Levothyroxine: The Importance of RDH Familiarity

Levothyroxine: The Importance of RDH Familiarity Jessica Jarrard As a registered dental hygienist, there are health concerns to remain aware of when providing care to clients, specifically health conditions that the client may or may not be aware of, and more importantly any medications that may affect dental care in general as well as in the office. As a RDH, one should be able to recognize signs and symptoms and be knowledgeable about how the care being provided to the client may be affected by medication and the health conditions associated with its use as it relates to dental health. The top medication prescribed to individuals is Levothyroxine. The use of this medication is common, and it is important for the RDH to be aware of the conditions associated with its use, the effects this medication may have on the care provided or vice versa, as well as how to direct the client for providing aftercare once they have the left the office. Any possible health concerns the RDH may recognize in regards to the use of Levothyroxine are especially import ant if the client has signs of a possible condition that may be associated with its use or if the client may be suffering an adverse effect resulting from a medication interaction that the client may be unaware of. Being familiar with the medication as it relates to the care provided will help the RDH recognize if referring the client to seek further care from their primary medical provider is necessary. Levothyroxine is a synthetic hormone medication used for the treatment of hypothyroidism, a condition associated with underproduction of hormones secreted within the thyroid gland. Thyroxine, the T4 hormone, is indirectly responsible for regulating many metabolic processes within the body and when deficient or absent can cause a number of health concerns including lethargy, low body temperature, myxedema, intolerance to cold, and weight gain among other, more serious complications (Weinberg, Westphal, Fine, 2008). Although Levothyroxine can regulate the symptoms associated with this health condition, there are also risks involved with long term use of the drug such as cardiovascular disease, stroke, and atrial fibrillation, especially among individuals with thyroid cancer (Nelson, 2017). Therapeutically this medication is utilized as a replacement hormone in the absence of Thyroxine (Vallerand, Sanoski, Deglin, 2013). Although there are other treatments available for hypothyroidism , there is no evidence they are better options, and Levothyroxine remains a common treatment and has been proven to work well (What is T4, n.d.). Levothyroxine C15H11I4NO4 is commonly known as Synthroid but is also known by other names such as Eltroxin or Euthyrox in Canada and Levo-T, Levothroid, Levoxyl, T4, Tirosint, and Unithroid depending on the manufacturer marketing the drug (Hopkins, 2006). Although most commonly used to treat hypothyroidism it is also used as a treatment for suppression of euthyroid goiter as well as thyroid cancer which is often directly related (Vallerand, Sanoski, Deglin, 2013, p. 779). Levothyroxine is absorbed through the GI tract and metabolized by the liver and other body tissues by being converted to Triiodothyronine, the T3 hormone, which regulates metabolism in the body as well as other body functions (What is T4 , n.d.). Levothyroxine can be taken intravenously and intramuscularly, although it is commonly prescribed as a single dose, oral medication. Dosages of this medication are determined by many factors including age, weight, severity of the condition being treated, and other present health conditions. As with all medications, individuals with certain health conditions should use caution while taking Levothyroxine. These include individuals suffering from cardiovascular disease, renal insufficiency, and uncorrected adrenocortical disorders as well as pediatric and geriatric patients who should be monitored especially close as they are more vulnerable to complications or risks associated with any medication or illness (Vallerand, Sanoski, Deglin, 2013). Dosages are increased at regular intervals, usually bi weekly and should be taken in the morning, as the risk for insomnia is increased with its use. It is important that this medication is taken at the same time daily and should not be stopped wi thout consulting the prescribing physician, as it may result in negative health consequences (Vallerand, Sanoski, Deglin,2013). When taking this medication, it is important that patients understand that treatment with Levothyroxine is not a cure for hypothyroidism and should be considered a lifelong therapy. Patients should also understand that it may have an effect on other body systems, resulting in undesirable symptoms such as headache, insomnia, irritability, angina pectoris, arrhythmias, tachycardia, abdominal cramps, diarrhea, vomiting, sweating, hyperthyroidism, menstrual irregularities, heat intolerance, weight loss, and accelerated bone maturation in children. These adverse effects are usually only seen when excessive doses of the medication cause iatrogenic hyperthyroidism (Vallerand, Sanoski, Deglin, 2013, p. 780). Some other medications have been known to interact in conjunction with Levothyroxine and should not be taken together unless directed by a physician. These medications include Warfarin, some diabetic medications, and Estrogen, which may increase the effects of Levothyroxine. Other supplements or foods which contain calcium, iron, and zinc prevent absorption of Levothyroxine and should also not be taken in conjunction. If these medications or supplements are needed, it is best to do so under the care of a physician who can monitor any potential risks or effects and make adjustments in health care accordingly (Vallerand, Sanoski, Deglin, 2013). The use of Levothyroxine is increasingly common in individuals and can cause undesirable effects if not considered when providing dental care as well as any other care to clients. For instance, a common side effect of this medication is xerostomia. This side effect can cause a number of risks to clients as the mouths essential, protective enzymes, which are provided and carried through saliva, are depleted or completely absent. Without this level of protection, the teeth and gums become weak and vulnerable to excessive damage from routine dental care as well as other normal activities, such as eating. It has been reported that there is almost four times greater prevalence of xerostomia in patients taking medications (28%), compared with those not taking any (7.5%) (Risk factors, hyposalivation, 2017). If the RDH is aware of this side effect, whether or not it is a result of the medication, adjustments in dental care can be made preventing further damage. The RDH can also provide repl acement therapy for the missing enzymes by offering products or medications that supplement these enzymes to prevent further dry mouth. All RDH should be educated and aware of the signs and symptoms of disorders or health conditions associated with Levothyroxine and the possible risks involved when providing dental care for a client taking this medication. Understanding how the medication works and the effects it has in conjunction with other medications, supplements, or medical/dental treatments will not only serve to protect the client from any further risks or complications regarding care, but will also allow the RDH to perform client services more effectively and with greater success to the clients well-being. References Flaitz, C., Shlafer, M., Tornwall, R., Viola, T. (2014). Mosby Dental Drug Reference 11th ed. St. Louis, MO: Elsevier Mosby. Haveles, E. (2011). Applied Pharmacology for the Dental Hygienist. Maryland Heights, MO: Mosby Elsevier. Joe (MSC Nutrition). (n.d.).What is T4 and T3: The complete guide. Retrieved from https://www.dietvsdisease.org/t4-t3-thyroid-hormone levels/?hilite=%22levothyroxin%22 Nelson, R. (2017). High risk for CHD and stroke in patients with thyroid cancer. Retrieved from www.medscape.com/viewarticle/875375 Niklander, S., Veas, L., Barrera, C., Fuentes, F., Chiappini, G., Marshall, M. (2017). Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life. Pub Med, 31. Retrieved from http://www.scielo.br/scielo.php?script=sci_arttextpid=S180683242017000100211lng =ennrm=isotlng=en#B12 Vallerand, A., Sanoski, C., Deglin, J. (2013). Daviss Drug Guide for Nurses 13th ed. Philadelphia, PA: F.A. Davis Company. Weinberg, M., Westphal, C., Fine, J. (2008). Oral Pharmacology for the Dental Hygienist. Upper Saddle River, NJ: Pearson Education Inc.

Jairo Morales Homwork

Lu is the person who handles looks after loan applications. 5 Mailman has announced that it will be intro icing _bringing out a new online payment system in the fall. 6 Can you check _ look up the bank reference code in the directory? 7 The government has decided to advance bring forward the date for submitting tax returns. 8 The bank has refused _turned down my application for a loan. 9 The exact conditions are explained set out in detail in the contract. 10 You need to provide proof of identify before you an open _set up an account.C Choose two of the verbs from the list below. How many phrasal verbs can you make by combining them with the prepositions or adverbs from box 2? Check come cut fall get go look make pay put run settle Check out/ up fall down/ out Grammar Check 2 A The modals can, could, might, may, should, will, and shall are used to express different degrees of likelihood. Look at their use in the sentences below. In which of the three categories (a, b, or c) would you include them? A Possible b Impossible c Certain Customers can't withdraw more than $300 a day in cash. B 2 It can take at least a month before a home loan is approved. _a 3 The insurance company will charge you for the whole year even if you don't deice to cancel after the first month. _ c 4 To cash a check for more than $200, clients may be asked to provide ID. _a 5 It could be difficult to get your associates to agree to those conditions. A _ 6 We shall need written confirmation Of the transfer request. _c 7 You might find it more convenient to do your banking by phone. A_ 8 The bank won't cover overdrafts beyond the specified limit. C B Read the sentences and choose the correct answer (a or b). 1 It b take longer than two days to process your applications. A couldn't B shouldn't lend you an additional $ 1000 if you maintain your credit record. A can B won't 3 They've promised that all the paperwork a _ be ready before next week. A will B may 4 It be better to ask if you can repa y the money in installments. A might shall 5 I'm afraid that we _ a accept payment in cash. A can't B mightn't 6 The local bank closes at six so B should Conclusion: be able to get there in time.A can Being weak in grammar poses a great challenge to ourselves, especially while writing and speaking. This often becomes a major problem. Nowadays most communication is through writing, be it courtesy mails, proposals, invoices, quotations, or invites. People who are into advancing their careers, their businesses, and those on the lookout for personal enrichment have no choice but to polish their grammar, especially the tenses. This will ensure the communication gets understood correctly and avoid misunderstandings.

The Dangers of Facebook

They found that 65% of Facebook users accessed their account daily, usually checking it several times to see if they had received new messages. The amount of time spent on Facebook at each log-in varied from just a few minutes to more than an hour. The Ohio report shows that students who used Facebook had a â€Å"significantly† lower grade point average – the marking system used in US universities – than those who did not use the site. â€Å"It is the equivalent of the difference between getting an A and a B,† said Karpinski, who will present her findings this week to the annual meeting of the American Educational Research Association.She has not yet analysed whether a student’s grades continue to deteriorate the longer he or she spends on Facebook. Some UK students have already spotted the potential danger. Daisy Jones, 21, an undergraduate in her final year at Loughborough University, realised the time she was spending on Facebook was threatening her grades – prompting her to deactivate her account. â€Å"I was in the library trying to write a 2,000-word essay when I realised my Facebook habit had got out of hand,† she said. â€Å"I couldn’t resist going online.You do that, then someone’s photo catches your eye. Before you know it, a couple of minutes has turned into a couple of hours and you haven’t written a thing. † Jones is among the few to have recognised the risks. According to Karpinski’s research, 79% of Facebook-using students believed the time they spent on the site had no impact on their work. Facebook said: â€Å"There is also academic research that shows the benefits of services like Facebook. It’s in the hands of students, in consultation with their parents, to decide how to spend their time. †

Nuclear Power and Its Problems - Free Essay Example

Sample details Pages: 2 Words: 508 Downloads: 8 Date added: 2019/08/16 Category Energy Industry Essay Level High school Tags: Nuclear Power Essay Did you like this example? Nuclear power occurs from a series of reactions that causes the build-up and release of energy which in turn generates heat. This heat is then used as steam to power turbines which helps produce the electricity. The production of this electricity is used to power many things including but not limited to homes, schools, business etc. (What Is Nuclear Power And Energy? | GE Hitachi Nuclear Energy) Nuclear power is considered safe when compared with some other energy sources such as solar, wind, hydropower and fossil fuels like coal, oil and natural gas. However, some issues do exist when producing the nuclear power. One of the issues with nuclear power is controlling the rate of the reactions during the production of nuclear power/energy. If the reaction becomes unmanageable and the reaction cant be contained this can lead to a meltdown causing high levels of radio-active fall out. Such an example of this occurred in Chernobyl 1986 – the reactor exploded due to loss of electricity, Three Mile Island – March 28 1979 – the water supply in the circuit malfunctioned causing the circuit to overheat due to the lack of the electricity, Fukushima Daiichi March 2011 – An earthquake caused the nuclear plant to shut down because of no electricity, the reactors over heated causing a disaster,   to mention a few (A Brief History Of Nuclear Accidents Worldwide) . Don’t waste time! Our writers will create an original "Nuclear Power and Its Problems" essay for you Create order Another example of the possible problems that can arise from nuclear power is the disposal of the waste products from the reactions. Once the waste material is produced they are radio-active and can stay radioactive at very high levels for many years. This could potentially cause a huge concern, as if this radio-active waste gets into the wrong hands, the waste can be used in nuclear weapons. (Nuclear Reprocessing: Dangerous, Dirty, And Expensive) Although the above-mentioned situations have occurred with nuclear power, the United States of America benefits from the use of nuclear power, without it there would be no electricity. The USA produces more nuclear power that any other country, producing more than 30% of nuclear generation of electricity. Since the production of electricity from the nuclear power plant is continuous, this saves the USA money for example, on the cost of other fuels such as petrol.   Another reason it is beneficial to the USA is that it reduces the cost of coal and oil as the nuclear power can be used as an alternative source. Cars can now be run on electricity instead of fuel, a cleaner and safer alternative to fuel (Nuclear Power In The USA World Nuclear Association) Although, Nuclear power has its problems, where would our country and the world be without it. Think about not having electricity in your home, you cant watch TV, use the computer, cook, keep your home warm in the winter and cool in the summer, the list is endless. This is why nuclear power is a necessity. With all the safety protocols put in place during the production of nuclear power, it is clean, safe and necessary for the United States and the rest of the World.

A Brief Note On The Criminal Justice System - 994 Words

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People are capable of finding almost anything that is contained on the i nternet or through computers. Having all communication on such a public forum puts the agencies at risk for a breach. For example, a computer hack made worldwide news this year when Sony, a major entertainment and media company, had a large portion of their emails leaked to the public. The leak included: employee social security numbers, celebrity emails, bank accounts, and personal and business conversations. The leak did not only hurt the business of Sony, but led people to feel an invasion of privacy andShow MoreRelatedA Brief Note On The Criminal Justice System999 Words   |  4 PagesMaya Patton Written Assignment #3 Over the years, the Criminal Justice System has developed in many ways. As the system and society grow, its naturally for advances to be made. most of the time, these advances only better society. But, there are times when advances create issues and barriers for the system. 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Gender Roles And Power Dynamics - 1640 Words

Gender roles and power dynamics have been a topic of great debate in regards to their portrayal in horror films. Over time, the horror genre’s boundaries, as well as ideas of gender roles, have become less strictly defined and many see this as being observable by looking at films from different points in time. Alfred Hitchcock’s Psycho (1960) and John Carpenter’s Halloween (1978) are both horror films which feature gender roles in different ways, although there are also similarities. The use of gender roles and their representation can be said to evolve over time as society’s views of gender roles also changed. There is a noticeable focus on sexual desires in both films, which relates to the role of sexuality in people’s views of†¦show more content†¦She uses this newfound confidence and invites Norman to her room, yet Norman declines and wants to assume the masculinity he never experienced due to being separated from society and its ge nder norms. 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Silvio case analysis free essay sample

Silvio Napoli, as head of Schindler Company’s corporate planning, is the best choice for the company’s India operations, given the facts of his adaptability of culture difference, his personality, background in Schindler, and his involvement of the Indian operation project, as well as his human resource management skills. First of all, Napoli is an Italian, who graduated from Harvard Business School. With solid education background, he became head of corporate planning in Schindler, which is a Swiss Company. His wife is a French-German dual national. Interacting with diversity of culture in life, he must be well equipped to adapt culture differences and handle the challenges. For instance, as he is employed as assistant of Chief Executive Officer of Schindler, he knows that Schindler is a formal Swiss company, so power distance is high that â€Å"the hierarchy was clear, politeness important, and first names rarely used. † (Silvio Napoli at Schindler India (A), page 3) He is well aware how people behave in the organizational context; he respects and embraces the culture, and he understands how he should behave as a manager. We will write a custom essay sample on Silvio case analysis or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page According to Thomas, D. C. , Lazarova, M. B. ’s article on Cultural and Institutional Context of Global Human Resource Management, they said, â€Å"HRM systems are embedded in the cultural and institutional context of their home country. HRM may be somewhat resistant to the forces of globalization because its ability to change is limited by regulatory structures, interest groups, public opinion and culture norms, which are relatively slow to change. †(Page 38) Because of this reason, manager that is in charge of opening Indian subsidiary must be aware of culture difference and be flexible in adapting it while handling human resource management. As a result, his ability of solving culture challenges is strong. Also, his personality is well fit with the role of foreign market operator. He is willing to carry the risk to take the job that â€Å"involved dragging [his] family to a developing country. †(Silvio Napoli at Schindler India, page 4) His courage for dealing challenges and ambition for success is necessary for managing foreign market entrance. Moreover, because his role in the company and the Indian entry project, he understands clearly about the objective for both the company and the project. As staff to the corporate executive committee, he is acquainted with the company’s mission, strategies, and challenges it encountered. With his in-depth knowledge and responsibility of the company, the corporate executive committee-the Verwaltungsrat Ausschuss trusts him. As India is an attractive market and partnership with local company BBL broke down, the company decided to operate a subsidiary company in India, which is legally available now. Appointing the right person to start up a wholly owned Indian subsidiary is the key role for the success of the operation, so the person must be trusted by the senior managers of the parent company. As the investigator and planner for the India project, he spent nine months in analyzing the Indian market. He not only consults experts of India to analyze the market size of elevator industry, rivalry of the industry, and legal environment in India, but also develops a detailed business plan for Schindler to enter the Indian market. As a result, he is acknowledged of the economics of Indian market and details of the expansion project. While starting his first job of Indian project, he recruited his management team. His demonstrated his resource management skills by selecting the right people that specialize in certain area, so the team, as a whole, is excelled in all dimensions. For example, he recruited Mehar Karen Singh, who is well understood of Indian culture and he has valuable customer and leadership experience, such as leading construction projects, as managing director. Also, Napoli recruited T. A. K Matthew as head field operation. Matthew has nine years elevator experience in Otis, which has the biggest market share-50% in Indian elevator industry and it is the most profitable industrial companies in India. Therefore, he is expertise and in-depth experience in elevator industry and he understands how the leader company behaves in elevator industry. Therefore, Napoli has excellent human resource management skills, especially in recruiting the right people for the right role. In sum, among all the candidates in Schindler, Silvio Napoli is the best choice as the director of operating Indian subsidiary, based on his openness and ability to adapt culture difference, his courage for challenges and achievement-driven personality, his management role in Schindler, as well as his high involvement in planning the business strategies for the entrance of Indian market. Putting myself into Silvio Napoli’s position, I would choose to be flexible when approach the nonstandard glass wall elevator. Specifically, the company should accept the order and customized the elevator with glass wall in order to suit the customer’s need. There are several reasons for this approach, which includes the company’s current situation and threats from the changing economic environment that the company operates in. First of all, Schindler is a new entrance company to Indian elevator industry. There is intense competition in the industry, with â€Å"four major players accounted for more than three-quarters of the Indian market value: Otis (50%), BBL (8. 6%), Finland’s Kone (8. 8%), and ECE (8. 4%). †(Silvio Napoli at Schindler India (A), page 8) In the low-rise segment, which consists of 23% market share, were controlled by 25 regional companies. Customers in this segment are extremely price sensitive. In order for Schindler to successfully enter the market and build up market share, it should take the order since the company has not received any order so far. When there is intense competition in the market, it is tough for new company to survive. Customers who choose new companies are looking for either attractive price or differentiate products or/and services. Since price is already low for model S001, so it is better for the company to differentiate the products and services. In addition, the four elevators that were ordered are used for government building in Mumbai, so if the customer is satisfied with the service and the product, positive word of mouth will be generated and subsequent orders will be coming in. Even though the order will cost more than what it cost for standardized the elevators, it make more sense take the order. The company should take the initiative negotiate the term, specific products with nonstandard glass wall, costs involving with customization, and the price regarding to customizing products. Beside the fact that Indian elevator industry has intense level of rivalry, customers in the industry has relative high power and they are very price sensitive in low-rise segment, which Schindler S001 is trying to tack in. As a result, gaining customers’ awareness and preference is important. Accepting the order for the government building not only help increasing brand exposure to general public, but also help creating the brand image as safe and quality. Secondly, the changing Indian economic market condition create many threats for the company, so Schindler should move fast and take the order which help break even the costs for setting up the company. According to Schindler India’s outsourcing strategy, there would be â€Å"no in-house manufacturing, no centralized assembly, and no logistics infrastructure. Instead, the production of most components for the dominant S001 model would be outsourced to approved local suppliers. †(Silvio Napoli at Schindler India (A), page 9) When the strategy is in place and Napoli estimated that the transfer prices on the basic S001 elevators are 30% higher than what he has calculated on the schedule. Also, the Indian government announced that import duties on â€Å"noncore† goods, including elevators, will increased from 22% to 56%. With changing economic condition, Schindler India must act fast to cover the cost it has encountered since it will be late if it changes the strategy now. Without generating any revenue, Schindler India would get into deep business challenges as there may be lack of funding and lack of reasons to request extra funding from its parent company. In short, Schindler India should accept the first order of four elevators because the business plan for its first year is to sell twenty elevators, so accepting the order will help break even the cost. Also, with intense level of rivalry in Indian elevator industry and price-sensitive customers in low-rise segment which Schindler model S001 positioned in, the company should receive the order because it will help creating brand exposure and brand image that will eventually contribute to the company’s bottom line. Lastly, the changing Indian economic environment post serious business challenges for Schindler India; as a result, it is better for the company to act fast and generate some income to keep the business running and to provide some supports for future funding from the parent company if needed. Now putting myself in the shoes of Luc Bonnard, I would appraise Silvio Napoli’s recruitment strategies of Human Resource practices and operation strategies as the general manager of the India operation; however, I would give some advice on his human resource management in the Indian operation and his strategy should be more focus on customers’ needs. First of all, Napoli did a very good job on recruiting his management team. As discussed in the first section, Napoli recruited Mehar Karan Singh as managing director. M. K. Singh brings the company valuable customer and leadership experience because he has led construction projects for some of India’s largest hotel. Napoli also recruited T. A. K. Matthew as head field operation because he has expertise and in-depth elevator knowledge and experience. Notable, Matthew has worked for Otis, the largest and most profitable elevator company in India, for nine years. Therefore, he can provides many industrial insights and recommendation for Schindler India. Napoli also hired Ronnie Dante, who has experience in Otis for 24 years, as general manager for engineering. With solid elevator engineering background and experience, Ronnie Dante helps managing the hard-core part of the business. Pankaj Sinha is giving a role of human resource manager. As he promised, he will take care all the employees. Finally, Jujudhan Jena, with â€Å"high ethical standards, integrity, assiduousness to work, and drive,† is recruited as chief financial offer. His characteristic is the common value that the company would like to achieve. (Silvio Napoli at Schindler India (A), page 6) As a result, Silvio Napoli recruited a talent pool as his management team. These people are specialized in some dimensions, and as a whole, the team has edge in multi-dimensions, which achieve competitive advantage. In addition of recruiting the right people in the company, Napoli also create a business strategy that differentiate the company from its competitors. The business plan is to sell standardized products, with model S001 for low-rise segment and model S300P for mid to high end segment, and some manufacturing activities will be outsourced to local suppliers. This approach can lower production and overhead costs because there are standardization in productions and limited manufacturing equipment. Even though doing something different creates lots of uncertainty and risks, strategy is able to help the company to achieve unique positioning and establish substantial market share. Since standardization lowers production costs, so the company can lower the price to penetrate the market, giving the fact that customers in low-rise segment are high price sensitive. However, communication and cooperation within the company is required for the success of the strategy. I would advice Napoli to work on this challenge. For instance, â€Å"several of Napoli’s new management team had questioned him on the feasibility of his plan. † They â€Å"wondered how the company would survive selling only standard elevators† and â€Å"outsourcing strategy, since no other company in the industry worked this way. †(Silvio Napoli at Schindler India (A), page 10) As not every employee has the vision as Napoli and there is culture difference regarding creating business strategy, therefore, clear communication is necessary. Employees must have the belief of success and cooperate together to make the plan successful. In addition to that, Napoli should behave more flexible in the changing environment. He should be more understandable when it comes to culture differences. For example, Indian employees are more inclined to work in a relaxed environment and they tend to accept things that they do not have control of. Napoli, on the other hand, wants to get things done as soon as possible. Employees in Schindler India describe him as â€Å"’driving very hard’, ‘impulsive’, ‘impatient,’ and at times ‘over-communicative. ’†(Silvio Napoli at Schindler India (A), page 6) To better manage a foreign subsidiary, Napoli should be more flexible in adapting culture differences and understand employees’ value and needs. If employees feel they constantly experience stress from work, they will be less motivated and productive. Human resource management can be a differential advantage for Schindler India only if the director understands the culture dynamics and consider his employees’ concern. Lastly, I would advice Napoli to think and act in â€Å"a monk side†. In India, political, economic, and natural environments are constantly changing; so Indian people tend to accept what unexpected things happen. Therefore, when transfer prices and import duties raise, Napoli should accept the facts and take actions immediately. When order of customized elevators comes, he should negotiate the term, such as increasing price according to customization and extra services, with the customer; since the revenue will contribute to bottom line and help the firm to break even. Overall, Napoli’s performance as general manager in Schindler India has both up and down sides.