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Clinical Director, Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
Ultimately blood pressure of athletes discount olmesartan 20mg with amex, if third parties fail to meet their obligations to us blood pressure chart based on height and weight olmesartan 20mg low price, we may lose our investment in the collaborations or fail to receive the expected benefits of our agreements with such third parties can high blood pressure medication cause joint pain best olmesartan 40mg. In addition blood pressure q10 purchase olmesartan 10mg amex, 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. Our future growth will demand that we retain talented associates and leaders while also recruiting new talent who bring new skills and perspectives. The supply of new talent is especially limited in many of the geographies that are expected to be sources of growth for Novartis, including Emerging Growth Markets such as China, where there is a limited pool of executives and functional experts with the experience needed to work successfully in a global organization like Novartis. The geographic mobility of talent worldwide is decreasing, with ample career opportunities available closer to home to talented individuals in developed and developing countries. This decrease in mobility may be worsened by anti-immigrant sentiments in many countries, and laws discouraging immigration. The necessity to adopt remote working across a portion of the workforce has accelerated our transition toward a new working model, in which a number of our associates have the flexibility to determine where, when and how they work. Our transition toward a more flexible working model accelerated our efforts to expand our sources to recruit talent from an increasingly global pool. We aspire to become less inhibited by job location requirements or candidate mobility preferences when searching for the highest caliber talent to fill openings. However, these efforts may not achieve the intended results in any particular time frame, or at all, or may have unanticipated negative consequences, including possible negative impacts on company culture and productivity. Key Information Legal and compliance Risk description Challenges in keeping up with legal and regulatory requirements, and evolving societal expectations Context and potential impact We are obligated to comply with the laws of all of the countries in which we operate and sell products with respect to an extremely wide and growing range of activities. The laws and regulations relevant to the healthcare industry and applicable to us are broad in scope and are subject to change and evolving interpretations, which could require us to incur substantial costs associated with compliance or to alter one or more of our business practices. For example, we have been, are currently and may in the future be subject to various significant legal proceedings, such as private party litigation, government investigations and law enforcement actions worldwide. These types of matters may take various forms based upon evolving government enforcement and private party litigation priorities, and could include matters pertaining to pricing; bribery and corruption; trade regulation and embargo legislation; product liability; commercial disputes; employment and wrongful discharge; antitrust; securities; government benefit programs; reimbursement; rebates; healthcare fraud; sales and marketing practices; insider trading; occupational health and safety; environmental regulations; tax; cybersecurity; data privacy; regulatory interactions; and intellectual property. Such activities can involve criminal proceedings, and can retroactively challenge practices previously considered to be legal. There is also a risk that governance for our medical and patient support activities, and our interactions with governments, public officials/institutions, healthcare professionals, healthcare organizations and patient organizations may be inadequate or fail, or that we may undertake activities based on improper or inadequate scientific justification. Our Sandoz Division may from time to time seek approval to market a generic version of a product before the expiration of patents claimed by the marketer of the patented product. We do this in cases where we believe the relevant patents are invalid or unenforceable, or would not be infringed by our generic product. As a result, affiliates of our Sandoz Division frequently face patent litigation, and in certain circumstances, we may make the business decision to market a generic product even though patent infringement actions are still pending. Should we elect to do so and conduct a so-called "launch at risk," we could face substantial damages if the final court decision is adverse to us. Legal proceedings and investigations are inherently unpredictable, and large judgments sometimes occur. As a consequence, we may in the future incur judgments that could involve large payments, including the potential repayment of amounts allegedly obtained improperly, and other penalties, including treble damages. As a result, having taken into account all relevant factors, we have in the past and may again in the future enter into major settlements of such claims without bringing them to final legal adjudication by courts or other such bodies, despite having potentially significant defenses against them, in order to limit the risks they pose to our business and reputation.
In early May 2015 blood pressure medication interaction with grapefruit discount olmesartan 10mg without prescription, a constitutional amendment bill from 2013 finally passed the Rakya Sabha (the Upper House of the Parliament of India) arterial dissection cheap 20mg olmesartan with visa, allowing for the operationalization of a Land Boundary Agreement between India and Bangladesh that was drawn up in 2011 heart attack album buy cheap olmesartan 20mg on line, although essentially agreed upon 40 years before20 wireless blood pressure monitor buy 20 mg olmesartan with amex. The issue is a post-colonial legacy of almost 200 border enclaves and counter-enclaves, as well as a solitary counter-counter-enclave (a piece of Bangladeshi territory surrounded by India, itself within a Bangladeshi enclave in India) on either side of the India-Bangladesh border21. The Agreement will see 111 Indian enclaves transferred to Bangladesh, with 51 Bangladeshi enclaves going in the opposite direction, with a net loss to India of about 40 square kilometres. The desire to clarify the extent of the border, to secure the body of the nation, has provided justification for its partial amputation23. Yet this seeming move toward simplification has encompassed contradictory directions for India, with the demarcation of insiders and outsiders moving beyond the borders of 20 Al-Jazeera, "India and Bangladesh seal land-swap deal," Al-Jazeera, June 6, 2015, accessed September 8, 2015. Modern borders: condition, performance, management the state itself with the creation in the early 2000s of Overseas Citizenship of India, granting its holders most rights associated with citizenship apart from those involving electoral office. The increasing trend towards jus sanguinis as the basis of citizenship has parallels elsewhere (in South Korea in particular), and as in other cases relies on the territorial demarcation of the state at a particular moment in time (in the case of India, the introduction of the Constitution in 1950, and thus the exclusion of Pakistanis and Bangladeshis). The bombastic celebrations in India of its striking against militants in Myanmar, and the parallels drawn with Operation Geronimo in which the United States killed Osama bin Laden, also speak to this longing for superpower status, one secure behind its border walls at home while able to strike beyond them at will. The constant ratcheting up of Homeland (in)security within the United States suggest that such a future may well prove equally illusory in a South Asian context. In a similar vein to the borders of South Asia noted above, many state boundaries and borderlands throughout Southeast Asia, such as those of Myanmar, southern Thailand, New Guinea, East Timor, and the southern Philippines, to offer some of the more obvious examples, are characterized by the most shocking violence, as local populations find themselves squeezed between state and paramilitary forces, on the one hand, and heavily armed guerrilla forces on the other. Tempting, but somewhat trite; as such conflicts are frequently driven by a confused overlap of ethnic or religious differentiation with more material issues of resource competition, the vast stakes of which swell the violence occurring far from the "civilized center" of such states. The actual "geo-coded" lines of the state tends towards secure institutionalization whilst concealing a flurry of movement across them. This is all predicated upon the maintenance of borders between distinct national economic units, creating a hierarchy of value. The economic center of the region, Singapore, has long used the adjacent borderlands of neighboring Malaysia and Indonesia, in particular, as zones in which illegal businesses not tolerated within the city-state itself have been able to flourish. Borders provide the structural conditions that drive the regions inherently inequitable economic development. This is not to claim that their postcolonial status renders such borders immutable. The March 2013 standoff at Lahad Datu in Sabah, East Malaysia between Malaysian security forces and militants associated with the Philippine Sultanate of Sulu, which claims eastern Sabah25, illustrates that there remains the potential for such territorial issues to be mobilized26. Such security incidents tend to only strengthen the enforcement of existing border regimes, with the victims being the over 25,000 Filipinos expelled from Sabah over the subsequent year for residing their illegally, many of whom had lived there for decades27. However, undoubtedly the most serious issue in this region over the past decade has little relation to populations at all, centering as it does on the South China Sea, and legitimized by possession over the scattering of islands within it. Arguably, this issue remains the most intractable precisely because it was not incorporated by Europeans into their legal-territorial framework, and consequently the islands and there surrounding seas are even more open to the 25 Map of the disputed border between Malaysia and the Philippines, accessed 12 July 2016. Modern borders: condition, performance, management claims of nationalized historical narratives. The combination of uninhabited scraps of land and potential resources has been driving an increasingly acrimonious dispute. Overlapping portions of the region have been claimed by Vietnam, Malaysia, Brunei, Indonesia and the Philippines. Both Chinas wish to claim the entire South China Sea by historical precedent, before then incorporating it into their maritime territory, although neither has set forth what exactly the nine-dash line, the basis of their claim, specifically represents. This gives rise to further worries, about whether China will also claim an Air Defense Identification Zone over the Paracels and Spratleys, as it recently did over the Diaoyu (Sen28 "Declaration on the Conduct of Parties in the South China Sea," accessed September 8, 2015. The sudden upsurge in maritime border issues represented by the South China Sea dispute also finds reflection in East Asia, where one of the main participants is, once again, a seemingly revisionist China. One week later, Prime Minister Medvedev announced his attention to visit Etorofu in August, with the Japanese government responding that such a trip to what it considers the Northern Territories would be considered "unacceptable"31. This maritime border is one of three currently disputed by Japan with its neighbors, but in some senses is of a different character to other Asian maritime disputes.
Such temporary rules are important in order for the organization to take action from day to day heart attack man purchase genuine olmesartan, but they also must be seen as forever imperfect and in need of continual improvement hypertension medication drugs cheap olmesartan 40 mg with amex. This behavior of managers is sometimes called "disagree and commit"-a necessary skill in the exercise of authority in organizations that value and preserve diversity blood pressure zones buy 40 mg olmesartan amex. One organization that I know has so deeply integrated this notion of "disagree and commit" that people who sit passively in meetings blood pressure medication hydroxyzine trusted olmesartan 10mg, who do not ask questions, or who refuse to challenge colleagues soon find themselves on the outside. Diversity of values, beliefs, opinions, and knowledge is so prized that the organization has made cognitive conflict and "disagree and commit" integral components in how it runs every meeting and how it makes every decision. This organization of over twenty thousand people is one of the most successful firms in its industry and leads the market in launching new products and maintaining market share. It has attracted and retained a wide assortment of people with differing values, experiences, and opinions, who also happen to represent a wide range of races and ethnic heritages as well as both genders. And it is an organization in which the best contributors in the field want to work. Achievement within the organizational structure, regardless of race, gender, or ethnicity, is valued above all else. The purposes of the organization are clear to all employees, and all employees can voice their opinions about those purposes. As those purposes are all related to remaining number one in their industry (and breaking into new, related areas), people find it easy to support them. This commonality of purpose provides the foundation for the variety of approaches, suggestions, and solutions that are introduced daily. This organization has learned that when organizational purposes become mutual goals that are shared by the work force, the goals tend to supersede individual differences that might interfere with their achievement. Superordinate Goals In my work I refer to the concept of all-encompassing mutual goals as "superordinate goals. Working on superordinate goals is the most underutilized yet effective means of enabling people from different cultures, races, and genders to work together successfully while simultaneously reducing their levels of prejudice and stereotyping. Even if a group fails to achieve a superordinate goal, its members stand a good chance of viewing one another with less prejudice as a result of working together. And when different people are able to work together without the interference of prejudice or stereotyping, their participation and contributions will inevitably increase and will form the foundation from which a diversity of knowledge and opinions can be expressed. Although there is a lot of emphasis on training as the preferred method for addressing diversity in organizations, training sessions will not help unless senior management is committed to creating an environment that supports and values individual differences. People who want shortcuts for dealing with those from different cultural backgrounds. These people will expect you to provide tips for getting along with and working with certain kinds of people or groups. Instead, they will want to begin immediately applying a system or model of diversity to their work situations. Affirmative action officers and diversity-training managers who have no real power to effect change. In their organizations, diversity initiatives fall into the domain of training, human resources, or affirmative action-not the domain of organizational or cultural change. Given the magnitude of the diversity problems that most organizations are facing, your efforts with these people may feel like shouting into a hurricane. What To Emphasize If you focus on the following three points, your efforts will remain headed in the right direction: 1. It must include much deeper individual designations, such as basic assumptions and values, which can be shown to have a more direct impact on the organization. Organizations must be willing to tolerate beliefs, values, and styles of work that do not represent the status quo. Only when diverse viewpoints are allowed to be constantly expressed and acted on will the organization benefit from diversity. Managing diversity is often a matter of uncovering opportunities for employees to work together on teams to achieve superordinate goals.
However ihealth blood pressure dock purchase discount olmesartan on-line, many prefer not to criticize the theory with no equivalent theory to substitute for it hypertension guidelines jnc 8 olmesartan 10mg with amex, because the void would cause an insurmountable setback arteria lusoria definition best 10mg olmesartan. Also arteria meningea anterior discount olmesartan 40 mg online, many facilitators and academics hesitate to acknowledge to learners the confusion in the motivational field if they can, instead, present a theory (even an unproven one) clearly and elegantly. For example, do college graduates in high-tech industries in Southern California have the same motivations as accountants and engineers in Cleveland thirty or thirtyfive years ago Do any of the recent migrants from Mexico, Haiti, or Southeast Asia have the same motivations as those whom Herzberg studied Answering these questions requires separating what Herzberg himself might answer (because he is a meticulous researcher) from the typical answers given by group facilitators and academics who offer watered-down theories alleged to be Herzbergian ideas. There is a difference in sound and unsound salary administration that varies importantly by organizational systems experimenting with new pay-plan designs (Schuster & Zingheim, 1992). It is likely that Herzberg ignored the pay-administration variable (the manner in which pay systems work) more than researchers would today. Today the absolute amount of pay is not as important as the way in which pay reflects performance. An adequate system of performance-based pay has hypothetically higher motivational 458 the Pfeiffer Library Volume 20, 2nd Edition. Interestingly, McGregor (1957) was aware of this and wrote a slightly convoluted piece about it in the Harvard Business Review. Kurt Lewin (1948) is reputed to have been the first to state, "There is nothing so practical as a good theory. The crispness of conceptualization of the hierarchy of needs, Theory X and Theory Y, and intrinsic and extrinsic factors was a significant virtue of these theories in their heyday. This conceptualization did not receive the attention that Maslow received in describing his original hierarchy. Existence may have several levels, but they all fulfill the same purpose: survival. Relatedness also can have levels, but the main intention is to tie the person to others. Relatedness would seem rationally to be a compelling need once existence seems assured. The level that enables the person to grow psychologically appears to be salient when the other two have been achieved. Fear-Greed Reductionism Another reduction is possible, although the alleged creator of it was not a psychologist but Joseph P. In discussing Wall Street and the New York Stock Exchange, his words-so the story goes-were something like this: "There are only two emotions that motivate people on Wall Street: fear and greed. Somehow that realization seems to have been denied in the interpretation of early research in the social sciences. But more is still the goal of organized labor and, perhaps, of other workers as well. From 1960 to 1970, one might have received the impression from some scholars that money was a minor matter in industrial employment. People need paychecks to provide the wherewithal for living in a modern industrial society. The tendency to want more and more apparently reflects the desire to amass enough money for perfect and total security. In psychology, modern expectancy theory is founded on effort-reward probabilities and mostly self-serving variables (Lawler, 1981). Exchange theory in sociology, publicchoice theory in political science, and the emerging sociobiology also focus on self- 460 the Pfeiffer Library Volume 20, 2nd Edition.
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