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Costs of consultation, investigation, hospitalization and medication may be beyond the means of poor people, especially those who do not have welfare benefits or medical insurance plans. This seriously hampers the provision of care to patients who are otherwise able to seek medical attention. Although hospital care represents a large proportion of the costs of stroke, institutional care also contributes significantly to overall stroke care costs. Most developing countries do not have well-established facilities for institutional care. The bulk of long-term care of the stroke patient is likely to fall on community services and on family members, who are often ill equipped to handle such issues. There is thus a need for appropriate resource planning and resource allocation to help families cope with a stroke-impaired survivor. Priorities for stroke care in the developing world Governments and health planners in developing countries tend to underestimate the importance of stroke. To compound this difficulty, 80% of the population in developing countries live in rural areas, a factor that limits access to specialized services. In these parts of the world, top priority for resource allocation for stroke services should go to primary prevention of stroke, and in particular to the detection and management of hypertension, discouragement of smoking, diabetes control and other lifestyle issues. To achieve this task, stroke prevention awareness must be neurological disorders: a public health approach raised among health-care planners and governments. Another priority is education of the general public and health-care providers about the preventable nature of stroke, as well as about warning symptoms of the disease and the need for a rapid response. Furthermore, allocation of resources for implementation and delivery of stroke services. Finally, it is very important to establish key national institutions and organizations that would promote training and education of health professionals and dissemination of strokerelevant information. The primary focus of this international collaboration will be to harness the necessary resources for implementing existing knowledge and strategies, especially in the middle and low income countries. The purpose of this strategy is threefold: to increase awareness of stroke; to generate surveillance data on stroke; and to use such data to guide improved strategies for prevention and management of stroke (20). The Global Stroke Initiative is only possible through a strong interaction between governments, national health authorities and society, including two major international nongovernmental organizations. Increasing awareness and advocacy among policy-makers, health-care providers and the general public of the effect of stroke on society, health-care systems, individuals and families is fundamental to improving stroke prevention and management. Advocacy and awareness are also essential for the development of sustainable and effective responses at local, district and national levels. Policy-makers need to be informed of the major public health and economic threats posed by stroke as well as the availability of cost-effective approaches to both primary and secondary prevention of stroke. Health professionals require appropriate knowledge and skills for evidence-based prevention, acute care and rehabilitation of stroke. Relevant information needs to be provided to the public about the potential for modifying personal risk of strokes, the warning signs of impending strokes, and the need to seek medical advice in a timely manner. One of the major problems of stroke epidemiology is the lack of good-quality epidemiological studies in developing countries, where most strokes occur and resources are limited. This flexible and sustainable system includes three steps: standard data acquisition (recording of hospital admission rates for stroke), expanded population coverage (calculation of mortality rates by the use of death certificates or verbal autopsy), and comprehensive population-based studies (reports of nonfatal events to calculate incidence and case-fatality). These steps could provide vital basic epidemiological estimates of the burden of stroke in many countries around the world (20). Further increase of stroke mortality is expected, with the majority of deaths from stroke to occur in less developed countries. By 2015, over 50 million healthy life years will be lost from stroke, with 90% of this burden in low and middle income countries. In developed countries, up to 80% of strokes represent ischaemic stroke, while the remaining 20% are attributed to either intracerebral or subarachnoid haemorrhage. Non-contrast computerized tomography is a reliable diagnostic tool allowing proper differentiation between ischaemic and haemorrhagic stroke and excluding other causes of brain damage. Advent of thrombolytic therapy together with development of stroke units leads to a reduction of mortality and disability caused by stroke. Immediate aspirin treatment of ischaemic stroke is beneficial in terms of reducing early stroke recurrence and increasing disability-free survival.
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Information on population needs must be synthesized and disseminated in a way that encourages commitment from decisionmakers. Communication methods such as media features and the identification and engagement of community leaders can be used to help build alliances between different stakeholders. Increase public and professional awareness Public and professional awareness of public health aspects of neurological disorders needs to be raised through the launch of global and local campaigns and initiatives that target health professionals, general practitioners and primary care physicians, specialists in public health, neurologists, health planners, health economists, the media and the general public. Another route of sensitization is the development of educational programmes on the public health aspects of neurology (taking into account local practices and traditions) and including them in the teaching and training curricula of all institutions where neurology is taught. Self-help groups, patient information programmes and basic educational and training interventions for caregivers need to be encouraged and facilitated. Patients, their families and carers should be represented and fully involved in the development and implementation of policies and services for people with neurological disorders. The ultimate goal of all such efforts should be to prevent the isolation of patients with neurological disorders and their families and to facilitate their social integration. The dignity of people with neurological disorders needs to be preserved and their quality of life improved. Development of social and health policies for minimizing stigma must take into consideration such key issues as access to care and financing health care, as well as basic human rights. Driving privileges for people with controlled epilepsy indicates practical needs for policy to examine not just personal and public safety, but also how stigma, culture, liability and ethics interact. Legislation represents an important means of dealing with these problems and challenges. Governments can reinforce the efforts with laws that protect people with brain disorders and their families from abusive practices and prevent discrimination in education, employment, housing and other opportunities. Legislation can help, but ample evidence exists to show that alone it is not enough. For example, efforts to alleviate the stigma of epilepsy need to be focused on helping individuals acknowledge and adjust to life with treatable disease in a large number of cases. Information, education and communication and social marketing campaigns need to enhance compassion and reduce blame. In the case of other diseases, for example leprosy, the control programme can be made effective by use of a simple message that leprosy can be cured with medicines. Strengthen neurological care within the existing health systems the most promising approach for reducing the burden of neurological disorders in developing countries is a comprehensive system of primary health care: primary care services supported by secondary and tertiary care facilities, physicians and specialists. Primary care is the point of entry for the vast majority of people seeking medical care - indeed, for many people it is their sole access to medicine. Moreover, because primary care teams work in the community, they are well placed to recognize factors such as stigma, family problems and cultural factors that affect treatment for neurological disorders. Thus, primary care is the logical setting in which neurological disorders need to be dealt with. For example, effective management of headache disorders can be provided in primary care for all but a very small minority of patients, as the common headache disorders require no special investigation and they can be diagnosed and managed with skills generally available to health-care professionals working in primary care settings. A careful analysis is required of what is and what is not possible for the treatment and care of neurological disorders at different levels of care. It is thus very important to establish a referral system for management of severe cases and patients requiring access to diagnostic and technological expertise. What is needed is a continuing, seamless care approach to handle the long-term nature of neurological disorders and the call for ongoing care. Incorporate rehabilitation into the key strategies Rehabilitation complements the other key strategies, promotion, prevention and treatment. While prevention involves targeting risk factors of disease and treatment is dealing with health conditions, rehabilitation targets human functioning. Though rooted in the health sector, rehabilitation is also a relevant strategy that brings together other sectors such as education, labour and social affairs. There is a wide range of rehabilitation interventions, programmes and services that have been shown to be effective in contributing to optimal functioning of people with neurological conditions. Rehabilitation services need to be made available to all people with disabilities, and this includes people with disabilities attributable to neurological disorders.
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Patients with severe persistent rhinitis have asthma more often than those with intermittent disease (80). Although differences exist between rhinitis and asthma, upper and lower airways may be considered as a unique entity influenced by a common and probably evolving inflammatory process, which may be sustained and amplified by intertwined mechanisms (51). According to more recent studies, the prevalence of allergic rhinitis has increased, in particular in countries with a low prevalence (8290). In a recent study in the general population in Europe, the prevalence of allergic rhinitis was around 25% (35, 36). The prevalence of an IgE sensitization to aeroallergens measured by allergen specific IgE in serum or skin tests is over 40% of the population in Australia, Europe, New Zealand and the United States of America (57, 9193). Most but not all of the sensitized subjects are suffering from allergic rhinitis or asthma or both. The sequential development of allergic disease manifestations during early childhood is often referred to as the "allergy march" (94). Various epidemiological and birth-cohort studies have begun to elucidate the evolution of allergic disease manifestations and to identify populations at risk for disease (95, 96). These studies emphasize the effects of environmental factors and genetic predisposition on the allergy march. In the allergy march, atopic dermatitis and asthma are linked, but atopic dermatitis does not necessarily precede asthma, whereas allergic rhinitis is a risk factor for asthma and can precede asthma (9799). In most low and middle income countries, the prevalence of active smoking in adults with asthma is about 25%. Compared to nonsmokers with asthma, active smokers have more severe asthma symptoms (100), an accelerated decline in lung function (101) and a reduced response to corticosteroid therapy (102). Every effort should be made to encourage individuals with asthma who smoke to stop (103). Chronic obstructive pulmonary disease was the fifth cause of death in 2002 and it is projected to be the fourth cause of mortality by 2030 (104). Tobacco smoking is the major risk factor, but the use indoors of solid fuels for cooking and heating also presents major risks. Strategies to reduce exposure to major risk factors are likely to have an impact on morbidity and mortality. Table 7 Definitions of chronic bronchitis, emphysema and chronic obstructive pulmonary disease Disease Chronic bronchitis Reference 108 Definition Clinical definition Chronic productive cough for 3 months in each of 2 consecutive years in a patient in whom other causes of productive chronic cough have been excluded. Permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis. Preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs in response to noxious agents including cigarette smoke, biomass fuels and occupational agents. This classification was found to correlate with pathologic findings (112) and the prediction for mortality (113). Respiratory failure is defined as arterial partial pressure of oxygen (PaO2) less than 8. It is a major cause of chronic morbidity and mortality worldwide (107) and is projected to rank seventh in 2030 as a worldwide burden of disease (104). It has been estimated to range from 4% to up to 20% in adults over 40 years of age (120125), with a considerable increase 22 by age, particularly among smokers. These are attributable to many factors, including differences in diagnostic methods, year of study, age of the population, and prevalence of main risk factors such as tobacco smoking. In China, chronic respiratory diseases are the second leading cause of death (32). It is estimated that over 50% of Chinese men smoke, whereas smoking rates among women are lower in this country (159). Recent studies from the same authors (162, 163) show a prevalence of respiratory symptoms in 6% 7% of non-smokers and up to 14% of smokers. The proportion of deaths from various diseases, as reported in the United States, is shown in Figure 10 (174).
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Other approaches include: selecting targets based on stimulability, personal relevance. Treatment Approaches: Contextual Utilization Contrast Therapy Treatment starts with practicing syllable based contexts in which the sound is produced correctly. For example, a /s/ may be more easily produced in the syllable with a high front vowel (MacDonald, 1964; Bleile, 2002). Minimal pairs are different by one feature or phoneme that changes the word meaning (tip vs. Maximal pairs use a sound target differing by several distinctive features which affect phoneme placement and manner to introduce sounds that the child cannot produce (beat vs. Used with children who are highly unintelligible due to inconsistent misarticulations and may not respond well to traditional therapy. Words the child commonly uses are selected for practice and feedback is provided to reinforce the most accurate production of each word (Dodd, Holm, Crosbie, & McIntosh, 2006). Focuses on improving phonological patterns with a strategy similar to normal sound acquisition. It is used with children who have poor intelligibility, characterized by numerous omissions and limited phonemic inventories. Each cycle targets all phonological patterns in error until they emerge in spontaneous speech (Hodson & Paden, 1983). Focuses on sound features the child cannot produce (nasals, fricative, voicing, placement) and is usually used with children who substitute sounds. Error patterns are targeted using tasks such as minimal pair contrasts; usually once a contrast pattern emerges, it can be generalized Core Vocabulary Approach Cycles Approach Distinctive Features Therapy © 2019 eviCore healthcare. Examples are descriptive and provide information about how a sound is produced. Uses everyday activities to elicit the target sound frequently during the session. For example, the child is asked about a toy that involves responses using the targeted sound. Speech perception tasks are used to help the child gain a consistent perception of the target sound. Usually used prior to or at the same time as speech production intervention (Rvachew, Rafaat, & Martin, 1999). Metaphon Therapy Naturalistic Speech Intelligibility Intervention Speech Sound Perception Training Referral Guidelines for Speech Sound Disorders If speech intelligibility does not improve or improvement has reached a plateau: Refer patients to the referring physician or specialist. Consult with a specialist in the field of augmentative and assistive communication systems Refer to local support groups Home Medical Equipment Augmentative and assistive communication device Self-Management Techniques Train the individual and parents to follow a home program Alternatives to Speech Sound Disorders Treatment Treatment Plan Timeline Frequency and duration of services is based upon the specific needs of the individual at the time of the evaluation. Early stages of treatment Explore factors that could impact outcomes now and in the future Explore strengths and weaknesses; breakdowns in production, stimulability, self-monitoring, and other components for best treatment outcomes Explore patient and family understanding, challenges, and capabilities to develop education and training program Develop treatment program based on findings and best practices for this patient © 2019 eviCore healthcare. American Speech-Language-Hearing Association Speech Sound Disorders: Articulation and Phonology. Evidence-Based Practice for Children with Speech Sound Disorders: Part 1 Narrative Review. Remediation of Phonological Disorders in Preschool Age Children: Evidence for the Cycles Approach. Speech and Language Therapy Interventions for Children with Primary Speech and Language Delay or Disorder. Non-Speech Oral Motor Treatment for Children With Developmental Speech Sound Disorders. Target Selection in Speech Therapy: Is a NonDevelopmental Approach More Efficient Than a Developmental Approach? Definition Spoken language disorders in children are characterized as deficiencies in the understanding and/or use of spoken language. The impairment may involve the form of language (phonology, morphology, and syntax), the content of the language (semantics), the function of the language in communication (pragmatics), or any combination of the above. Difficulty initiating communication in a structured environment Possible Consequence or Cause Early interventions for infants and toddlers with expressive language delays-birth to 48 months Language Expression Delay in children older than 4 years © 2019 eviCore healthcare.
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We see this as an opportunity given our strong internal research capabilities, and we expect to sustain long-term growth in part through our 15 ongoing and upcoming major launches. These trends could help society address the changing healthcare needs of aging populations and produce better health outcomes for patients. In addition, drug pricing is an increasingly prominent issue in many countries as healthcare spending continues to rise. This impacts our ability to establish satisfactory rates of reimbursement for our products by governments, insurers and other payers, which could affect our ability to generate returns and invest for the future. We expect loss of market exclusivity and the introduction of branded and generic competitors to continue to significantly erode sales of our products. Our ability to grow depends on the success of our research and development efforts to replenish our pipeline, as well as on the commercial acceptance of our products. We may also fail to take advantage of rapid progress in new technologies and in the development of new business models. Third parties may enter the healthcare field, which could increase the competition we face or supplant portions of our business. Our manufacturing processes are technically complex and subject to strict regulatory requirements, which introduce a greater chance for supply disruptions and liabilities. We have a significant global compliance program in place, but any failure to comply with local laws could lead to substantial liabilities and harm our business and our reputation. We carry a significant amount of goodwill and other intangible assets on our consolidated balance sheet, and may incur significant impairment charges in the future. Tax authorities around the world have increased their scrutiny of company tax filings. This could lead to an increased risk of international tax disputes and an increase in our effective tax rate. For more details on these trends and how they could impact our results, see "-Factors affecting results of operations" below. Sales growth was driven by volume growth of 12 percentage points, mainly driven by Cosentyx, Entresto, and Zolgensma for the Novartis Pharmaceuticals business unit and Promacta/Revolade, Kisqali and Lutathera for the Novartis Oncology business unit. The strong volume growth was partly offset by the negative impacts of pricing (2 percentage points) and generic competition (1 percentage point). This increase was driven by higher net income adjusted for non-cash items and other adjustments, including divestment gains. The increase was mainly driven by higher operating income adjusted for non-cash items. We also present our core results, which exclude the impact of amortization, impairments, disposals, acquisitions, restructurings and other significant items, to help investors understand our underlying performance. Emerging Growth Markets sales grew (+6%, +12% cc), led by double-digit growth in China, including the launches of Cosentyx and Entresto. Three additional facilities in Les Ulis, Stein, and Japan have started manufacturing clinical batches. Novartis acquired Xiidra from Takeda and began recording sales as of July 1st, 2019. Dermatology teams help support commercial efforts of Xolair in chronic spontaneous urticaria/chronic idiopathic urticaria. New data from trials were presented at 2019 congresses, including the American Academy of Neurology Annual Meeting. It has now been launched in 38 countries for the preventive treatment of migraine and additional launches are underway. Amgen issued a termination notice in April 2019, based on an alleged material breach of the collaboration agreements, and this notice, as well as other ancillary matters, are the subject of legal proceedings between Novartis and Amgen. Growth for both indications benefited from the recent approval of Xolair for home-use in Europe and strong performance in Emerging Growth Markets. Core adjustment were broadly in line with the prior year as higher legal provisions were offset by higher divestment income and lower restructuring. Core gross margin was broadly in line with prior year as productivity improvements were offset the ramp up of capacity for cell / gene therapies and lower other revenue (-0. The change in core adjustments compared to prior year was driven mainly by higher impairments of intangible assets and property, plant and equipment, higher restructuring charges mainly from the ongoing transformation, net changes in legal settlements and lower divestment income.
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The lateral part of the hypothalamus responds primarily to cues to start eating, whereas the ventromedial part of the hypothalamus primarily responds to cues to stop eating. If the lateral part of the hypothalamus is damaged, the animal will not eat even if food is present, whereas if the ventromedial part of the hypothalamus is damaged, the animal will eat until it is obese (Wolf & Miller, 1964). Glucose is the main sugar that the body uses for energy, and the brain monitors blood glucose levels to determine hunger. Glucose levels in the bloodstream are regulated by insulin, a hormone secreted by the pancreas gland. When insulin is low, glucose is not taken up by body cells, and the body begins to use fat as an energy source. Eating and appetite are also influenced by other hormones, including orexin, ghrelin, andleptin (Brennan & Mantzoros, 2006; Nakazato et al. Normally the interaction of the various systems that determine hunger creates a balance or homeostasis in which we eat when we are hungry and stop eating when we feel full. But homeostasis varies among people; some people simply weigh more than others, and there is little they can do to change their fundamental weight. A naturally occurring low metabolic rate, which is determined entirely by genetics, makes weight management a very difficult undertaking for many people. When researchers rigged clocks to move faster, people got hungrier and ate more, as if they thought they must be hungry again because so much time had passed since they last ate (Schachter, 1968). Eating Disorders In some cases, the desire to be thin can lead to eating disorders, which are estimated to affect about 1 million males and 10 million females the United States alone (Hoek & van Hoeken, 2003; Patrick, 2002). Anorexia begins with a severe weight loss diet and develops into a preoccupation with food and dieting. Bulimia nervosa is an eating disorder characterized by binge eating followed by purging. Bulimia involves repeated episodes of overeating, followed by vomiting, laxative use, fasting, or excessive exercise. The cycle in which the person eats to feel better, but then after eating becomes concerned about weight gain and purges, repeats itself over and over again, often with major psychological and physical results. Eating disorders are in part heritable (Klump, Burt, McGue, & Iacono, 2007), and it is not impossible that at least some have been selected through their evolutionary significance in coping with food shortages (Guisinger, 2008). Obesity Although some people eat too little, eating too much is also a major problem. Obesity is a medical condition in which so much excess body fat has accumulated in the body that it begins to have an adverse impact on health. Its prevalence is rapidly increasing, and it is one of the most serious public health problems of the 21st century. Although obesity is caused in part by genetics, it is increased by overeating and a lack of physical activity (Nestle & Jacobson, 2000; James, 2008). Dieting is difficult for anyone, but it is particularly difficult for people with slow basal metabolic rates, who must cope with severe hunger to lose weight. Although most weight loss can be maintained for about a year, very few people are able to maintain substantial weight loss through dieting alone for more than three years (Miller, 1999). Although dieting alone does not produce a great deal of weight loss over time, its effects are substantially improved when it is accompanied by more physical activity. People who exercise regularly, and particularly those who combine exercise with dieting, are less likely to be obese (Borer, 2008). Exercise increases cardiovascular capacity, lowers blood pressure, and helps improve diabetes, joint flexibility, and muscle strength (American Heart Association, 1998). Almost half of the people who start an exercise regimen give it up by the 6-month mark (American Heart Association, 1998). Successful reproduction in humans involves the coordination of a wide variety of behaviors, including courtship, sex, household arrangements, parenting, and child care. The Experience of Sex the sexual drive, with its reward of intense pleasure in orgasm, is highly motivating.
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Due to the risks and uncertainties involved in progressing through preclinical development and clinical trials, and the time and cost involved in obtaining regulatory approvals, among other factors, we cannot reasonably estimate the timing, completion dates and costs, or range of costs, of our drug development program, or of the development of any particular development compound (see "Item 3. In addition, for a description of the research and development process for the development of new drugs and our other products, and the regulatory process for their approval, see "Item 4. E Off-balance sheet arrangements We have no unconsolidated special purpose financing or partnership entities or other off-balance sheet arrangements that have or are reasonably likely to have a current or future effect on our financial condition, changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures or capital resources, that is material to investors. Financial Statements Note 2 Significant transactions significant pending transactions". The Group intends to fund the research and development; property, plant and equipment; intangible asset purchase commitments with internally generated resources, and the acquisition of business commitment through available cash and short- and long-term borrowings. The acquisition of business commitments relate to the acquisition of the Medicines Company (see "Item 18. Significant transactions -Significant Transactions entered into in 2019 and closed in January 2020") and to the pending acquisition of the Japanese business of Aspen Global Incorporated (see "Item 18. C Board practices-Corporate governance- Executive Committee" is incorporated by reference. During 2019, the committee continued to engage with shareholders and proxy advisors to gather feedback on the compensation system for the Executive Committee and our disclosures. Our recent transactions in M&A are strengthening our innovation programs and further supporting our strategy to become a leading, focused medicines company. Recently launched products, including Zolgensma, Piqray and Beovu, also contributed to our growth. For the Executive Committee, the requested maximum aggregate amount of compensation remains broadly unchanged compared to the prior year. Shareholders will also be asked to endorse this Compensation Report in an advisory vote. On behalf of Novartis and the Compensation Committee, I would like to thank you for your continued support and feedback, which we consider extremely valuable in driving improvements in our compensation systems and practices. The payout range remains at 0% to 200% of target opportunity based on achievement against performance. Directors, Senior Management and Employees 2019 Board compensation system the compensation system applicable to the Board of Directors is shown below, and remains unchanged since prior year. All fees to the Board members are delivered at least 50% in equity and the remainder in cash. Directors, Senior Management and Employees Executive Committee compensation philosophy and principles Novartis compensation philosophy Our compensation philosophy aims to ensure that Executive Committee members are rewarded according to their success in implementing the Company strategy, and their contribution to Company performance and longterm value creation. Pay for performance Shareholder alignment · Variable compensation is tied directly to the achievement of strategic Company targets · Our incentives are significantly weighted toward long-term equity-based plans · Measures under the Long-Term Incentive plans are calibrated to promote the creation of shareholder value · Executive Committee members are expected to build and maintain substantial shareholdings Balanced rewards · Balanced set of measures to create sustainable value · Mix of targets based on financial metrics, strategic objectives, and performance versus our competitors Business ethics · the Novartis Values and Behaviors are an integral part of our compensation system · They underpin the assessment of overall performance for the Annual Incentive Competitive compensation · Total compensation must be sufficient to attract and retain key global talent · Overarching emphasis on pay for performance 1 performance within the pharmaceutical and biotechnology industries. As such, external peer compensation data is one of a number of key reference points considered by the Board of Directors and the Compensation Committee when making decisions on executive pay, helping to ensure that the compensation system and compensation levels at Novartis remain competitive. Novartis makes the commitment to shareholders to confirm benchmarking practices, including the peer group, each year. The Compensation Committee believes in a rigorous approach to peer group construction and maintenance. The Compensation Committee also believes that using a consistent set of peers that are similar in size and scope enables shareholders to evaluate the compensation year on year and make pay-for-performance comparisons. As such, following a review of the benchmarking peer group, the Compensation Committee decided to maintain the same primary peer group of 15 global healthcare companies until the end of 2019, which will be updated from 2020 to consider the acquisition of Celgene, as presented below. Roche AstraZeneca Celgene1 GlaxoSmithKline Novo Nordisk Sanofi Celgene will be removed from the 2020 peer group as a result of the acquisition by Bristol-Myers Squibb Alignment with Company strategy Our strategy is to become a leading, focused medicines company powered by advanced therapy platforms and data science. We believe these elements drive continued innovation and will support the creation of value over the long term for our Company, society and shareholders. The Compensation Committee has reviewed the existing compensation system and determined that it continues to support our new strategy. Approach to market benchmarking There remains significant competition for top executive talent with deep expertise, competencies and proven the companies in this peer group reflect our industry and are similar to Novartis in terms of both size and scope of operations.
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Bats and birds use this mechanism to catch up with prey, dogs use it to catch a Frisbee, and humans use it to catch a moving football. The brain detects motion partly from the changing size of an image on the retina (objects that look bigger are usually closer to us) and in part from the relative brightness of objects. The beta effect refers to the perception of motion that occurs when different images are presented next to each other in succession (see Note 4. The visual cortex fills in the missing part of the motion and we see the object moving. The phi phenomenon looks like a moving zone or cloud of background color surrounding the flashing objects. The beta effect and the phi phenomenon are other examples of the importance of the gestalt-our tendency to "see more than the sum of the parts. In the phi phenomenon, the perception of motion is based on the momentary hiding of an image. Light enters the eye through the transparent cornea and passes through the pupil at the center of the iris. The lens adjusts to focus the light on the retina, where it appears upside down and backward. Receptor cells on the retina are excited or inhibited by the light and send information to the visual cortex through the optic nerve. Color blindness occurs when people lack function in the red- or greensensitive cones. Consider some ways that the processes of visual perception help you engage in an everyday activity, such as driving a car or riding a bicycle. Do you think you would be able to compensate for your loss of sight by using other senses? Segregation of form, color, movement, and depth: Anatomy, physiology, and perception. Distributed and overlapping representations of faces and objects in ventral temporal cortex. The development of prospective grasping control between 5 and 7 months: A longitudinal study. Sound waves that are collected by our ears are converted into neural impulses, which are sent to the brain where they are integrated with past experience and interpreted as the sounds we experience. The human ear is sensitive to a wide range of sounds, ranging from the faint tick of a clock in a nearby room to the roar of a rock band at a nightclub, and we have the ability to detect very small variations in sound. But the ear is particularly sensitive to sounds in the same frequency as the human voice. In a fraction of a second, our auditory system receives the sound waves, transmits them to the auditory cortex, compares them to stored knowledge of other voices, and identifies the identity of the caller. Vibrating objects (such as the human vocal chords or guitar strings) cause air molecules to bump into each other and produce sound waves, which travel from their source as peaks and valleys much like the ripples that expand outward when a stone is tossed into a pond. Unlike light waves, which can travel in a vacuum, sound waves are carried within mediums such as air, water, or metal, and it is the changes in pressure associated with these mediums that the ear detects. As with light waves, we detect both the wavelength and the amplitude of sound waves. The wavelength of the sound wave (known as frequency) is measured in terms of the number of waves that arrive per second and determines our perception of pitch, the perceived frequency of a sound. Longer sound waves have lower frequency and produce a lower pitch, whereas shorter waves have higher frequency and a higher pitch. Zero decibels represent the absolute threshold for human hearing, below which we cannot hear a sound. Each increase in 10 decibels represents a tenfold increase in the loudness of the sound (see Figure 4. The sound of a typical conversation (about 60 decibels) is 1,000 times louder than the sound of a faint whisper (30 decibels), whereas the sound of a jackhammer (130 decibels) is 10 billion times louder than the whisper. Audition begins in the pinna, the external and visible part of the ear, which is shaped like a funnel to draw in sound waves and guide them into the auditory canal. At the end of the canal, the sound waves strike the tightly stretched, highly sensitive membrane known as thetympanic membrane (or eardrum), which vibrates with the waves. The resulting vibrations are relayed into the middle ear through three tiny bones, known as the ossicles-the hammer (or malleus), anvil (or incus), and stirrup (or stapes)-to the cochlea, a snail-shaped liquid-filled tube in the inner ear.
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The next level of care to be prioritized would be respite care, both in day centres and (for longer periods) in residential or nursing homes. Such facilities (as envisaged in Goa, for example) could act also as training resource centres for caregivers. Residential care for older people is unlikely to be a priority for government investment, when the housing conditions of the general population remain poor, with homelessness, overcrowding and poor sanitation. China and India), nursing and residential care homes are opening up in the private sector to meet the demand from the growing affluent middle class. Good quality, well-regulated residential care has a role to play in all societies, for those with no family support or whose family support capacity is exhausted, both as temporary respite and for provision of longer-term care. Absence of regulation, staff training and quality assurance is a serious concern in developed and developing countries alike. Similarly, low income countries lack the economic and human capital to contemplate widespread introduction of more sophisticated services; specialist multidisciplinary staff and community services backed up with memory clinics and outpatient, inpatient and day care facilities. Nevertheless, services comprising some of these elements are being established as demonstration projects. The ethics of health care require that governments take initial planning steps, now. The one certainty is that "in the absence of clear strategies and policies, the old will absorb increasing proportions of the resources devoted to health care in developing countries" (28). At least, if policies are well formulated, its consequences can be predicted and mitigated. Prevention, where it can be achieved, is clearly the best option, with enormous potential benefits for the quality of life of the individual, the family and carers, and for society as a whole. Primary preventive interventions can be highly cost effective, given the enormous costs associated with the care and treatment of those with dementia (see the section on Disability, burden and cost, above). Thus, in developed countries with their comprehensive health and social care systems, the vital caring role of families, and their need for support, is often overlooked. This is true for example in the United Kingdom, where despite nuclear family structures and contrary to supposition, there is a strong tradition that persists today for local children to provide support for their infirm parents. Conversely, in developing countries the reliability and universality of the family care system is often overestimated. Older people are among the most vulnerable groups in the developing world, in part because of the continuing myths that surround their place in society (30). It is often assumed that their welfare is assured by the existence of the extended family. Arguably, the greatest obstacle to providing effective support and care for older persons is the lack of awareness of the problem among policy-makers, health-care providers and the community. Mythologizing the caring role of the family evidently carries the risk of perpetuating complacency. Caring was associated with substantial psychological strain as evidenced by high rates of psychiatric morbidity and high levels of caregiver strain. People with dementia in developing countries typically live in large households, with extended families. Larger families were associated with lower caregiver strain; however, this effect was small and applied only where the principal caregiver was co-resident. Indeed, it seemed to operate in the opposite direction where the caregiver was non-resident, perhaps because of the increased potential for family conflict. In many developing countries, traditional family and kinship structures are widely perceived as under threat from the social and economic changes that accompany economic development and globalization (30). Some of the contributing factors include the following: Changing attitudes towards older people. The education of women and their increasing participation in the workforce (generally seen as key positive development indicators); tending to reduce both their availability for caregiving and their willingness to take on this additional role. Populations are increasingly mobile as education, cheap travel and flexible labour markets induce young people to migrate to cities and abroad to seek work. In the economic catastrophe of the 1980s, two million Ghanaians left the country in search of economic betterment; 63% of older persons have lost the support of one or more of their children who have migrated to distant places in Ghana or abroad. Older people are particularly vulnerable after displacement as a result of war or natural disaster.
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The future payout will be determined only after the performance cycle concludes in three years. Actual payout (0200% of target) will be known at the end of the three-year cycle in January 2022. Until the end of the notice period, he will receive further contractual compensation that includes the base salary, Annual Incentive and pension benefits. The column "Other 2019 compensation" includes inter alia their pro-rata compensation from the date they left the Executive Committee to December 31, 2019 or to the end of the performance cycle in the case of the "Long-Term Incentive 2019-2021 cycle grants at target". Actual payout (0200% of target) will be known at the end of the three-year cycle in January 2021. The information under the column "Other 2018 compensation" also includes, inter alia, their pro-rata compensation from the date they stepped down from the Executive Committee to December 31, 2018. The difference is primarily due to: · the reduced overlap of members (in total, 17 Executive Committee members were granted compensation in 2018 compared to 15 members in 2019). Malus and clawback Per our "-Executive Committee compensation philosophy and principles," in 2019, there was no legal or factual basis on which to exercise malus or clawback for current or former Executive Committee members. The vesting of this grant is subject to performance conditions assessed at the end of the period. Andrй Wyss stepped down from the Executive Committee on March 31, 2018, and ended his notice period on September, 30 2018. The Compensation Committee reviews compliance with the share ownership guideline on an annual basis. As of December 31, 2019, all members who have served at least five years on the Executive Committee have met or exceeded their personal Novartis share ownership requirements. Also includes unvested keep-whole shares received in connection to the Alcon spin-off. The multiple is calculated based on the full-year annual base salary and the closing share price as at the end of the 2019 financial year. Paul Hudson and Richard Francis stepped down from the Executive Committee in 2019. Hudson owned zero vested shares, and 140 121 unvested shares and other equity rights and Mr. Francis owned 50 615 vested shares and 86 740 unvested shares and other equity rights. No other payments (or waivers of claims) were made to former Executive Committee members or to "persons closely linked" to them during 2019. Loans to Executive Committee members Our policy does not allow loans to be granted to current or former members of the Executive Committee or to "persons closely linked" to them. Therefore, no loans were granted in 2019, and none were outstanding as of December 31, 2019. Novartis delivers treasury shares to associates to fulfill these obligations, and aims to offset the dilutive impact from its equity-based participation plans. Michael Ball, received a one-off award of 50 000 Performance Share Units (the payout range was 0200% of target) on February 1, 2016, when he joined Novartis, subject to the achievement of targets linked to the turnaround of Alcon during the 2016-2018 performance cycle. Ball gave notice to retire from the Executive Committee on July 1, 2018, following the announcement of the spin-off of Alcon but continued to work in a full-time capacity for Alcon. The performance metrics of the award were based on financial and non-financial targets, including sales growth ahead of peers, core operating income growth ahead of sales growth, core operating income margin at least in line with the average of peers, and successful developments and launches of new products. Performance was monitored regularly across the three-year performance cycle and assessed against the targets supported by the Compensation Committee at the end of each financial year. After a significant gap in performance versus the targets in the first year, Alcon partially closed the gap in the next two years. Overall, the turnaround of the business resulted in a very successful spin-off, creating significant value for shareholders. Core operating income grew ahead of sales, and target launches of new products like PanOptix, and Dailies Total1 were well executed.