By: Robert Arntfield, MD
However muscle relaxant walgreens generic rumalaya gel 30 gr overnight delivery, catheterization of the right heart muscle relaxant orange pill order 30gr rumalaya gel with amex, although useful for the accurate assessment of the degree of hemodynamic compromise muscle relaxant gel uk order rumalaya gel with a mastercard, is too invasive and hazardous spasms stomach cheap 30 gr rumalaya gel with mastercard. Usually, an 18 G, thin-walled, conductive, short-beveled (30°), long (up to 20 cm) needle is used. It is inserted through a small incision in the angle between processus xiphoideus and the left rib margin (0. The needle is then removed, and a 6 F or 7 F soft, tapered, standard or pig-tail catheter with central and side holes is advanced over the wire. Similarly, it is more frequent in young adults with the disease than in the elderly. Bacterial or fungal sepsis is not uncommon during the induction therapy of these patients. In those cases, the procedure should be performed as early as possible, as the morbidity and mortality is high. If indicated, exchange transfusion is to be preferred, particularly in small children (< 12 to 15 kg body weight). Should the platelet count fall below 60,000/µL, transfusion of platelet concentrates will be necessary. This is a rare, yet life-threatening complication that must be managed promptly by rapidly acting antihistaminics (e. The degree of the deficit and mainly the rate at which it evolves are the pacemakers of its clinical relevance in terms of morbidity and mortality as well as of therapeutic intervention. Hyponatremia may be due to a negative sodium balance (losses > intake), water retention, or the combination of both. However, hyponatremia can also result from excessive losses of Na relative to those of water. Finally, hyponatremia is often encountered in severe illnesses and in the terminally ill patient, probably due to redistribution of total body sodium. True hyponatremia should be distinguished from the pseudohyponatremia of hyperlipidemia and paraproteinemia as well as from socalled water-shift hyponatremia of diabetes mellitus. However, as soon as they would go downhill, appropriate therapy must be started without delay. They can be managed on outpatient basis with oral salt tablets, furosemide and fluid restriction. The latter is more effective, yet more toxic to the kidneys, and azotemia may be a concern, particularly when hepatopathy is also present. Special attention should be paid to the edematous states that may be associated with oliguria, where hyponatremia (± hypokalemia) is a typical feature despite increased total body water and salt content. Most of the time, it is associated with tissue hypoxia, albeit this is not always the case as in extensive infiltration of the liver by tumor cells. If the patient is not exhausted and not yet overbreathing to the level of Kussmaul, aminophylline to support hyperventilation along with humidified O2 given by mask may be of benefit. If feasible, attempt at dialysis is justified in severe, life-threatening cases, while managing the underlying disease/disorder properly. Occurring at different stages of the disease, it is usually associated with significant morbidity and may be severe enough to threaten life. Management guidelines: these are governed by the severity and symptomatology of the hypercalcemia as well as by cardiac & renal function (Tab. Only loop diuretics may be used, and only after volume has been already replenished. Therefore, the drug is suitable for either urgently acute or intermittent management. The mortality rate has been high, with 75% of the patients dying of hyperammonemia. The drug binds glutamine to form phenylacetylglutamine, which is also cleared rapidly by the kidney. Institute mechanical ventilation/hyperventilation in case of altered sensorium/intracranial hypertension or brain edema. A stroke-like acute neurotoxicity syndrome has been described to occur at different dosages and with different routes of administration- discussed in section 2. It has been also shown that therapy with aminophylline is effective and safe in managing this adverse event, with recovery being prompt and complete or almost so most of the time. The aim should be a plasma concentration of 10 30 µmol/L, which is safe in asthma patients. Unfortunately, the only test available to reliably define this population is the just exposure to the first high dose of the drug. Similarly, any high dose of the drug- not only the first one- could be poorly eliminated. Although less efficient compared to the renal route, biliary excretion of the drug becomes more important as renal function deteriorates. Depending on dose, it may cause hyperchloremic acidosis and constipation- both manageable. Availability: It is advised the drug be deposited in a central store at a national or regional level. Of these, extravasation is the most stressful and most serious from the viewpoint of both the patient and caregiver, for the harm it could entail may have large and far-reaching consequences (anatomic, functional, cosmetic, socio-psychologic & economic). Although any drug may hurt the vessel wall, cross it or leak out to permeate the surrounding tissues, mechanical injury sustained via a penetrating venepuncture is certainly more important, and with vesicant or otherwise aggressive agents being particularly dangerous. In this regard, attention should be paid to daunorubicin, doxorubicin, vincristine, vindesine & etoposide. Early revision of the necrotic lesion and surrounding inflamed-looking tissues, with wide excision, plastic covering and delayed grafting should be considered, particularly in case of anthracycline extravasation. Follow up the patient for months, as necrosis may not develop until several weeks. Document the evolution of this adverse event and the outcome of the undertaken measures thoroughly. Specific measures: A number of specific measures and actions have been shown to be useful in the management of extravasation of vesicant or aggressive cytotoxic agents. The cons & pros should be therefore carefully considered from case to case when deciding on this type of therapy. The storage shelf life at 1° 6° C is 35 42 days, depending on the stabilizer used and licensing conditions. The platelets are retrieved from 1 whole-blood donation and suspended in 50 ml plasma. The rare patient who has been alloimmunized at platelet-specific antigens will need platelets lacking the corresponding antigen. Persistent refractoriness to platelet transfusions is a problematic albeit not inevitably desperate challenge, and should be discussed with the national study coordinator. However, in splenomegaly and conditions associated with increased platelet consumption. It is also encouraged to employ in-line pre-storage leukodepletion, as it has been shown that immunocompetent leukocytes are always admixed in this preparation, too. Dosage will depend on the underlying indication, the size of the patient and other considerations. More frequently, "episodes" of worsening are superimposed on a background of chronic anemia. One may decide to substitute a moderate degree of anemia (Hb = 80 to 100 g/L), particularly if it is likely to become soon more severe. The majority of pediatric hematologists/oncologists will not probably give treatment in case of asymptomatic mild anemia. On the other hand, to forestall cardiac failure in this case, transfusion should be given at a low dose, slow rate and, if need be, fractionated, i. Although some questions have been addressed in randomized clinical trials, overall the available information does not allow for providing a simple and clearcut solution for every situation that may be encountered. Often the evidence has been merely an article of experience or expert opinion, and the physician in charge has therefore to rely on clinical judgment in many cases.
An audit involves performing procedures to spasms on left side of abdomen 30gr rumalaya gel visa obtain audit evidence on the disclosures made in the Compensation Report with regard to back spasms 22 weeks pregnant discount rumalaya gel 30gr mastercard compensation muscle spasms 6 letters generic 30gr rumalaya gel overnight delivery, loans and credits in accordance with articles 1416 of the Ordinance spasms under eye order 30 gr rumalaya gel free shipping. This audit also includes evaluating the reasonableness of the methods applied to value components of compensation, as well as assessing the overall presentation of the Compensation Report. The Board of Directors is also responsible for designing the compensation system and defining individual compensation packages. These standards require that we comply with ethical requirements, and plan and perform the audit to obtain reasonable assurance about whether the Compensation Report complies with Swiss law and articles 1416 of the Ordinance. Arogya Parivar, which means "healthy family" in Hindi, is designed to bring health education and medical care to poor communities in a commercially sustainable way. Risk overview Our financial results are affected to varying degrees by external factors. Loss of market exclusivity and the introduction of branded and generic competitors could significantly erode sales of our innovative 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 in the markets. Increased pricing pressure could impact our ability to generate returns and invest for the future. We have a significant global compliance program in place, but any failure to comply with local laws could lead to substantial liabilities. There are strict regulatory requirements surrounding our manufacturing processes, which introduce a greater chance for disruptions and liabilities. With products sold in approximately 155 countries, our ability to hedge against foreign exchange fluctuations could have a significant effect on our reported results. 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. We pay taxes in numerous countries, and tax authorities around the world have increased their scrutiny of company tax filings. We may also fail to take advantage of rapid progress in digital technologies and in the development of new business models, and third parties may enter the healthcare field and could supplant our business. For more detail on these trends and how they could impact our results, see details starting on page 175. These measures assist us in evaluating our ongoing performance from year to year and we believe this additional information is useful to investors in understanding the performance of our business. We present information about our net sales and other key figures relating to operating and net income in constant currencies (cc). We calculate constant currency net sales and operating income by applying the prior-year average exchange rates to current financial data expressed in local currencies in order to estimate an elimination of the impact of foreign exchange rate movements. Group overview Novartis delivered solid performance in 2017 as strong sales of our growth drivers, including Cosentyx, Entresto and other recently launched products, continued to offset the impact of generic competition for our cancer treatment Gleevec/Glivec, which lost patent protection in the United States and Europe during 2016. Our results underscore the breadth and strength of our product portfolio and highlight our success at steering through the patent expiration of one of our biggest-selling drugs. Additional comments on the changes in operating income by division can be found starting on page 22. Additional comments on the changes in the core operating income by division can be found starting on page 22. Total Core Research and Development expense in the Innovative Medicines Division as a percentage of sales decreased by 0. Excluding the impact of these rate changes the reported tax rate for 2017 would have been 14. The core tax rate (core taxes as a percentage of core pre-tax income) increased to 15. For further details on significant transactions, see Note 2 to the Group consolidated financial statements. Cash flows in connection with the acquisition or divestment of subsidiaries, associated companies and non-controlling interests in subsidiaries are not taken into account to determine free cash flow. The increase was mainly driven by favorable working capital changes, lower legal settlement payments out of provisions and lower taxes paid, partly offset by the decrease in operating income adjusted for non-cash items and higher net investments. We are not aware of any significant demands to change the level of liquidity needed to support our normal business activities. We make use of various borrowing facilities provided by several financial institutions. We also successfully issued various bonds in previous years (including 2016 and 2017), and raised funds through our commercial paper programs. The maturity schedule of our net debt can be found in Note 28 to the consolidated financial statements on page 249. The Group intends to fund the Research & Development, Property, plant & equipment and intangible asset purchase commitments with internally generated resources. This in turn may significantly affect reported earnings (both positively and negatively) and the comparability of period-to-period results of operations. As a result, even if the amounts or values of these items remain unchanged in the respective local currency, changes in exchange rates have an impact on the amounts or values of these items in our consolidated financial statements. In addition, there is a risk that certain countries could take steps that could significantly impact the value of their currencies. If this occurs, it could impact the effective prices we would be able to charge for our products and also have an adverse impact on both our consolidated income statement and balance sheet. The Group is exposed to a potential adverse devaluation risk on its intercompany funding and total investment in certain subsidiaries operating in countries with exchange controls. The most significant country in this respect was Venezuela, where the Group incurred significant foreign exchange losses in 2015 and 2016. Gains and losses incurred upon adjusting the carrying amounts of non-monetary assets and liabilities for inflation are recognized in the income statement. The Group manages its global currency exposure by engaging in hedging transactions where management deems appropriate, after taking into account the natural hedging afforded by our global business activity. For 2017, we entered into various contracts that change in value with movements in foreign exchange rates to preserve the value of assets, commitments and expected transactions. Based on our current incurred loss provisioning approach, we consider that our provisions for doubtful trade receivables are adequate. We continue to monitor the level of trade receivables particularly in Greece, Italy, Portugal, Spain, Brazil, Russia, Saudi Arabia and Turkey. Should there be a substantial deterioration in our economic exposure with respect to those countries, we may change the terms of trade on which we operate. The majority of the outstanding trade receivables from these closely monitored countries are due directly from local governments or from government-funded entities, except for Russia, Brazil and Turkey, which are due from private entities. At December 31, 2017, amounts past due for more than one year are not significant in any of these countries. Currency exposures are described in more detail in the "Effects of currency fluctuations" section on page 166. While there is some uncertainty about the final taxes to be assessed in our major countries, we believe that our estimated amounts for current income tax liabilities, including amounts related to uncertain tax positions, are appropriate based on currently known facts and circumstances. In our key countries, Switzerland and the United States, assessments have been agreed by the tax authorities up to 2014 in Switzerland and up to 2012 in the United States, with the exception of one open United States position related to the 2007 tax filing and one for the 2010 tax filing. Novartis believes that its total provisions are adequate based upon currently available information. Given the uncertainties inherent in our business activities, we must make certain estimates and assumptions that require difficult, subjective and complex judgments. Application of the following accounting policies requires certain assumptions and estimates that have the potential for the most significant impact on our consolidated financial statements. These programs provide a rebate after the plans have demonstrated they have met all terms and conditions set forth in their contract with us. These rebates are estimated based on the terms of individual agreements, historical experience, product pricing, and projected product growth rates. These provisions are adjusted based on established processes and experiences from filing data with individual states and plans. There is often a time lag of several months between us recording the revenue deductions and our final accounting for them. Non-United States specific healthcare plans and program rebates Deductions from revenues As is typical in the pharmaceutical industry, our gross sales are subject to various deductions which are primarily composed of rebates and discounts to retail customers, government agencies, wholesalers, health insurance companies and managed healthcare organizations. These deductions represent estimates of the related obligations, requiring the use of judgement when estimating the effect of these sales deductions on gross sales for a reporting period. The following summarizes the nature of some of these deductions and how the deduction is estimated.
Order genuine rumalaya gel on-line. Asian traditional massage culture New 2019 | muscle relaxation and foot stress relief fully in HD.
Effective use of a strategy using assigned red cell units to spasms calf muscles purchase rumalaya gel online pills limit donor exposure for neonatal patients spasms upper left abdomen order 30 gr rumalaya gel otc. A novel strategy to muscle relaxant baclofen cheap rumalaya gel 30 gr on-line limit blood donor exposure and blood waste in multiply transfused premature infants muscle relaxant constipation cheap rumalaya gel uk. Commentary on the safety of red cells preserved in extended-storage media for neonatal transfusions. Effect of an infusion device on the integrity of whole blood and packed red blood cells. Analysis of a linear peristaltic infusion device for the transfusion of red cells to pediatric patients. The early detection and management of inborn errors presenting acutely in the neonatal period. Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g. Meta-analysis of clinical studies of the efficacy of granulocyte transfusions in the treatment of bacterial sepsis. The role of intravenous immunoglobulins for the prevention and treatment of neonatal sepsis. Preterm infants with low immunoglobulin G levels have increased risk of neonatal sepsis but do not benefit from prophylactic immunoglobulin G. Additional confirmation of the lack of effect of intravenous immunoglobulin in the prevention of neonatal infection (editorial). A randomized, placebo-controlled trial of granulocyte colony-stimulating factor administration to newborn infants with neutropenia and clinical signs of early-onset sepsis. Granulocyte colony-stimulating factor serum and urine concentrations in neutropenic neonates before and after intravenous administration of recombinant granulocyte colonystimulating factor. The current prospects for neutrophil transfusion for the treatment of granulocytopenic infected patients. Randomized trial of granulocyte transfusions versus intravenous immune globulin 72. Selection of white cell-reduced blood components for transfusions during early infancy. Clinical outcomes following institution of universal leukoreduction of blood transfusions in premature infants. Febrile transfusion reactions in pediatric hematology/oncology patients: the effect of leukodepletion (abstract). Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. Alloimmunization to platelets in heavily transfused patients with sickle cell disease. Summary of symposium: the future of stem cell transplantation for sickle cell disease. Long-term trial of deferiprone in 51 transfusion-dependent iron overload patients. Antigen-matched donor blood in the transfusion management of patients with sickle cell disease. Leukoreduction of red cell transfusions is associated with a decreased incidence of red cell alloimmunization. The classic example of cell therapy is the use of pluripotent stem cells, which are capable of self-renewal and differentiation into all blood-cell lineages. These stem cells-transplanted in preparations of marrow, stimulated peripheral blood mononuclear preparations, or cord blood-also give rise to other regenerative tissues such as hepatocytes, endothelial cells, and other tissue under the proper microenvironmental circum1 stances. However, committed progenitor cells lack capacity for sustained self-renewal or the ability to differentiate into other blood-cell lineages. In the special case of an identical twin donor and recipient, such transplants are referred to as syngeneic. As new indications for transplantation are developed, some others are drastically changed by new discoveries. This nonmyeloablative transplantation expands the number of patients eligible for transplant by accepting patients of more advanced age and with more health problems. These patients would not be candidates to enter more toxic myeloablative regimens because the risk of the treatment would be so great. The patient does not have to undergo extensive periods of cytopenia with exposure to infection and bleeding risk. The engrafted cells become the treatment agent, allowing the chemotherapy and/or radiation to be low-dose and relatively low toxicity. However, because of currently insurmountable immunologic barriers and disease concerns, these transplants are not now clinically feasible. Sources of progenitor cells include marrow, peripheral blood, umbilical cord blood, and fetal liver (although this source is experimental and not in routine clinical use). In some cases, certain cell populations are "positively" selected (selectively isolated) for their special therapeutic effects. Alternatively, some cell populations may be "negatively selected" (culled out or destroyed), as by antibody-mediated lysis of malignant cells or by flow cytometry separation of cell populations in clinical trial situations. Overall, long-term survival rates are generally 30% to 60% for otherwise fatal diseases. Chapter 25: Cell Therapy and Cellular Product Transplantation 585 graft with an autologous transplant for a patient with malignant disease and provide possible immune help after transplantation from graft-vs-tumor response. For other patients, such as those with marrow failure, immunodeficiency, inborn errors of metabolism, or hemoglobinopathy, an allogeneic transplant is the only appropriate type of graft. The median time from initiating a search to receiving a transplant has been 120 days, but a new expedited search and donor preparation program is being implemented to shorten this time. Molecular technology provides greater resolution, including subtypes of alleles identified as cross-reactive groups using conventional serologic techniques. With further experience in molecular typing and transplant outcomes, the extent to which successfully transplanted cells can tolerate disparities in specific alleles will be elucidated. The skin, the gastrointestinal tract, and the liver are most commonly involved, although usually not concurrently. This occurs despite immunosuppressive therapy administered for several months after the procedure. Genetically, there is a 25% chance of a sibling being a complete match, a 50% chance of a haplotype match, and a 25% chance of a complete mismatch. Pediatric patients are more tolerant of partially mismatched grafts and, therefore, have a larger available donor pool. However, syngeneic grafts do not provide the graft-vs-tumor effect found in allogeneic transplants. Cord blood obtained from a delivered placenta is known to be rich in early and committed progenitor cells. In-vitro data have suggested that placental blood has an increased capacity for proliferation. Chapter 25: Cell Therapy and Cellular Product Transplantation 589 difficulty finding a suitably matched donor. A study of 23 such recipients with advanced-stage disease showed a mean neutrophil engraftment of 23 days and a 57% chance of disease-free survival after 1 year. In these two-unit transplants, the cells of one of the units prevailed and provided the lasting 40 engraftment population. The program has stored in excess of 14,000 cord blood units and has provided cells for more than 1500 transplant procedures. The National Cord Blood Bank of the New York Blood Center, NetCord, Bone Marrow Donors Worldwide, and the Caitlin Raymond Registry are additional search sites available today. Related Cord Blood Donors Sibling-derived cord blood has been used as a source of hematopoietic engraftment in more than 250 allogeneic transplants in Europe and North America, representing 15% of the allogeneic cord blood transplants. Patients scheduled for an autologous transplant should undergo an extensive history and physical examination to identify any risks from the marrow harvest and/or apheresis procedures. Ideally, a full six-antigen match should be found; however, transplant procedures have been performed successfully using one-antigen mismatched and haploidentical donors. Infectious Disease Testing Autologous and tested allogeneic donors must be screened and tested for certain infectious diseases. They also include requirements for questioning donors about risk factors for variant Creutzfeldt-Jakob disease and new or emerging pathogens such as West Nile virus and severe acute respiratory syndrome, and requirements for tests for carriers of these illnesses as soon as they are practically available.
The payout matrix includes a significant reduction (including scope to muscle relaxant menstrual cramps purchase rumalaya gel 30 gr online reduce to muscle relaxant football commercial buy rumalaya gel 30 gr mastercard nil) when Novartis does not outperform the majority of the companies in the group spasms left upper abdomen discount rumalaya gel express. Disclosing realized compensation means that the Annual Incentive and the Long-Term Incentives are disclosed at the end of their respective performance cycles spasms after hemorrhoidectomy discount 30gr rumalaya gel mastercard, reflecting actual payouts based on performance. The total actual payout may vary year-on-year depending on multiple factors, including the composition of the Executive Committee and the tenure of its members (as new members may not have vested Long-Term Incentives), compensation increases, payout of variable compensation based on actual performance, share price fluctuations of Long-Term Incentives, and dividend equivalents. For two members of the Executive Committee, the vesting value is reported pro-rata based on the period they were an Executive Committee member during the performance cycle. This is because they were either recent external hires who did not receive a grant three years earlier, or internal promotions who received lower Long-Term Incentive grants based on their compensation prior to Executive Committee appointment. This latter award was granted with performance conditions attached, to mirror the forfeited award. The main reason for the higher aggregate realized pay in 2016 was the overlap in compensation for outgoing and newly appointed Executive Committee members in 2016. Three members who stepped down in 2016 received ongoing contractual payments during their notice periods while their successors were already in place. In addition, for the three Executive Committee members who stepped down during 2016, it includes, inter alia, their pro-rata compensation from the date they stepped down from the Executive Committee to December 31, 2016. All abovementioned buy-out awards were disclosed at the time of grant in previous Compensation Reports. The future payout will only be determined after the performance cycle concludes in three years. Strigini, were compensated in 2017 for the first time on a full year basis, including their Annual Incentive based on 2017 performance and full Long-Term Incentive grants. In addition, for Executive Committee members who stepped down during 2016, it includes, inter alia, their pro-rata compensation from the date they stepped down from the Executive Committee to December 31, 2016 (see also note 8 below). The information under the column "Other 2016 compensation" includes, inter alia, the aggregated pro-rata value from the date they stepped down from the Executive Committee to December 31, 2016. The performance metrics are based on financial and non-financial targets of Alcon, including sales growth ahead of peers, core operating income growth ahead of sales growth, core operating income margin at the average of peers, and successful launches of new products. Toward the end of 2017 (the second year of the three-year performance cycle), Alcon began to close that gap versus target. Innovation targets are being met and products in development are beginning to emerge. Most other members of the Executive Committee were awarded increases of between 0% and 3%. Consistent with our Executive Committee appointments compensation policy (see page 124), four members were appointed to the Executive Committee in recent years with total target compensation below the market median level of compensation against comparable roles at external peer companies. In making its decisions, the Compensation Committee took into account the annual benchmarking analysis, for each of these roles, provided by Willis Towers Watson. The total target compensation for these members has been assessed over the last two to three years, and increases in line with proven performance have been made, as described below. Vasant Narasimhan Vasant Narasimhan was promoted to Global Head of Drug Development and Chief Medical Officer, and joined the Executive Committee in early 2016. He strengthened the pipeline by receiving 11 development approvals and completing 13 major submissions. He also strengthened the interface between the Novartis Institutes for BioMedical Research and Global Drug Development. He has strengthened the Novartis Business Services organization by improving the governance and optimizing processes. He has ensured great quality of service, as reflected by customer satisfaction scores. At the onset of 2017, his annual base salary was increased by 4% and his target aggregate incentive opportunity was increased from 310% of annual base salary to 320% for 2017. Baert received an annual base salary increase of 4% at the onset of 2017, and his target aggregate incentive opportunity was increased from 290% of annual base salary to 310% for 2017. He led his team during difficult circumstances to deliver each quarter in 2016 at a high level against ambitious targets in sales and profitability, and without jeopardizing sustainability. Biosimilars sales were significantly ahead of target following the filings for rituximab and etanercept in Europe, and they will continue to be key to the success of Sandoz. His target aggregate incentive opportunity remained unchanged at 320% of base salary for 2017. Ehrat Richard Francis Paul Hudson Harry Kirsch Vasant Narasimhan Bruno Strigini (until December 31, 2017) 4 Andrй Wyss total 1 23749 7998 10110 10402 10770 5127 11465 9660 9741 2715 14862 116599 58865 16399 24893 25268 22159 19061 21528 24780 19061 20183 19734 271931 36791 6560 10891 11891 7821 7148 9419 11661 7148 7569 7401 124300 See page 140 for 2016 comparative figures. Ehrat Richard Francis Paul Hudson (from July 1, 2016) 4 Harry Kirsch Vasant Narasimhan (from February 1, 2016) Bruno Strigini (from July 1, 2016) Andrй Wyss subtotal executive Committee members who stepped down during 2016 David Epstein (until June 30, 2016) Mark C. In the event of a substantial rise or drop in the share price, the Board may, at its discretion, amend that time period accordingly. The Compensation Committee reviews compliance with the share ownership guideline on an annual basis. As of the same date, no members of the Executive Committee held any share options to purchase Novartis shares, with the exception of Andrй Wyss, who held 373 000 options, purchased on a private basis. As of December 31, 2017, all members who have served at least five years on the Executive Committee have met or exceeded their personal Novartis share ownership requirements. Ehrat Richard Francis Paul Hudson Harry Kirsch Vasant Narasimhan Bruno Strigini Andrй Wyss total 1 2 16. No other payments (or waivers of claims) were made to former Executive Committee members or to "persons closely linked" to them during 2017. 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. Payments to former Executive Committee members Award and delivery of equity to Novartis associates Two former Executive Committee members stepped down in 2016 and ceased employment in 2017 following a 12-month contractual notice period. Novartis delivers treasury shares to associates to fulfill these obligations, and aims to offset the dilutive impact from its equity-based participation plans. In line with the incentive plan rules, there will be no accelerated vesting of his unvested equity. The deferred equity under the Annual Incentive for the performance years 2015 and 2016 will respectively vest in January 2019 and 2020 per the rules of the Deferred Share Bonus Plan. His Long-Term Incentives for the 2016-2018 and 2017-2019 performance cycles will vest on the normal vesting dates (January 2019 and January 2020, respectively), to the extent that the company performance conditions are met. Jimenez meets the retirement conditions under the Long-Term Incentive plan rules, these two outstanding Long-Term Incentives will not be pro-rated in line with the plan rules. Clawback and malus, and non-compete restrictions as defined by the plan rules will apply. He will also receive pension and other benefits in line with all other Swiss-based employees. During his contractual notice period, which ends on December 31, 2018, he will receive his annual base salary and Annual Incentive in accordance with plan rules. There will be no accelerated vesting, as awards will remain subject to performance over the full cycle. Elizabeth will receive compensation for loss of entitlements with her previous employer on a like-for-like basis, subject to evidence and in line with our Executive Committee members appointment compensation policy regarding buy-outs. The value of the replacement cash and equity awards will be determined on the date of her entry into the company. Therefore, details of this buy-out will be communicated in the 2018 Compensation Report. In view of market changes since the current system was implemented in 2014, the Board and Compensation Committee have decided to make evolutionary changes to provide greater simplicity and further enhance the link between pay and performance. Changes are also based on constructive feedback from shareholders as part of our ongoing dialogue and consideration of their views. Values and Behaviors remain a key component of the Annual Incentive and are embedded in our culture. As such, members of the Executive Committee are expected to demonstrate these to the highest standard. Going forward, members who fulfill the retirement conditions under the plan rules will receive pro-rata vesting, rather than full vesting, of outstanding Long-Term Incentives. These incentives will continue to have performance conditions applied, and will vest at the end of the cycle on the normal vesting date.