a higher proportion of patients present with advanced disease, reducing the number requiring retreatment for disease recurrence or a second primary tumour. The proportion of protracted radiotherapy courses versus short course treatments will affect the total number of fractions needed, which in combination with the complexity of the techniques used, will in turn determine the number of megavoltage machines needed. This table reveals that the current availability of megavoltage machines worldwide is below the number needed in 2015, and a significant increase will be necessary to cover future needs. For example, 3400 additional machines will be needed by 2020, and about 8000 additional machines to cover the projected need in 2030. Since the crude cancer incidence in the world will increase, it is not risky to assume that the demand for all three mature cancer treatment modalities (surgery, radiotherapy and systemic therapies) will increase as well. If, in the more distant future, cancer is effectively managed through genetic manipulation, it is possible that locoregional modalities of treatment, such as surgery and radiotherapy, will be used less. Until this approach becomes a reality, the result of the above exercise is cause for concern because current capacity in radiotherapy services is not sufficient to cover the needs of low and middle income countries, making the future even grimmer if decisive action is not taken. Drugs developed as countermeasures against terrorism could prove valuable as radioprotectors for cancer patients undergoing radiotherapy. For more advanced cancers treated with radiotherapy, with or without surgery and chemotherapy, the local control rates remain unsatisfactory. It is notable that the limiting factor in these examples was not excessive normal tissue toxicity but poor tumour control despite the higher doses. Accelerated radiotherapy has been somewhat more successful in a few sites such as the head and neck and lung [30. Another approach to increasing the biological dose that is worth rigorously testing is the use of charged particles heavier than protons. Irradiation of symptomatic metastases is usually employed for effective palliation.

The expert missions included radiation oncologists pregnancy zofran generic femara 2.5 mg on line, medical physicists and technologists breast cancer questions to ask 2.5mg femara overnight delivery. A series of local events related to staff led to unforeseen delays in the actual initiation of brachytherapy treatments in the new unit breast cancer jackets femara 2.5mg cheap. Gocheva-Petkova Each year breast cancer volleyball shirts 2.5 mg femara amex, hundreds of cancer patients in Bulgaria receive bone marrow transplants as treatment for haematological malignancies such as leukaemia, lymphoma and multiple myeloma, or for solid tumours such as neuroblastoma, one of the more common cancers in infancy. To undergo a bone marrow transplant, patients must first go through a preparatory process that conditions the body for the transplant. To avoid complications, patients must also receive irradiated cellular blood components during the preparatory process. To avoid this complication, patients should receive irradiated cellular blood components throughout the period of their conditioning regime. This special table allows for the positioning of the patient in such a way that the radiation can be delivered more homogeneously to the whole body and the placement of adequate shields to protect the lungs. Over the same period, 3650 blood samples of patients with different kinds of leukaemia and lymphoma have been irradiated. The hospital was officially opened on 19 July 2007 and more than 7000 new cancer patients have since been cared for. This initial project assisted the Ministry of Health in identifying concrete milestones that needed to be put in place for the successful implementation of the project. The project developed a document that dealt with: - Financing the construction of the facility and purchase of radiotherapy equipment; - Training of the seminal core staff to run the centre once constructed; - Identifying community mobilization issues. Construction was completed between 486 2003 and 2005, and in 2006 radiotherapy equipment was delivered, installed and commissioned. Through the year, planning for running costs was carried out and small equipment, treatment accessories and reference books were procured. In 2003, the core staff were identified, made up of four medical doctors, seven radiotherapists, three medical physicists, five oncology nurses and two maintenance engineers. They were sent to South Africa to train at the University of the Witwatersrand and the University of Pretoria. The training provided to staff, the expert mission services and the equipment delivered have led to an overall 487 improvement in the quality and quantity (improved access for patients) of the services delivered by the hospital. It was evident that local human resource development should be extended to other key personnel in radiation oncology, including radiation oncologists, oncology nurses, oncology pharmacists and medical physicists. No diagnostic, treatment and follow-up capacity for cancer management is available there. As is usually the case in countries without radiotherapy services, cancer patients with a need for this treatment travelled to neighbouring countries (Morocco or Tunisia) or to Europe to receive it, or switched to alternative forms of care. The number of patients sent abroad for treatment by the National Health Insurance Fund rose to 500 patients in 2007, causing a significant drain on the State budget. The National Oncology Centre, including a radiotherapy department, was built in Nouakchott in 2010 and began operation in early 2011 with a limited staff, all hired from abroad. The centre was planned with an additional bunker, where a second accelerator can be installed in the future. The centre treated a total of 250 patients in 2012 and treated 176 in the first half of 2013. Most patients undergo simulation and computerized radiotherapy treatment planning. More professional staff members are undergoing training in other Francophone African countries. Between 1991 - the date of the first official evacuation of a Mauritanian cancer patient for treatment abroad - and 2008 - the date of the establishment of the cancer centre - there was no specific support policy for cancer patients in Mauritania. As a result, the creation of the oncology centre faced three main challenges: (1) (2) (3) the total absence of basic infrastructure, including buildings and equipment; the total absence of trained human resources capable of taking care of cancer patients; Pressure from the families of hundreds of patients who had been sent abroad for treatment to rapidly establish the centre and repatriate their sick relatives. Four years later, and despite these challenges, Mauritania had an operational radiotherapy unit (Figs 28.

It works by making one or two birds acutely ill pregnancy 7 weeks symptoms cheap femara 2.5 mg amex, and they warn off the remaining birds with their cries of distress menstrual cramps icd 9 purchase discount femara. The chief mechanism of toxicity is enhancement of cholinergic transmission in the nervous system through the release of acetylcholine both centrally and peripherally breast cancer metastasis to lung cheap 2.5mg femara with amex. Because of enhanced transmission at neuromuscular junctions women's health magazine zymbiotix femara 2.5mg sale, severe muscle spasms may be a prominent manifestation of toxicity. No human poisonings have occurred as a result of ordinary use, but toxic effects following intentional ingestion have been reported. In a report of ingestion of about 60 mg, patients experienced immediate abdominal discomfort, nausea and vomiting, weakness, dizziness and profuse diaphoresis. As seen above, seizures may also occur and be severe, although recovery with supportive therapy and ventilatory support has been the usual outcome. Decontaminate the skin with soap and water, as outlined in the Chapter 3, General Principles. Treat severe muscular spasms that may occur with this agent with neuromuscular blockade in an intensive care unit setting. In contact with water, especially under acidic conditions, hydrogen cyanamide is released. It has toxic properties totally different from those of cyanide, and it does not degrade to cyanide. Toxicology While the initial ingredient, calcium cyanamide, is only moderately irritating to skin, the byproduct hydrogen cyanamide is severely irritating and caustic to skin. Dermal and mucosal lesions in the mouth, tongue and upper esophagus have occurred after exposure. Manifestations of systemic poisoning includeflushing,headache,vertigo,dyspnea,tachycardiaandhypotension,sometimes progressing to shock. Treat eye contamination by irrigating the exposed eyes with copious amounts of clean water or saline for at least 15 minutes. It was used in the past as an animal dip and disinfectant, but is currently only registered for use on heavy-duty, pressure-treated industrial products, such as railroad ties and utility poles. Some phenolic compounds such as cresol are also used as disinfectants; more information on toxicity from these compounds is found in Chapter 20, Disinfectants. Creosote is carcinogenic in animals and epidemiological evidence has suggested an association with some human cancers. Workers in contact with technical creosote or with treated timbers sometimes develop skin irritation, vesicular or papular eruptions, dermal pigmentation and occasionally gangrene and skin cancer. Eye contamination has resulted in conjunctivitis and keratitis, sometimes resulting in corneal scarring. Absorption of ingested phenolic compounds from the gut occurs promptly, and there may be significant absorption of vapor by the lung. Acute toxic effects are similar to those of Lysol, but the corrosive nature of creosote is somewhat less because of greater dilution of phenol in the creosote. Death is due to multiorgan system failure as patients develop shock, acidosis, respiratory depression and anuric renal failure. A chronic toxicosis from continuing gastrointestinal absorption (creosote used medicinally) has been described, consisting of gastroenteritis and visual disturbances. Methods to determine urinary levels of phenolic compounds using capillary gas chromatography have been described. Decontaminate the skin with soap and water, as outlined in Chapter 3, General Principles. If irritation persists after irrigation, specialized medical treatment in a healthcare facility should be obtained. Given the corrosive nature of phenolic compounds such as creosote, efforts to use an adsorbent such as charcoal (or repeated use of charcoal) depend on whether there has been corrosive injury to the esophagus. Treat severe systemic creosote poisoning in an intensive care unit setting with appropriate supportive care including respiratory support, intravenous fluids, cardiac monitoring and renal function support as necessary. Examine the urine for protein and cells, and for "smoky" phenolic excretion products. If there are any signs or symptoms suggestive of mucosal pharyngeal or esophageal injury (visible burns in the oral mucosa, stridor, drooling, dysphagia, refusal to swallow or abdominal pain) following inadvertent or unintentional ingestion, those patients should also have an endoscopy. Recognized systemic toxic mechanisms in mammals include a corrosive effect on the gastrointestinal tract (particularly from high concentrations of the free acid), cardiomyopathy and vascular injury leading to shock, and central nervous system injury, causing convulsions and respiratory depression.

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