History and Origins of Wheat Domestication

Wheat is a grain crop with some 25,000 different cultivars in the world today. It was domesticated at least 12,000 years ago, created from a still-living ancestor plant known as emmer. Wild emmer (reported variously as T. araraticum, T. turgidum ssp. dicoccoides, or T. dicocoides), is a predominantly self-pollinating, winter annual grass of the Poaceae family and Triticeae tribe. It is distributed throughout the Near Eastern Fertile Crescent, including the modern countries of Israel, Jordan, Syria, Lebanon, eastern Turkey, western Iran, and northern Iraq. It grows in sporadic and semi-isolated patches and does best in regions with long, hot dry summers and short mild, wet winters with fluctuating rainfall. Emmer grows in diverse habitats from 100 m (330 ft) below sea level to 1700 m (5,500 ft) above, and can survive on between 200–1,300 mm (7.8–66 in) of annual precipitation. Wheat Varieties Most of the 25,000 different forms of modern wheat are varieties of two broad groups, called common wheat and durum wheat. Common or bread wheat Triticum aestivum accounts for some 95 percent of all the consumed wheat in the world today; the other five percent is made up of durum or hard wheat T. turgidum ssp. durum, used in pasta and semolina products. Bread and durum wheat are both domesticated forms of wild emmer wheat. Spelt (T. spelta) and Timopheevs wheat (T. timopheevii) were also developed from emmer wheats by the late Neolithic period, but neither has much of a market today. Another early form of wheat called einkorn (T. monococcum) was domesticated at about the same time but has limited distribution today. Origins of Wheat The origins of our modern wheat, according to genetics and archaeological studies, are found in the Karacadag mountain region of what is today southeastern Turkey—emmer and einkorn wheats are two of the classic eight founder crops of the origins of agriculture. The earliest known use of emmer was gathered from wild patches by the people who lived at the Ohalo II archaeological site in Israel, about 23,000 years ago. The earliest cultivated emmer has been found in the southern Levant (Netiv Hagdud, Tell Aswad, other Pre-Pottery Neolithic A sites); while einkorn is found in the northern Levant (Abu Hureyra, Mureybet, Jerf el Ahmar, Gà ¶bekli Tepe). Changes During Domestication The main differences between the wild forms and domesticated wheat are that domesticated forms have larger seeds with hulls and a non-shattering rachis. When wild wheat is ripe, the rachis—the stem that keeps the wheat shafts together—shatters so that the seeds can disperse themselves. Without hulls, they germinate rapidly. But that naturally useful brittleness doesnt suit humans, who prefer to harvest wheat from the plant rather than off the surrounding earth. One possible way that might have occurred is that farmers harvested wheat after it was ripe, but before it self-dispersed, thereby collecting only the wheat that was still attached to the plant. By planting those seeds the next season, the farmers were perpetuating plants that had later-breaking rachises. Other traits apparently selected for include spike size, growing season, plant height, and grain size. According to French botanist Agathe Roucou and colleagues, the domestication process also caused multiple changes in the plant that were generated indirectly. Compared to emmer wheat, modern wheat has shorter leaf longevity, and a higher net rate of photosynthesis, leaf production rate, and nitrogen content. Modern wheat cultivars also have a shallower root system, with a larger proportion of fine roots, investing biomass above rather than below ground. Ancient forms have built-in coordination between above and below ground functioning, but the human selection of other traits has forced the plant to reconfigure and build new networks. How Long Did Domestication Take? One of the ongoing arguments about wheat is the length of time it took for the domestication process to complete. Some scholars argue for a fairly rapid process, of a few centuries; while others argue that the process from cultivation to domestication took up to 5,000 years. The evidence is abundant that by about 10,400 years ago, domesticated wheat was in widespread use throughout the Levant region; but when that started is up for debate. The earliest evidence for both domesticated einkorn and emmer wheat found to date was at the Syrian site of Abu Hureyra, in occupation layers dated to the Late Epi-paleolithic period, the beginning of the Younger Dryas, ca 13,000–12,000 cal BP; some scholars have argued, however, that the evidence does not show deliberate cultivation at this time, although it does indicate a broadening of the diet base to include a reliance on wild grains including the wheat. Spread Around the Globe: Bouldnor Cliff The distribution of wheat outside of its place of origin is part of the process known as Neolithicization. The culture generally associated with the introduction of wheat and other crops from Asia to Europe is generally the Lindearbandkeramik (LBK) culture, which may have been made up of part immigrant farmers and part local hunter-gatherers adapting new technologies. LBK is typically dated in Europe between 5400–4900 BCE. However, recent DNA studies at Bouldnor Cliff peat bog off the northern coast of mainland England have identified ancient DNA from what was apparently domesticated wheat. Wheat seeds, fragments, and pollen were not found at Bouldnor Cliff, but the DNA sequences from the sediment match Near Eastern wheat, genetically different from LBK forms. Further tests at Bouldnor Cliff have identified a submerged Mesolithic site, 16 m (52 ft) below sea level. The sediments were laid down about 8,000 years ago, several centuries earlier than the European LBK sites. Scholars suggest that the wheat got to Britain by boat. Other scholars have questioned the date, and the aDNA identification, saying it was in too good a condition to be that old. But additional experiments run by British evolutionary geneticist Robin Allaby and preliminarily reported in Watson (2018) have shown that ancient DNA from undersea sediments is more pristine than that from other contexts.   Sources Avni, Raz, et al. Wild Emmer Genome Architecture and Diversity Elucidate Wheat Evolution and Domestication. Science, vol. 357, no. 6346, 2017, pp. 93–97. Print.International Wheat Genome Sequencing Consortium. A Chromosome-Based Draft Sequence of the Hexaploid Bread Wheat (Triticum Aestivum) Genome. Science, vol. 345, no. 6194, 2014. Print.Fuller, Dorian Q, and Leilani Lucas. Adapting Crops, Landscapes, and Food Choices: Patterns in the Dispersal of Domesticated Plants across Eurasia. Human Dispersal and Species Movement: From Prehistory to the Present. Eds. Boivin, Nicole, Rà ©my Crassard and Michael D. Petraglia. Cambridge: Cambridge University Press, 2017. 304–31. Print.Huang, Lin, et al. Evolution and Adaptation of Wild Emmer Wheat Populations to Biotic and Abiotic Stresses. Annual Review of Phytopathology, vol. 54, no. 1, 2016, pp. 279–301. Print.Kirleis, Wiebke, and Elske Fischer. Neolithic Cultivation of Tetraploid Free Threshing Wheat in Denmark and Nort hern Germany: Implications for Crop Diversity and Societal Dynamics of the Funnel Beaker Culture. Vegetation History and Archaeobotany, vol. 23, no.1, 2014, pp. 81–96. Print.Larson, Greger. How Wheat Came to Britain. Science, vol. 347, no.6225, 2015. Print.Marcussen, Thomas, et al. Ancient Hybridizations among the Ancestral Genomes of Bread Wheat. Science, vol. 345, no. 6194, 2014. Print.Martin, Lucie. Plant Economy and Territory Exploitation in the Alps During the Neolithic (5000–4200  cal Bc): First Results of Archaeobotanical Studies in the Valais (Switzerland). Vegetation History and Archaeobotany, vol. 24, no. 1, 2015, pp. 63–73. Print.Roucou, Agathe, et al. Shifts in Plant Functional Strategies over the Course of Wheat Domestication. Journal of Applied Ecology, vol. 55, no. 1, 2017, pp. 25–37. Print. Smith, Oliver, et al. Sedimentary DNA from a Submerged Site Reveals Wheat in the British Isles 8000 Years Ago. Science, vol. 347, no. 6225, 2015, pp. 998–1001. Print.Watson, Traci. Inner Workings: Fishing for Artifacts beneath the Waves. Proceedings of the National Academy of Sciences, vol. 115, no. 2, 2018, pp. 231-33. Print.

Beelzebufo Devil Frog Facts and Figures

Name: Beelzebufo (Greek for devil frog); pronounced bee-ELL-zeh-BOO-foe Habitat: Woodlands of Madagascar Historical Period: Late Cretaceous (70 million years ago) Size and Weight: About a foot and a half long and 10 pounds Diet: Insects and small animals Distinguishing Characteristics: Large size; unusually capacious mouth About Beelzebufo (Devil Frog) Slightly outweighing its contemporary descendant, the seven-pound Goliath Frog of Equatorial Guinea, Beelzebufo was the largest frog that ever lived, weighing about 10 pounds and measuring nearly a foot and a half from head to tail. Unlike contemporary frogs, which are mostly content to snack on insects, Beelzebufo (at least by the evidence of its unusually wide and capacious mouth) must have chowed down on the smaller animals of the late Cretaceous period, perhaps including baby dinosaurs and full-grown dino-birds in its diet. Reprising a common theme, this prehistoric amphibian evolved to its giant size on the relatively isolated Indian Ocean island of Madagascar, where it didnt have to deal with the large, predatory, theropod dinosaurs that ruled the earth elsewhere. Recently, researchers investigating a second fossil specimen of Beelzebufo made an amazing discovery: as big as it was, this frog may also have sported sharp spikes and a semi-hard, turtle-like shell along its head and back (presumably, these adaptations evolved to keep the Devil Frog from being swallowed whole by predators, though they may also have been sexually selected characteristics, the more heavily armored males being more attractive to females during Devil Frog mating season). This same team also determined that Beelzebufo was similar in appearance to, and perhaps related to, horned frogs, genus name Ceratophrys, which today live in South America — which may hint at the exact time of the breakup of the Gondwanan supercontinent toward the end of the Mesozoic Era.

The success of generic medicines in the worldwide pharmaceutical industry - Free Essay Example

Sample details Pages: 23 Words: 6882 Downloads: 1 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Chapter 1 Executive Summary This research will look at the adoption of generic medicines in specific three countries in Europe (The Netherlands, Poland and Portugal). These three countries have a significant difference in adoption; the reasons for this adoption difference can be explained by several regulations which are implemented by these countries. In previous research it is proven that regulations have a direct effect on the adoption however, this research will have a closer look which regulations in specific are important to stimulate generic medicines in the market. Don’t waste time! Our writers will create an original "The success of generic medicines in the worldwide pharmaceutical industry" essay for you Create order Results show that too much regulation around the entry of generic medicines in the market will lead to slow growth adoption in the market compared to countries which adopt less regulation. Recommendations to stimulate the generic medicines in the market will be presented in the last chapter. The problem background A lot of research has been done on the introduction of generic medicines. Examples include the obstacles to generic substitution in Sweden (Anderesson et al. 2005) and the use of generic medicines and the implications for the pharmaceutical market (King Kanavos, 2002). However, there is limited cross-country research examining the relationship between the implementation of regulation, the effects of incentives given to pharmacies and physicians and consecutive adoption of generic medicines. The available research is limited to one of these elements, there has not been made a direct consideration between these elements which influence the adoption of generic medicines. In 1995 the European Medicine Evaluation Agency (EMEA) offers a EU- wide authorization process which replaced the ongoing single authorization process of each country separately, this means that regulation is harmonized regarding the entry of generic medicines The EMEA will approve the generic entry of a medicine before it can be presented on the European pharmaceutical market. This centralized procedure has decreased the approval delays for generic medicines in the EU resulting in the fact that patent regulation and approval procedures for medicines no longer have a large effect on the development of generics (Danzon, et al. 2003). National regulation still has an impact concerning price and reimbursement approval which has to be authorized by national authorities. Moreover, it is examined that generics have had more success in countries with more flexible pricing policies (Garattini Tediosi, 2000) and previous research has shown that the prescription of generic medicines is dependent on the incentives given to pharmacist, and other parties (Hellerstein, 1998). However, with recent reforms in the national regulation systems across European countries, flexible generic pricing policies and incentives given by the national governments are no longer the main determinants of successful entry of generics on the market. Obligatory generic substitution systems and other regulations implemented by European governments have become at dominant factor in explaining the adoption of generic medicines as a consequence that incentives for physicians, pharmacists and patient have decreased due to the obligatory system (Timonen, et al. 2009). This thesis gives an overview of the relation between the adoption of generic medicines and the regulation in three European countries: The Netherlands, Portugal and Poland. These countries are chosen because they have different implementations in regulation concerning generics and the adoption rate in these countries differs significantly. Recommendations for European countries and a conclusion about the most effective method to increase the use of generic medicines in relation with regulation will be exposed. The problem statement The differences among three countries; (The Netherlands, Portugal and Poland), concerning the adoption of generic medicines in relation with regulation and influencing incentives in these European countries. The motive to present these specific three countries is resulting from the fact that the adoption level of generic medicines differs significantly. Therefore a clear image can be provided between the differences of adoption connected with the accompanying regulation adopted in that country concerning generic medicines Dependent variable: adoption of generic medicines Independent variable 1: regulation of generics medicines Research Questions Research question 1: What are the differences in regulation about the use of generic medicines among the Netherlands, Portugal Poland? Research question 2: What is the role of these regulations on the adoption of generics? Relevance The thesis should give European countries and in particular public policy makers, a clear image on the effects incentives can have concerning the adoption of generic when prescribing these medicines, and which type of regulation is the most effective for the increase in adoption of generics. Managerial perspective The prescription of generic medicines is intensively regulated. This results in many implications for pharmaceutical companies especially, concerning the implementation of generic medicines in the market. Considering, the fact that the regulation of the prescription of generic medicines has a direct effect on the use of generic medicines. Therefore the adoption level for generic medicines is likely to change when the regulation changes. Pricing strategies for pharmaceutical companies have a diminishing effect due to the strict pricing regulation implemented by public policy makers. Branding strategies are also complicated to implement in the pharmaceutical industry because of the many regulations adopted. However, branding strategies are very important; they can strengthen the bond between the buyer and the seller (Blackett Robins, 2001). Pharmaceutical companies have to make important decisions regarding the implementation of the generic medicines in the market. They should be aware of all regulation to be able to compete in the pharmaceutical industry. Academic perspective Country-specific results have been presented in several papers how regulation influences the use and adoption of generic medicines. However, a cross-country research on the effects of regulations implemented, in relation to the adoption of generic medicines. More specifically, the effects of incentives, given by policy makers, to pharmaceutical companies and the accompanying marketing strategies implemented by pharmaceutical companies, have not been examined earlier. Overview of the Rest of the Chapters Chapter 2: This chapter gives an overview on the question: What are the differences in adoption of generic medicines between the Netherlands, Portugal and Poland? These three countries will be investigated carefully; previous literature studies will give a clear image about the actual adoption of generic medicines in these countries. Background information will be presented to understand the structure of the chosen countries and the differences in adoption. Chapter 3: Data will be gathered to come to an answer to the research question 1: What are the differences in regulation about the use of generic medicines among the Netherlands, Portugal Poland? Chapter 4: Chapter four will explain the role of regulation on the adoption rate of generic medicines (research question 2). Chapter5: Public policy makers are in general in favour of increasing the use of generic medicines, because of the market advantages. Chapter 5 will give an overview of the most effective policy which is used among the three countries presented earlier in the thesis. Further recommendation to the public policy makers and limitations of the research will be dealt with in this chapter. A conclusion of this research will be presented. Chapter 2: differences in adoption of generic medicines This chapter will give an answer to the differences concerning the adoption of generic medicines between the Netherlands, PortugalandPoland. The level of generic medicine adoption differs significantly across Europe. This chapter will have a look at these differences and the resulting factors that have lead to these differences in adoption. Other implications such as different policy regulations and incentives given to pharmacist by the policy makers will be dealt with in chapter 3. They will be dealt whit in a separate chapter because they are dominant factors in the adoption of generic medicines. A distinction can be made between mature generic markets and developing generic markets (Simoens, 2009). The level of adoption of generic medicines in these countries differs from less than 10 per cent to more than 40 per cent. The share value in the market for generic medicines is 8.8 per cent for the Portugal, 19.8 per cent in the Netherlands and Poland ranks the top with 65.2 per cent (A Review on the European, n.d.). Comparing these figures with other European countries, Portugal falls in the lower range of adoption and Poland is situated in the upper range of the adoption level of generic medicines in their market. According to Simoens and Coster, (2006), Poland and the Netherlands are seen as mature generic markets in Europe, while Portugal is seen as a developing market. There are several factors (historical background and cultural elements), which have influenced the adoption rate of generic medicines in these countries. Clarifications of these elements are stated below. Historical background An explanation for the differences in adoption of generic medicines can partially be explained by the historical differences between the Netherlands, Portugal and Poland. In Western Europe, pricing and reimbursement policies naturally developed as an evolutionary economic process. However, this was not the case for Central and Eastern Europe states (CEE) which are now members of the EU. These CEE countries used to have a socialistic type of economy, and after the fall of the Berlin wall (1989) many of those countries faced political and economic bankruptcy. Large-scale reform was necessary in every single sector to guarantee their economical and political well being. The health care system was also a part of this sector and even today, ongoing reforms are taking place. There is still a lot that has to be done in the CEE countries, specifically within the health care system. Hospital decentralization, modernization and privatization and pricing and reimbursement policies are some examples of areas where further development is preferred (Kazakov, 2007). These necessary reforms and changes are also applicable to Poland. The Netherlands and Portugal do not suffer from these reforms, due to fact of not having a communistic history. Another implication of this socialist history is the fact that Poland was already used to adopt generic medicines, as brand medicines were not available in these countries due the absence of product patents until early 1990s (Simoens de Coster, 2006). Cultural elements Cultural sensitivity is one of the most widely accepted principles among public health (Resnicow, et all. 2000). According to Resnicow (2000), cultural sensitivity indicates The extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of targeted health promotion materials and programs (page 272). The relation between the pharmacist and the pharmaceutical representative can have a huge impact on the prescription of medicines and therefore on the adoption of generic medicines. Historical developments in Poland have created a positive attitude towards prescribing generic medicines, as prescribing generic medicines has been a common practice in Poland until the early 1990s. In the Netherlands, on the other hand, generic substitution is more driven by the pharmacist (Simoens de Coster, 2006). On average a pharmaceutical company will spend twice as much on marketing to the pharmacist and the public than on research and development (Zipkin, et all. 2005). A more detailed view about the adoption rate of generic medicines concerned the three countries (the Netherlands, Poland and Portugal) are presented below: The Netherlands The Dutch generic market has grown rapidly over time; public expenditure has increased from 185 million euro in 1994, resulting in a market share value of 8.5 per cent. In 2004 the market share has increased to 17.7 per cent; this means that the value has almost doubled. The market share increased also dramatically from 19.9 per cent in 1994 to 44.3 percent in 2004 (Simoens de Coster, 2006). Results from an EGA survey conducted in 2007; show that the market share of generic medicines has increased to more than 50 per cent (see figure 2 and 3 in appendix B). Poland Due to historical implications mentioned before, Poland has a very mature generic market. In 2006 the market shares of Poland were 60 per cent by value and close to 80 per cent by volume (see figure 2 and 3 in appendix B). Portugal In the 1990s the generic medicines adoption in Portugal did not exceed more than 1 per cent. An introduction in the generic policy in the year 2000 caused for an increase in market share of 8 per cent measured until 2004. An explanation of the generic policy will be provided in chapter 3 (Simoens de Coster, 2006). Recent results from an EGA survey implemented in 2007 show that the market share has slightly increased to almost 10 per cent (see figure 2 and 3 in appendix B). Chapter 3: differences in regulation about the use of generic medicines What are the differences in regulation about the use of generic medicines among the Netherlands, Portugal Poland? There are several domains in regulation which will eventually influence the structure of the market and determine how the pharmaceutical companies can operate most effectively in this pharmaceutical market. This thesis presents the most important domains where regulations are implemented; market authorisation, pricing, incentives, and marketing implications. Market authorisation In Europe, the process regarding market authorisation is very complex. Market access for generic medicines may differ from country to country; this holds there is little transparency regarding the entry of generic medicines in Europe. A pharmaceutical company may receive market authorisation to enter the market in a specific country. However, other regulations regarding the reimbursement and price of the generic product still need to be determined by the government. This means the process, concerning the entry of the generic medicine, can be delayed up to three times (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). The EU directive was introduced to create a better system regarding the entry of generic medicines in Europe. There is a transparency directive, 89/105/EEC, which specifies that there is a 90 day limit regarding the reimbursement and pricing decision. However, the time delays vary from country to country (Garattini Tediosi, 2000). The table below (A Review on the European Generic Pharmaceutical Market in 2005, n.d.) gives an overview of the times delays per country for price approval to enter the market. With respect to the countries in this thesis, the table above (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). shows the following: Poland does not have a time delay because the pricing and reimbursement approvals are granted together with the market authorisation of the generic medicines. In the Netherlands, we can see a delay of between 10 and 15 days which could be defined as a relatively efficient time to approval compared to other countries in Europe. Portugal is very inefficient with the entry of the generic medicines, the status of pricing and reimbursement will only be given after a 90-day delay (A Review on the European, n.d.). Pricing Price regulations are only applicable when the generic medicines will be reimbursed. The most effective regulation is a price restriction on the maximum reimbursement of that specific medicine or a maximum price that pharmaceutical companies may charge the medicine users (Danzon Keuffel, 2007). Most European countries, including the countries in this study, have introduced a reference price system. A reference price system entails that there are regulations which will restrict the reimbursement level of generic medicines, but that the price of the generic medicines itself will be uncontrolled. Under the reference price system, groups are clustered into certain reimbursement level, based either on the same compound or different compounds but with the same mode of action or with a similar name. All products that are placed in the same group are reimbursed at the same price per daily dose, which is also called the reference price. In general, the reference price in a group will be set at the level of the cheapest medicine or the median in that group. If pharmaceutical manufacturers price their product above the reference price, the user of the generic medicines needs to pay the outstanding amount above the reference price. There are two different pricing systems in Europe: a generic free pricing system and a generic price-regulated system. Both systems determine the degree of adoption of generic medicines. In a generic free pricing system companies can decide on the height of the price of a new generic medicine introduced in the market themselves, in contrary to a price regulated system (Simoens, 2010). The reference pricing system has three levels of implementation, the higher the level of the system is, the more the prices are regulated. Poland has a low reference pricing system, the Netherlands could be defined as a medium reference pricing system and Portugal uses a high reference pricing system. As presented in the table below (Bongers Carradinha, 2009), one can see which European countries fall in a regulated price system and have no free pricing system. Consumer implications The patients themselves (the demand side) play an important role in the prescription of generic medicines. Physicians and pharmacists and other contributing parties will prescribe generic medicines to reduce the costs for the payer, which is in this case the consumer of the medicine. Patient co-payment Pricing and reimbursement systems play a role for the patient. The patient will contribute to the financing of the health care system, in particular with the co-payment arrangement. This is a common practice in all European countries (with the exception of Malta), but the implementation of co-payment differs significantly across countries. Nevertheless, in all countries that employ a co-payment arrangement a financial contribution is made by the medicine user. Patient co-payment arrangements can strongly influence the end decision of the patient on which medicines to take (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). The reimbursement of generic medicines is taken care of through an insurance model; however the co-payment arrangement is based on a percentage of the cost of the medicine (Kazakov, 2007). Pricing regulation related to the countries in the thesis; The Netherlands uses an enforcing pricing regulation, which sets a maximum for the pricing of medicines. In 1996, this system was implemented. In general, it led to a decrease of 15 per cent of the average medicine price in the market (Simoens de Coster, 2006). However, the prices of generic medicines in the Netherlands still tended to be higher compared to other EU countries. Mediation in short-term pricing strategies such as implementing similar pricing systems, have increased and stimulated the share in the markets for generic medicines, where competition already existed (Bongers Carradinha, 2009). Polish medicine prices tend to be lower compared to other EU countries. They work with a price regulated system for generic medicines. The pharmaceutical companies want to be absorbed in the reimbursement list for medicines. The reference price in Poland is set just below or just above the cheapest generic medicines in the Polish market (Simoens, 2009). Pharmaceutical companies may price their product above the reference price, taking into account that as a result they will not be placed on the reimbursement list (Kazakov, 2007). Portugal established a regulation which says that the minimum price difference of generic medicines and brand medicines should be a least 35 per cent in 2001. In 2005 Portugal agreed to reduce the overall medicine prices by 6 per cent. Of that 6 per cent 4.17 per cent had to be reduced by the pharmaceutical company and the other 1.93 per cent had to be reduced by the wholesalers and pharmacists. The reference price system was introduced in 2003 where the reference price was set at the level of the most expensive generic medicine (Simoens de Coster, 2006). Despite the fact Portugal has a developed market, the market share concerning generic medicines is still relatively low compared to other countries in Europe. Regardless, of the fact that companies producing generic medicines provide affordable treatments to patients, other savings can only be achieved if government supply side policy initiatives are designed to increase the competitiveness of generic medicines in the market (Bongers Carradinha, 2009). Incentives To establish a generic medicine market, the supply side (pricing system) needs to be supplemented by demand side policies which create incentives for physicians, pharmacists, and patients to use generic medicines (Simoens de Coster, 2006). The Netherlands Instruments to promote generic medicines have been in place for a long time and have been widely accepted in the Netherlands (Vogler Schmickl, 2010). Incentives for physicians The Dutch government has stimulated physicians to prescribe generic medicines, which is supported by an electronic prescription system. In the Netherlands it is customary to develop and implement guidelines and treatment protocols on how to prescribe generic medicines in order to efficiently increase the adoption of generic medicines. An important feature is that there are no sanctions for physicians who do not prescribe generic medicines (Simoens de Coster, 2006). Incentives for pharmacists Generic substitution is allowed for the pharmacist when the physician and the patient agree with it, however, it could be indicated by the physician that generic substitution is not permitted due to health reasons. This means that when a branded drugs patent has expired pharmacists are allowed to distribute a generic substitution unless indicated otherwise by the physician. Health insurers have also agreed upon several targets for the pharmacist in distributing generic medicines (Simoens de Coster, 2006). Generic substitution has been connected to financial incentives for the pharmacist for a long time, however these incentives have been abolished since 2004. Nevertheless, the adoption in the market of generic substitution has not decreased (Vogler Schmickl, 2010). Incentives for the patients In the Netherlands the patients do not have a financial incentive to buy generic medicines because there are no patient co-payments arrangements. Nevertheless, patients do have to pay the outstanding amount when the price of the medicines is above the reference price, which is set by the government (Simoens de Coster, 2006). Poland Incentives for physicians Physicians are not intensively encouraged to prescribe generic medicines. Due to the historical background physicians are already accustomed with the use and prescription of generic medicines (Simoens de Coster, 2006). Incentives for pharmacist Generic substitution is allowed by pharmacists; whenever a branded drug is prescribed a pharmacist may replace this by a generic substitution. Pharmacists are obliged to inform the patients about the generic substitution. Price reductions implemented by pharmaceutical companies encourage pharmacists to prescribe generic medicines (Simoens, 2009). Incentives for the patient There are four levels of reimbursement for the patient. The first level includes a fixed amount per prescription which will be reimbursed when these are essential medicines. The second and third level consist of supplementary medicines which will be charged to the patient through the co-patient system. The patients have to pay 30 to 50 per cent themselves. The fourth level holds that other prescribed medicines which are not on the reimbursement list will be fully paid by the medicine user (the patient). However, initiatives to inform the patients about generic medicines have not been presented (Simoens de Coster, 2006). Portugal Incentives for physicians In 2002, a regulation was implemented in Portugal which formulated that from that moment on physicians would be obliged to prescribe a generic medicine if possible. However, physicians and pharmacists are free to add brand medicines to prescriptions that include more than one medicine, of which at least one is generic. The physicians are to inform the patient about other generic medicines and the accompanying price differences. Even though guidelines are available, the system has not been fully implemented. An explanation for this is that the physicians and the pharmacists are neither being rewarded for prescribing, nor being punished when not prescribing generic medicines (Simoens de Coster, 2006). Incentives for pharmacists Physicians can indicate whether they permit generic substitution on the prescription form. In the cases that generic substitution is allowed by the physician, the pharmacists have to prescribe the cheapest generic medicines available. Pharmacists do not have any financial incentive to prescribe generic medicines as the generic margins for pharmacists have been dramatically low since the introduction of the regulation in 2005 (the overall reduction of generic medicines prices) (Simoens de Coster, 2006). Incentives for patients Portugal has 5 different levels of reimbursement. In the first level 100 per cent of the medicine will be reimbursed when they are classified as life saving. The second level holds that 95 per cent of the medicines will be reimbursed, the third level holds 70 per cent, the fourth level 40 per cent, and the fifth level holds a percentage of 20 per cent. Patients with a low income will receive a 15 per cent additional compensation on the stated reimbursement level. Until 2005, patients were rewarded with a 10 per cent additional reimbursement when they asked for a generic substitution. However, with the abolishment of the reward system of 10 per cent, the patient will now only receive a price reduction of 6 per cent for the use of generic medicines. The patient does not have an incentive but rather a discouraging effect to use generic medicines. Nevertheless, pro-generic campaigns have been introduced by the government since 2006; the effects of these campaigns are not yet clear (Simoens de Coster, 2006). Previous research shows that the patient co-payment arrangement in Poland and Portugal plays a visible role in stimulating the use and adoption for generic medicines (Simoens de Coster, 2006). For an overall overview of the regulation implemented across these three countries a table is presented below. Poland The Netherlands Portugal pricing Reference pricing low Medium high Patient co-payment yes no yes reimbursement 4 levels Pay excess when Above RP 5 levels Adoption level Very high mature market Medium mature market Low developing market Incentives Physician Not encouraged but accustomed to prescribe Stimulate to prescribe obligated pharmacist Allowed and have financial incentive Allowed unless indicated else Allowed but no financial incentive patient Financial incentive No financial incentive No financial incentive Marketing implications A generic medicine should appear under the international non-proprietary name (INN). This entails, that a generic medicine should be marketed without a commercial brand name but in fact, three categories there can be distinguished; branded generics (copies of generic medicines with their own brand name), semi-branded generics (products marketed under the INN following the name of the manufacturer of the medicines) and medicines marketed under INN (Garattini Tediosi, 2000). The EU directive 65/65/EEC was established, to approve marketing of a drug. An allowance for introducing a generic medicine and detailing these medicines should be supported by several data available of the generic medicines (for example clinical data.) There are a lot of restrictions concerning advertisements and promotion activities of pharmaceutical products. These are presented by the The European Parliament and the Council of the European Union (2004) .Together with price regulation, advertising plays an important role in the pharmaceutical market. In general patients are uninformed about the most effective and available treatments, they depend on the diagnosis and treatment suggestion from the physician. Since the physician will prescribe the medicine it can be stated that they will directly affect the extent of competition between different treatments and medicines available. Therefore it not remarkable that the physician is the target of huge advertisement campaigns and that detailing in the pharmaceutical industry is mainly focused on physicians (Knigbauer, 2006). The volume of detailing in the pharmaceutical market depends on several factors such as: the prevalence of the disease, the amount of competition for the medicine, the number of physicians who might prescribe the generic medicines, and like any other product in a market, taking into account the product life cycle of the product (Berndt, et al 2007). Chapter 4 What is the role of these regulations on the adoption of generics? Market authorisation Approval of generic medicines The success of a generic medicine depends on several factors including; patent, approval to the market, pricing and reimbursement. These factors eventually lead to successful product life cycle of a generic medicine. The generic medicines can be approved after the patent of the originator medicine is expired (Frequently asked questions about generic medicines, n.d.). Approval to the market will be regulated by the coordinating organization EMEA; they will approve a generic medicine, resulting in the fact that it can be launched on the EU market. The National authority of the EU countries will eventually approve the price and reimbursement authorization. These separated approvals can cause delays in the approval of a generic medicine in a country, while price and promotion regulation also affect the success of a product life cycle regarding a generic medicine (Danzon, 2003). Decrease in national medicine expenditure The national governments and the EMEA, which approve the market authorization for generic medicines, create a decrease in national medicine expenditure. A good regulation for generic medicines will increase the adoption level of generic medicines. The low development of new medicines and the increasing expiry dates of patent medicines has lead to a competitive generic market, the involving regulations (e.g: price regulations) will stimulate the adoption in the EU market (Garattini Tediosi, 2000). The ageing population in Europe, with its coherent prevalence age-diseases and the need for more specialized and individualised care treatments in Europe, will result in a considerable increase in pharmaceutical costs in the future. (see appendix figure 6) Pricing Introducing a controlling price system is a way to control supplier moral hazard. It applies to all services; this is also the case for the pharmaceutical industry. Consistent with this view of pharmaceutical price regulation, it can be seen that it has become a fundamental strategy for insurances to control the supplier moral hazard. In general it can be stated that price controls, in most countries, apply only when medicines are reimbursed by the public health insurance (Danzon Keuffel, 2007). Policy implications The reference pricing system which is implemented by the European countries plays a role in the economic pharmaceutical market. This means that the European countries influence the market entry of generic medicines and the price level of generic medicines on the supply side (Simoens de Coster, 2006). Subsequently, the reference price system will cause that pharmaceutical companies will decrease their prices, assuming that the demand for the generic medicine will become inelastic when pricing the product above the reference price (Danzon Keuffel, 2007). However, it is important to notice that the primary objective of a reference price system is to control the pharmaceutical expenditure by controlling the reimbursement level of medicines. The objective is not to stimulate generic use (Simoens de Coster, 2006). This means that countries in favour of free market pricing generally have higher medicine prices. High medicine prices stimulate generic market entry, in contrary to regulated price systems (e.g. Portugal) where regulation prices drive down the originator price over the life cycle of the medicine. This lowers the potential profit margin for a generic company and discourages market entry (Simoens de Coster, 2006). According to the internal EGA survey, in the case of compulsory prescriptions, doctors are encouraged to prescribe generics in 56 per cent more cases than when it is not compulsory. Only 11 per cent of European countries implement a compulsory subscription system. There are guidelines to inform doctors about the prescription and assist them in the procedure of prescribing (A Review on the European Generic Pharmaceutical Market in 2005, n.d) Incentives The consumer is not only responsible for the adoption of generic medicines in the market. The physician also plays an important role in the prescription of generic medicines. The physician will determine which specific medicines a patient will use and in which therapeutic class the medicines will be used. The therapeutic class will be determined from the input of the physicians and the patient together. Therefore it can be stated that this relationship is not only a principle agent relationship but that the patient- physician relationship can also be seen as a partnership due to the interaction of both parties (McCarthy, 2010). Overall, it can be stated that incentives given to physicians, pharmacists and patients have limited focus, in accordance with the improvability of regulation system incentives can stimulate an increase in adoption. Marketing implications Persuasive advertising namely, product differentiation stimulates generic medicines in the market. This will cause for lower prices of the medicines in specific after the patent is expired. The advantages of these lower prices have been explained earlier, in this chapter. Brand- name advertising will decrease the adoption in the market for generic medicines because price elasticity of demand in the pharmaceutical will decrease due to the fact that brand loyalty has increased (Knigbauer, 2007). Important to notice is that the regulations cannot affect the incumbent level of advertisement nor can they control the pharmaceutical firms whether they enter the market with generic medicines. However, regulations can manipulate the conditions under which the incumbent chooses to the profit maximization level. In addition health authorities can guide the extent physicians are allowed to accept gifts or sponsored reference trips to reduce the obligation of the physician to prescribe a specific brand or product. Detailing is generally allowed under strict condition concerning advertisement. It is assumed that detailing is mainly used to inform the physician or patient. Lenient price regulation will strengthen the advertisement advantages by allowing generic medicines in the market and restricting high patent prices (Knigbauer 2007). Chapter 5 Recommendations: General recommendations Time is an important factor when concerning the approval of generic medicines for the market. It can give a significant value to different patient groups, and therefore a reduction in the delay in approval for in the market of a generic medicine is crucial (Kazakov, 2007). This can be accomplished by a more transparent system. Considering the restrictions regarding promotion and advertisement of medicines, pharmaceutical companies have to find ways to introduce the product to the prescriber and the user of the generic medicine. Price competition also limits the revenue for pharmaceutical companies, this leads to a very competitive even rivalry pharmaceutical market. As a result, pharmaceutical companies have to respond to regulation in such way; they make a profit out of the regulation for their own interest. This complies with an ongoing regulation changes that have to be induced (Richard Frank, 2007). Another implication with price regulation can arise, when the price of generic medicines is too regulated. Resulting in a low percentage of competitive medicines available, causing a higher (monopolistic) price (Knigbauer, 2006). In other words, in a flexible pricing system, a pharmaceutical company has the opportunity to compete with other companies using pricing strategies taking into account the restrictions enforced by the national regulation in specific taken into account reference price. Therefore a flexible pricing system is recommended over a strictly regulated system (for example: Portugal). Other measures recommended are Pro generic measures. In particular, the areas of pricing and reimbursement mechanisms should be improved and be more transparent. Governments should also try to increase the knowledge of patients by informing them about generic medicines. This can be done through the channels of physicians and pharmacists (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). Although there is no concrete or well defined policy concerning the encouragement of the physician in the countries where measures exist toward the encouragement of prescription of generic medicines by the physician have a higher adoption level compared to countries who do not adopt such measures. Therefore measures encouraging physicians to prescribe generic medicines (example: budgetary incentives or prescription monitoring) are recommendable for all European countries (Bongers Carradinha, 2009). Finally, it remains difficult to recommend one best fitting regulation to implement for all European countries due to the fact that the adoption level concerning generic medicines differs significantly across European countries and not all regulations fit when there is a difference in the maturity of the market. Therefore one strategy will not be compliable anymore for all European countries. However a more transparent and central European regulation model should guide all European counties into one direction. Specific recommendation for the Netherlands, Poland and Portugal Given, that the adoption rate of generic medicines in the three concerning countries presented in the thesis have a significant difference and taking into account the different regulation presented above. There can be made several recommendations for the concerning policy makers in the specific countries. The Netherlands As mentioned earlier in the thesis, generics have a better adoption rate when the country has introduced a flexible pricing system, however, it does result in a higher medicines price compared to other EU countries (Garattini Tediosi, 2000). The Netherlands has developed an electronic subscription system however this is not completely introduced yet; a complete implementation of this system together with better transparency concerning pricing should create a competitive generic market. Poland Poland has chosen for a low Reference Pricing system by putting the reimbursement level on the cheapest generic medicine. When Poland switches to a flexible pricing system the adoption rate can increase, this is examined in previous research (Garattini Tediosi, 2000). However Poland should take in account that medicine prices will increase. Portugal As presented earlier in chapter 3, regulated pricing system drive down the price of generic medicines; resulting in a discouraging entry for generic medicines. Therefore it would be recommended to abolish the regulated pricing system and implement a flexible pricing system. This encourages pharmaceutical companies to adopt in de Portuguese market. In general Portugal should create proper regulations and conditions that increase the competitiveness and stimulate the entry of generic medicines (Bongers Carradinha, 2009). Limitations The research presented above is focused on three chosen countries (The Netherlands, Poland and Portugal). Due to the different national policies and regulations some regulations applicable specific for the countries presented in the thesis may not be declared applicable to other European countries. Therefore assumptions and conclusions for all European countries cannot be made or are not representative. However, it is possible to present European countries a guideline what a favourable policy or regulation would be considering the outcomes of these countries. Further comparisons between European countries should be made. A better insight of the ultimate adoption of generic medicine can be investigated; this can be done by comparing all developed generic markets in Europe. A more detailed insight should be presented of the European countries concerning several strategies and temporary policy agreements to explain particular increases in a specific period of time in relation with the adoption of generic medicines in the market. In extension of this further research and more detailed and concentrated adoption results of generic medicines in the market should be retrieved. Policies and regulations concerning a further increase of generic medicines in the markets have not been investigated. Therefore developed generic markets should try to find new short-term strategies or regulations which can increase the total adoption in the market for generic medicines, this to prevent that the increase of adoption concerning generic medicines will stop. Perception of neither the physicians nor the patients is included as a mediating variable. Research is conducted about the perception of generic medicines concerning these parties, as mentioned previous in the research the patients can play an influencing role in the prescription of the drugs. This can have consequences when taking in account that European countries have different cultures and therefore different perceptions regarding generic medicines. Conclusion It can be concluded that countries which do not have a long-term or consistent generic medicine regulation implemented, are in general countries that have the smallest market volume in the generic medicine market (see figure 7 appendix). These countries are creating little awareness and economic benefits for the healthcare system. Savings for governments and affordable prices for patients are minimal (Bongers Carradinha, 2009). Regulations implemented in a country, have a direct effect on the adoption of generics medicines in the pharmaceutical market. Flexible pricing systems are favored above strict price regulations, it encourages the pharmaceutical industry to develop and establish a better generic market in the concerning country, competitiveness among pharmaceutical companies will increase. Moreover pharmacists, patients and physicians are also encouraged to use and prescribe generic medicines. A flexible pricing system results in increasing adoption of generic medicines in the market (example the Netherlands). In general, we can conclude that regulations concerning generic medicines can constraint or provide the adoption of generic medicines in the pharmaceutical market. The Highest market share concerning generic medicines is found in countries where the industry had historically the greatest pricing freedom among which The Netherlands (Lofgren, 2002). Too much regulation will cause no flexibility for the pharmaceutical industry to develop (example Portugal). Hence, cultural and historical aspects also remain an important factor that influences the adoption in the generics industry (example Poland). Marketing implications concerning generic medicines constrain the development of generic medicines. Pharmaceutical industries are very limited regarding advertisements and branding of the medicines, other regulations such as price and reimbursement regulations make the possibilities to enter the pharmaceutical market inflexible therefore, policies makers should take that in account and mainly consider flexible policies. Transparency of generic medicines in the pharmaceutical market is also an important factor is; it can reduce delays for an approval on the European market. Another increasing concern of the European governments is the sustainability of the healthcare system. The expenditure on pharmaceutical products is a significant component of the healthcare system. Generic medicines contribute to a sustainable healthcare system partly due to the reduction in costs (Bongers Carradinha, 2009). The importance of a sustainable healthcare system is acknowledged. However, the implementation of these sustainable healthcare systems can be implemented by balanced policies and regulations. On the one hand, the policies and regulations will take care of affordable prices for healthcare systems in general, which extends to affordable prices for the patients. But on the other hand, the generic medicines sector provides a continuous source of cost effective medicine treatments and generates yearly savings of more than 25 billion Euros for the European healthcare system. In addition generic medicines will create a competitive market resulting in a decrease of medicine prices (Bongers Carradinha, 2009).

Obsessive Compulsive Disorder ( Ocd ) - 2087 Words

Obsessive compulsive disorder (OCD) was once thought to be extremely rare, but recent epidemiological studies have shown it to be the fourth most common psychiatric disorder (after substance abuse, specific phobias, and major depression). OCD is often a chronic disorder that produces significant morbidity when not properly diagnosed and treated. The mainstay of treatment includes cognitive behavioral therapy and medication management. The use of clomipramine in the 1960s and then the introduction of serotonin reuptake inhibitors in the 1980s represented important advances in the pharmacologic treatment of OCD. Despite effective treatment modalities, many patients demonstrate only a partial response or are resistant to available medications. SRI-resistant OCD is one of the few diagnoses in modern psychiatry for which invasive neurosurgical procedures remain part of the established treatment armamentarium. We review current treatment strategies used in the management of OCD symptoms. Introduction Obsessive compulsive disorder (OCD) is a debilitating neuropsychiatric disorder with a lifetime prevalence of 2 to 3 percent and is estimated to be the 10th leading cause of disability in the world. Patients with OCD experience recurrent, intrusive thoughts (obsessions) and/or repetitive, stereotyped behaviors (compulsions) that last for at least one hour per day and significantly interfere with the individual s normal level of functioning. The intrusive obsessional thoughtsShow MoreRelatedObsessive Compulsive Disorder (OCD)1756 Words   |  8 Pages Obsessive Compulsive Disorder (OCD) is a disorder that can affect children and adults. In order to fully understand OCD, many different areas of the disorder must be reviewed. First, OCD will be defined and the diagnosis criteria will be discussed. Secondly the prevalence of the disorder will be considered. 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Analysis Of “The Little Mermaid” By Hans Christian Andersen.

Analysis of â€Å"The Little Mermaid† by Hans Christian Andersen â€Å"The Little Mermaid† by Hans Christian Andersen is one of the worlds most cherished fairy tales. Through the years, this story has inspired its fair share of different adaptations and spinoffs, as well as intertwined itself in popular culture. Although it is widely considered a children’s story today, upon close examination, we can find various elements of literary devices and themes, all of which provide the seasoned reader with a deep connection to the story. To honor the tradition of story-telling, it is essential that a short summary of the story be given. Per Hans Christian Andersen’s account, the bottom of the ocean is nothing like what we humans imagine. Instead, a sea†¦show more content†¦She ultimately chooses death, but continues living as a â€Å"daughter of the air†. When first reading â€Å"The Little Mermaid†, the reader is sure to notice the imagery painted by Anderson. He finds a way to make a place we see as dark and abysmal, the sea floor, seem bright, vibrant, and full of joy. One sentence Hans Christian Andersen writes, â€Å"The most wonderful trees and plants are growing down there, with stalks and leaves that bend so easily that they stir at the very slightest movement of the water, just as though they were alive† (216), perfectly exemplifies this imagery. It is also important to take note of how the imagery changes by location. In the part of the sea where the witch lives, the imagery evokes the feeling of gloom and loneliness that one would naturally expect from the sea floor. Above the surface of the ocean, in the human world, the author uses imagery that quite frankly blows the beauty of our world out of proportion. Andersen writes, â€Å"The whole sky had looked like gold, she said, and the clouds—well, she just couldn’t describe how beautiful they were as they sailed, all crimson and violet, over her head.† (218) This makes something we find trivial seem l ike something everyone must see before they die. While some may view this as odd, it is important to consider that the story centers around a mermaid who has never seen these things before. Something that I believe the author does not emphasize enough is theShow MoreRelatedThe Rise Of Feminism Of The 19th And 20th Centuries2037 Words   |  9 Pagessociety and the influence they bring to children’s fundamental moral principles has enabled analysis of many aspects of sexual identity within society. The rise of literary gender criticism allowed examination of how sexual identity has influenced literary works and the influence it brings to society throughout history. 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Other men, like Mr. Wills, can throw seed on the ground, scuff dirt over it, walk off and leave it, and have a crop of the prettiest, biggest melons you ever saw. Mr. Wills always planted the little field directly behind his barn to watermelons. It ran from the barn to the creek, a good piece of land with just the right sandy soil for melon raising. And it seemed as though the melons just bulged up out of the ground for him. But they were

A Pastiche continuing from Part I of Franz Kafkas Metamorphosis Essay Example For Students

A Pastiche continuing from Part I of Franz Kafkas Metamorphosis Essay The following passage is a scene between Grete and her father her mother will not be in this scene. Her father is struggling to comprehend Gregors metamorphosis but is more concerned about how the family will survive monetarily whilst Grete quietly mourns her brothers transformation. My intention was to capture the boorishness of Gregors father which we see later on in the story when he flings an apple at Gregor, fatally wounding him. Gregors father is a somewhat defeated man due to the failure of his business and so, whilst his son works at a demoralising place with an unsatisfactory job, he lounges about. This may be due to his ill health but after Gregors transformation he does manage to regain his confidence and desire to work. This is partly represented by his smart blue uniform with gold buttons replacing his old overcoat. Indeed the gold buttons could be seen as a sign of his replenished sense of pride. Grete has a good relationship with her brother and cared for him deeply, as seen early on in the text. Gregor is locked in the room and she asks him, Oh Gregor? Are you not well? Can I bring you anything? Despite initially being fearful of the cockroach, she takes on the role of Gregors carer. Gregor believes that the reasons for Grete assisting him are a mixture of devotion, due to the memory of their relationship, and her youthfulness. Grete flourishes as a person and displays her ability to take on the responsibility of dealing with a dilemma such as Gregor. This is unlike her parents who, in the text, seem incapable of dealing with the issue themselves. In the passage we also see Grete with her violin. This is a symbol of the strong relationship between Grete and her brother since he admires her music to the point where, as it states later on in the text, he wishes to send her to the Conservatorium. This seems to be the only way in which both Gregor and Grete rebel as, their pare nts disliked even innocent references to the Conservatorium. My aim is to capture Kafkas use of simple and clear prose. The resonance of the declarative opening line, When Gregor Samsa awoke one morning from troubled dreams, he found himself changed into a monstrous cockroach in his bed, is perhaps the only startling or unexpected line in Metamorphosis and my pastiche has been written to continue with this lack of eventfulness. In the text speech is always followed by actions and so I have tried to emulate this narrative style of writing in my characterisation of Grete and her father. Kafka employs this style of writing through the use of an omniscient third-person. This is particularly true in regards to Gregor but in my passage I employ this technique for Grete and her father. The opening paragraph is also very long so as to annunciate the characters confusion, as Kafka does for Gregor who remains in a constant state of confusion due to his state. In this pastiche I have also touched on a theme that appears in Metamorphosis; that of the effect of financial hardships on relationships. In the text, Gregor is merely seen as a means to make money and so when he undergoes a metamorphosis, he is treated with contempt. In my passage I have shown this contempt through Gregors father as he is the main reason why Gregor had to do a job he hates in the first place. Furthermore, I will highlight the fact that income is the most important issue according his father and this makes up a large part of his dialogue with Grete in the pastiche. This is to mimic way in which Kafka highlighted the fact that the characters are only deemed valuable as long as they can maintain a salary. .u781f8085ed9b9b410b504a81e5ed9508 , .u781f8085ed9b9b410b504a81e5ed9508 .postImageUrl , .u781f8085ed9b9b410b504a81e5ed9508 .centered-text-area { min-height: 80px; position: relative; } .u781f8085ed9b9b410b504a81e5ed9508 , .u781f8085ed9b9b410b504a81e5ed9508:hover , .u781f8085ed9b9b410b504a81e5ed9508:visited , .u781f8085ed9b9b410b504a81e5ed9508:active { border:0!important; } .u781f8085ed9b9b410b504a81e5ed9508 .clearfix:after { content: ""; display: table; clear: both; } .u781f8085ed9b9b410b504a81e5ed9508 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u781f8085ed9b9b410b504a81e5ed9508:active , .u781f8085ed9b9b410b504a81e5ed9508:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u781f8085ed9b9b410b504a81e5ed9508 .centered-text-area { width: 100%; position: relative ; } .u781f8085ed9b9b410b504a81e5ed9508 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u781f8085ed9b9b410b504a81e5ed9508 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u781f8085ed9b9b410b504a81e5ed9508 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u781f8085ed9b9b410b504a81e5ed9508:hover .ctaButton { background-color: #34495E!important; } .u781f8085ed9b9b410b504a81e5ed9508 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u781f8085ed9b9b410b504a81e5ed9508 .u781f8085ed9b9b410b504a81e5ed9508-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u781f8085ed9b9b410b504a81e5ed9508:after { content: ""; display: block; clear: both; } READ: Play of social criticism EssayPastiche: With her mother having retreated to her bed in order to recover from the sight of the cockroach, Grete went into her room herself and had barely closed the door when her father came hurrying in, closing the door shut. His eyes were red but before he could say a word Grete said, quite calmly: Mother is in bed, I ought to be bringing her some medicine. Grete walked to her drawer and extracted from it the medicine that she kept for her mother. Making her way to the door, her father stopped her. That can wait, replied her father. I fear there are more pressing issues at hand. Taking in what her father had just said, Grete silently proceeded to open her wardrobe and retrieved the fragile case in which was her violin. Must you bring that out? her father asked. She sat on her bed and opened the case to reveal the violin, which was free of the hardships experienced by its case. Grete took the violin out of the case and plucked the strings, making sure that they were note perfect. However, her distraction proved temporary as her father took the violin out of her hand and placed it firmly in its case. Snatching his daughters hand he stared at her with puffy eyes and hissed: Your brother is sick, in case you didnt notice, music at this time is somewhat inappropriate. As these words left his lips her father slumped onto the floor, once again in tears. Not wanting to look at her father, Grete placed a solitary hand on his shoulder and stared at the ceiling. There was a cobweb in one of the corners. Looking at the cobweb she once again saw the repulsive image of the cockroach which had replaced her brother. Finally looking at her father, she studied his broken face and began to weep. But her tears were not for her father but for her brother whom she imagined was most likely bewildered and in pain, after her fathers brutish attack. Her mind then turned to the image of her mother fainting after the shock of seeing her son and sole breadwinner turned into a monstrous state. No doubt she would blame herself and her husband for finally destroying Gregor. Grete herself knew that he was always never content with having to spend his days travelling, selling goods of little use. But no, that wasnt her brother, it couldnt be. What man wakes up to find that he has turned into a cockroach? Perhaps it was all an elaborate joke though Gregor was never one to joke. Perhaps he had fled and instead replaced himself with a cockroach, in rebellion for their over-reliance on him. But she had seen that vile thing and it could only have been her brother. Of course, she could not comprehend a single thing that came out of his mouth but still that cockroach was surely Gregor. The way it pursued that clerk was Gregor through and through. Always trying to reason, always having to plead his case. Grete removed her hand from her fathers shoulder and walked to her drawer. From it she took out the medicine which she kept for her mother and went to her bedroom. After giving her the medicine Grete went back to her room to find her father pacing the room. Since that cockroach is of no use, we will have to find some way to forge an income, he said calmly. God knows what caused this monstrosity to be bestowed on our family but we must not allow this burden to be the ruin of us. Grete remained silent and this annoyed her father. Perhaps this is a sign of things to come. Perhaps I can start afresh, all of us in fact. Mr Samsa looked at his daughter and with mild regret, wished that she had been born a man. You could perhaps put down that violin and find some work, he said pointedly. It is about time that you helped to reduce our debt. Grete didnt bother to conceal her raised eyebrow and for a second Mr Samsa considered throwing an object at his daughter. Deciding against this, however, he merely took her violin out of its case and stared at it. Grete eyed her father and said, Father, as repulsive as that thing may be, it is my brother. Please do not strike it again. At this her father scoffed and stared in Gretes direction, hands clasped together. That creature you speak of so lovingly is no more your brother than I, he retorted bluntly. Mr Samsa stood up and made for the door. .u3a9f4e2f550418b0744814aca1db92b1 , .u3a9f4e2f550418b0744814aca1db92b1 .postImageUrl , .u3a9f4e2f550418b0744814aca1db92b1 .centered-text-area { min-height: 80px; position: relative; } .u3a9f4e2f550418b0744814aca1db92b1 , .u3a9f4e2f550418b0744814aca1db92b1:hover , .u3a9f4e2f550418b0744814aca1db92b1:visited , .u3a9f4e2f550418b0744814aca1db92b1:active { border:0!important; } .u3a9f4e2f550418b0744814aca1db92b1 .clearfix:after { content: ""; display: table; clear: both; } .u3a9f4e2f550418b0744814aca1db92b1 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u3a9f4e2f550418b0744814aca1db92b1:active , .u3a9f4e2f550418b0744814aca1db92b1:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u3a9f4e2f550418b0744814aca1db92b1 .centered-text-area { width: 100%; position: relative ; } .u3a9f4e2f550418b0744814aca1db92b1 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u3a9f4e2f550418b0744814aca1db92b1 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u3a9f4e2f550418b0744814aca1db92b1 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u3a9f4e2f550418b0744814aca1db92b1:hover .ctaButton { background-color: #34495E!important; } .u3a9f4e2f550418b0744814aca1db92b1 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u3a9f4e2f550418b0744814aca1db92b1 .u3a9f4e2f550418b0744814aca1db92b1-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u3a9f4e2f550418b0744814aca1db92b1:after { content: ""; display: block; clear: both; } READ: How is Love Described in 'How do I love thee' by Elizabeth Barrett Browning and 'Remember me' by Christina Rossetti EssayTurning around, he addressed Grete saying: As I said before, I suggest you look for work, we are going to need to support ourselves. At that he left, closing the door behind him. Grete fell onto her bed but she did not weep. Contemplating what had become of her family over the years, she sat down. Her mother seemed to be getting weaker and weaker and her brother was a cockroach. As for her father, well it seemed that this would inevitably push him into a further decline. Grete turned her head and saw her violin case, slightly ajar. She went over to it an d corrected the violins position, closed the case and put it back in her wardrobe. She sighed and thought about something Gregor had said. Smiling she said to herself: He is right; perhaps it is time I got married. She then made her way to the kitchen, to get some milk for Gregor.

Corporate Finance Future Expansion Plans

Question: Describe about the Corporate Finance for Future Expansion Plans. Answer: Introduction The present report aims to provide advice to Woolworths as a financial advisor for supporting its future expansion plans. In this context, the report demonstrates the current financial standing information of the company by analyzing its market value, share value and debt to profit ratio. It also describes the recent capital raising activity of the company through share equity financing or debt financing. In addition to this, the financial strategy is also analyzed to gain an understanding of the strategies used by the company to raise funds. At last, the report provides advice to the company for raising capital in order to fund its future expansion plans. Background of the company Woolworths Limited is an Australian company that is involved in retail business in the country offering food, petrol, liquor, home improvement and general merchandise products to the customers. The company is recognized as largest supermarket chain of the country and operates about 961 stores across the Australia. It is publicly listed on Australia Stock Exchange (ASX) since past 20 years. The company is believed to employ about 111,000 people in its retail stores, distribution centers, and support offices for providing customers high quality products conveniently. The company is recognized as Fresh Food People as it procures about 98% of fresh fruit and vegetable from Australian farmers and growers (Woolworths Supermarkets, 2012). Woolworths Current Financial Standing Position The current market capitalization of Woolworths is around 28.72B and it shares are worth around $ 19.87 (Raszkiewicz, 2015). The debt/equity ratio indicates the financial leverage of the company and is calculated by dividing the total liabilities by stockholders equity. The best/equity radio of Woolworths for the financial year 2015 is calculated as follows: Formula: Debt/Equity = 5331/10834 = 0.49 The ratio indicates the incorporation of more equity in comparison to debt in the capital structure of the company. This is a good sign for the company as it decreases the business risk and therefore supports its long-term growth and development. As indicated by debt/equity ratio, the company incorporates more the use of equity as compared to debt for financing its assets (Annual Report, 2015). Thus, it is analyzed from the market value, share value and debt to equity ration of Woolworths that its current financial position is stable but the company must take future measures for increasing the share prices as market value of shares are low as compared to the previous years. Capital Raising Activity of Woolworths The companys performance is declining in the recent years due to the huge investments made by it in sectors such as home improvements. This caused a shift in focus of the company from manufacturing its food products from fresh ingredients to other sectors causing a decrease in its profitability. The fund manager is currently planning to raise the capital through asset sales of its unprofitable home improvement business (Heffernan, 2016). The credit rating of the company is under risk with rapid decline in its supermarket sales in the past few financial years. The board of directors is cutting down the dividends paid to the shareholders by about 30 per cent and also reducing the payout ration from 70 per cent to about 50 per cent. This is done to retain cash and thus strengthen the balance sheet of the company for improving its credit rating (Mitchell, 2015). The company is also currently emphasizing on incorporating more debt in its capital structure for meet out its current liabilit ies (WOOLWORTHS HOLDINGS LIMITED 2015 INTEGRATED REPOR, 2015). Thus, it can be said that the company is preferably incorporating the use of equity and debt financing both for raising its capital structure. Woolworths financial strategy The financial strategy of the company includes appropriate capital structuring for enhancing the shareholder value. The company pays good dividends to shareholders through optimizing its weighted average cost of capital (Annual Report., 2015). The debt financing policy of the company includes creating an adequate match between long-term debt to long-term equity, minimizing re-financing results and hedging of interest rate for outweighing the potential risks from foreign currency exposure. The board of directors ensures the presence of certainty in liquidity position for meeting the challenges of occurrence of any global financial crisis. The companys incorporate the use of equity financing largely for maximizing shareholder value. It seek to provide highest dividend to shareholders through reducing its liabilities from debt financing (Managing Directors Report Capital Management and Outlook., 2012). Woolworths is also recently utilizing the use of its balance sheet for raising capita l as to reduce its dependence on debt financing. The company is reducing its payout ratio and re-selling its unprofitable assets for enhancing the equity proportion in the capital structure (Mitchell, 2015). However, the company is also currently planning to increase the debt proportion in its capital structure for meet its current liabilities (WOOLWORTHS HOLDINGS LIMITED 2015 INTEGRATED REPOR, 2015). Conclusion On the basis of the overall discussion held in the report, it can be concluded that current financial position of Woolworths is not sound as it is facing huge loss in its profitability owning to less market sales of its retail products ion home improvement category. The company, is recommend to emphasizes on its main business area, that is, manufacturing fresh food products by divesting its unprofitable businesses for regaining its market leader position in the retail sector of the country. It has invested largely in the manufacturing of products such as home improvement, petrol station, liquor that are not proving to be largely profitable for the company. The company can acquire funds through selling its non-profitable business units and therefore raise capital for supporting its future expansion plans of acquiring finance for production of its main business area of food products. The Company should also incorporate less debt in its capital structure as it would increase the future liabilities posing a threat for its sustainability. The company should focus largely on incorporation of equity financing for reducing the business risk of increasing liabilities. References Annual Report. 2015. [Online]. Available at: https://www.woolworthslimited.com.au/icms_docs/182381_Annual_Report_2015.pdf [Accessed on: 19 September 2016]. Managing Directors Report Capital Management and Outlook. 2012. [Online]. Available at: https://www.woolworthslimited.com.au/annualreport/2012/md-capital-management-outlook.html [Accessed on: 19 September 2016]. Mitchell, S. 2015. Woolworths dividend, credit rating at risk. [Online]. Available at: https://www.smh.com.au/business/retail/woolworths-dividend-credit-rating-at-risk-20151103-gkq2lr.html [Accessed on: 19 September 2016]. Heffernan, M. 2016. Capital raising, store closures may be in store for Woolies. [Online]. Available at: https://www.smh.com.au/business/retail/capital-raising-store-closures-may-be-in-store-for-woolies-20160722-gqbiae.html [Accessed on: 19 September 2016]. Raszkiewicz, O. 2015. How much are Woolworths Limited shares REALLY worth? . [Online]. Available at: https://www.fool.com.au/2015/06/12/how-much-are-woolworths-limited-shares-really-worth/ [Accessed on: 19 September 2016]. WOOLWORTHS HOLDINGS LIMITED 2015 INTEGRATED REPORT. 2015. [Online]. Available at: https://www.woolworthsholdings.co.za/investor/annual_reports/ar2015/whl_2015_integrated_report.pdf [Accessed on: 19 September 2016]. Woolworths Supermarkets. 2012. [Online]. Available at: https://www.woolworthslimited.com.au/page/Who_We_Are/Our_Brands/Supermarkets/Woolworths/ [Accessed on: 19 September 2016].