Chinese History Essay Example for Free

Chinese History Essay The Tang dynasty came into existence after the collapsed of emperor Yangdi’s imperialist reign which unified China, and his death in the hands of his own trusted aid in 618 A. D. From the rubbles of rebellion and war against the emperor, a powerful General named Li Yuan; Duke of Tang and chief officer of Taiyuan City, emerged as the man of the hour. General Yuan joined the rebellion against the emperor and reestablished order and the authority of the central government when the smoke of rebellion had cleared. He became the founder of the Tang dynasty and reign as Tang Gaozu. Li Shimin (Tang Gaozong) on the other hand is the second son of General Li Yuan. Being thoroughly trained in martial skills and was very much acquainted of the administrative procedures he has acquired primarily from his exposure when his father was the principal commander of the Sue dynasty, appointed to command the army facing the Sue remaining forces, at the age of only nineteen. David Graff described his military skills as â€Å"one case where the use of the word genius does not seem at all inappropriate† Li Shimin was highly successful in his career as a military general and his military strategy according to Graff â€Å"is worth noting. † Before he became emperor in 626, he has displayed contrasting behavior with regard to his strategy, which was extremely cautious, and when he is in combat in which he always places himself â€Å"at the head of the final, decisive cavalry charge†¦. † How Well the Respective Career of the first two Tang Emperors fit to the Chinese Proverbs on Empire Building and Governance and Model to this Proverb. The proverb maybe fits rightfully to the first two Tang emperors in terms of the way they acquired the empire and how they built it to become the most prosperous and most powerful country in the world during this time. It was during the reign of these two emperors that China experienced its glorious period as their economy, culture, politics and military might attained an unequaled superiority level. Tang Gaozu seized the imperial power after a bloody rebellion that took the life of emperor Yang that mark the end of Sue dynasty, while it heralded the coming of a new dynasty under the able military leadership of Li Yuan. The reign of Tang Gaozu as the first emperor of the Tang dynasty spent its reign mostly in subduing the remaining forces loyal to Emperor Yang in different provinces and cities of the whole country. All throughout his reign he was facing major problems relating to the threat of war by the Eastern Turks and the Tibetans who posed serious challenges to China’s security, and major invasion was a constant possibility. Until his last moment in power however, Tang Gaozu’s hold in China was not sufficiently secure to risk committing the forces to war against the Turks, thus, his reign can be characterized as more on military maneuvering in order to survived the different challenges the empire were facing. The Emperor then being the chief of the military forces assigned his sons and relatives to command forces numbering thousands, and all throughout his reign, the empire did not perform political and economic activities; it was purely military that characterized this particular reign. That means, Emperor Tang Gaozu ‘conquer the empire on horseback’ but it was his son Li Shimin who ‘built the empire from horse back. ’ Tang Gaozu spent his reign in conquering the whole empire that was broken into many independent forces loyal to the former emperor. This situation has indeed proved to be difficult as the empire was unable to wage war against the Turks and the Tibetans. According to Warren Cohen, â€Å"Gaozu had little choice but to buy peace;† however, what Tang Gaozu had failed to accomplished, his son did. Tang Gaozong also known to most Chinese historians as Tang Taizong, came into power in 627. His ascendancy to the throne was not at all smooth and easy, rather marked by his murderous scheme in connivance with some of the high-ranking military officials particularly those in-charge of the palace gates. Xueshi Guo noted that Li Shimin found himself at a â€Å"disadvantage in challenging his brothers,† to be heir to throne. After getting support from some powerful military generals, he staged a military coup against his brothers in 626 after which he killed both his brothers. According Guo, bare two months after the successful coup, â€Å"Gaozu was forced to to appoint Li Shimin as his successor and two months later he handed over his power completely to Li Shimen. † Taizong Ascended to the throne in 627, which marked a new era for the Chinese society. Having warned by the officials who recalled the disastrous consequence of Sui Imperialism, they urged the new emperor to concentrate on domestic affairs. Warren Cohen noted that Taizong or Gaozong listened to their advice and implements a more diplomatic policy in relation to the Turks. Because of this diplomatic policies, Cohen Pointed out â€Å"in due course China was prosperous again, its people well fed and responsive to his rule. † Taizong was indeed a great leader but he was moderate in his expansion policies compared to his father who. Taizong had more time to economic activities that bolstered China’s growing prosperity, he re opened trade routes, and the eliminations of tolls once exacted by those who had previously controlled passage across central Asia. Cohen further noted, â€Å"Student of Tang history will note the peaceful expansion of China’s contacts with rest of the world during Taizong’s days on the throne and China’s power and wealth attracted people from all over Asia, the Middle East, and Africa. † Based on these historical accounts, the implication of the Chinese proverbs rightly fits these first two Tang emperors. They were both powerful military ruler. Li Yuan curved out the empire on ‘horseback’, that is; through rebellion and war, and reestablishing the empire through conquering every forces that challenges the new power, while Tang Gaozong or Tang Taizong, the successor, strengthened the empire and brings more prosperity, stability and peace through a more enlightened civil and military administration. They may have some difficulty to be model of this Chinese proverb, for some reason. Both had acquired imperial power through violent means. Li Yuan had staged a rebellion against the emperor Yang and had perhaps connived with some palace officials to murder the emperor. Tang Gaozong on the other hand, conspired with some powerful military generals and orchestrated a coup against his own brothers and killing them and forcing his own father to hand over to him imperial throne. Nevertheless, on the ground of their accomplishment, they can fit to be model of this proverb. Gaozu was able to curve out a new empire that has more regard to its citizens, unlike with its predecessor who was ruthless and oppressive. An empire that was willing to take on new economic challenges that brought stability, peace and prosperity to its citizens. These two Tang emperors must be credited in their efforts that has brought enormous prosperity, and respect to Chinese people all over Asia, and to the world and if making them heroes will be a compensation of their achievements for the Chinese society, then they were very much deserving of such compensation. They deserved to be model of the proverb.

Generics Medicines Regulation Comparison

Generics Medicines Regulation Comparison 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. 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 (â€Å"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 â€Å"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 (â€Å"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 (â€Å"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 (â€Å"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 (â€Å"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 (â€Å"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. 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 (Kà ¶nigbauer, 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 gene

Traumatic Brain Injury Issues among the Maori

Traumatic Brain Injury Issues among the Maori Michelle Anastacio Introduction Traumatic Brain Injury is one of the health issues that Maori people face nowadays. Traumatic brain injury or TBI is caused by a blow or by a traumatic shock to the head or body. The extent of harm may vary on numerous aspects, including how it occured and the severity of impact. According to Brain Injury Support, 90 New Zealanders per day, suffer from mild to severe brain injury and most of them doesn’t seek medical attention. In New Zealand, the large population that suffer from this injury are Moari clients and the most common causes of traumatic brain injury are falls, vehicular accidents and assult. The issue on TBI cases is not only for the increasing mortality rate for children but with the consequences of non-fatal TBI cases for adults as well. Abstract Traumatic head or brain injury is one of the leading cause of fatality and hospitalisation among rich and fast growing countries like New Zealand. This is more prevalent among Maori and Pacific children. This paper aims to help New Zealanders specially Maori clients to be more aware of the importance of seeking medical treatment after accidents that may result to serious head trauma. This is also to promote the existing practices and provisions that are accessible to Maoris and other ethnic group. This will help the healthcare providers check for improvements on health services concerning trauma and how they can better serve the Maori people. Topic Definition Traumatic Brain Injury is best define as an injury acquired from severe jolt or impact to the head that cause brain dysfunction. This type of injury is commonly a result of a violent blow on the head, an object that penetrates the head like a bullet, accidents like fall and vehicular accidents. It may as well include one or more of the following factors; damage to brain cells just below the area of the impact, multiple joint damage that caused the brain to move backwards and forward, bleeding in or around the brain,swelling or blod clot and unrepairable damage to brain cells caused by an explosive device. People that are more susceptible to TBI are newborns to four years of age, young adults between 15 to 24 and elderly aging 75 and older. The sign and symptoms of Traumatic Brain Injury or TBI depends on the level of trauma. TBI can be classified as mild, moderate to severe categories. The common physical symptoms of mild TBI are; loss of conciousness for few minutes, being dazed, confused or disoriented, headache,nausea and vomitting and change on sleep pattern.This can be associated by mental issues like agitation, sensitivity to light and sound. They may also display cognitive issues such as memory and concentration problem, mood changes and depression.Where as mild TBI clients may show signs like, persistent headaches that worsens, repeat nausea and vomitting, seizures,dilation of one or both pupils, appearance of clear fluid on nose or ears, numbness or weakness of fingers and toes. Cognetive or mental symptoms such as agitation, unusual behavior, slurred speech, coma or other disorders of conciousness. Although TBI can be categorized into 3 stages depending on their signs and symptoms, it is still essential to co nsult or visit a doctor. The term mild or moderate doesn’t mean a client is safe or won’t suffer any other consequences in the future. Traumatic Brain Injury can cause a person to have difficulty with social interaction and may have family relationship problems if not treated or was not given a proper attention. Traumatic Brain Injury can lead to several complications if its’ not assessed and treated correctly. TBI can lead to distorted conciousness like coma, locked in syndrome and brain death. It can also cause seizures, fluid build up infection for those who have skull breakage and damaged on brain cells or nerves that can lead to paralysis of face. The test and assessment of TBI is done with the aid of Glasgow Coma Scale. This scale helps healthcare professional to assess the severity of the injury. Further tests like computerized tomorgraphy scan or what we commonly call â€Å"CT Scan† and Magnetic resonance imaging (MRI) provides a detailed view of the brain for healthcare personnel to rapidly see any signs of TBI. Significance of the Discussion Since the number of Maori clients who suffer from traumatic brain injury is increasing and most of them don’t seek medical treatment or are not aware of how traumatic brain injury can affect their lives as well as how and what help they get from New Zealand Government. There are concerns that expalin on why traumatic brain injury among Maori is significant. Currently, the statistics of TBI cases here in New Zealand are still inaccurate due to the fact that some of the healthcare providers don’t have the proper coding of the injury. There are times that mild TBI injuries don’t seek further medical attention whick means there’s a huge possibility that they won’t make ACC claims and won’t be identified by ACC. Among children, unintentional head injuries are the leading cause of death in New Zealand specifically for children aging 1 to 14 years old. On the other hand, non-fatal head injuries cause a huge impact not only to the childs’ life but their families as well. The family members’ level of stress and accessibility of trauma services are the main concern. Adults, according to different studies 91% of Maori prisoners here in New Zealand suffered at least 1 head injury in their lives. The issue of Maori offenders in relation to behaviour issues that somehow connected to traumatic brain injury is increasing. Traumatic Brain Injury can incorporate serious public safety risks. Since, brain trauma can affect the behaviour of an individual, the Department of Corrections now provides programmes that supports the rehabilitation and corrections of any cognitive and mental issues of prisoners with TBI. These programmes aim to reduce the re offenders specially among Maori. It also essential that health care services will be well equiped and develop strategies to empower Maoris with the relevant oral and written information to cope with the difficulties brought by traumatic brain injuries. Barriers in improving services for Traumatic Brain Injury Though New Zealand Government and Ministry of Health know the importance of making sure that TBI clients get the proper attention, barriers to implement the procedures is one of the aspect that needs to be addressed. The Kaitiaki and Pacific Support is a group that helps Maori and Pacific Islanders by providing them with practical and emotional support. The main issue that they face in providing provision is the limit when it comes to their budget because they don’t have their own funds or resources and they often need to get an approval from social workers. There are times that families are hesitant to approach or accept help from Kaitiaki and Pacific Support because they mistake them as social workers and Maoris and Pacific are worried that they might take their child away. Language barrier is another factor why Maori and other ethnicity like Pacific don’t get the right help for a family member with TBI. These ethnic group are often cautious of their confidentiality. They think that if they’ll get an interpreter their privacy will be snatch from them. Another barrier that is connected to language is gathering the correct information. The key workers of the Kaitiaki and Pacific Support knows the significance of accurate information to ensure that the TBI client and family members are given the correct support,treatment and rehabilitation. Precise data not only save the clients and their family from wrong treatment but it also helps the healthcare personnels and be certain that the client and family members understand what needs to be done and the process of rehabilitation to accelerate the clients’ recovery. Printed or written information like booklets that are given to parents and children also needs to be comprehensive, to ensure they grasp the facts that they need. The increasing population and healthcare provision demands influence the delivery of health and disability services as well. Shortage on healthcare personnels and poor staff continuity becomes a burden. The process of transferring of a TBI client from one healthcare provision to another, from one hospital to other facility and the collection and administration of care methods from one staff to another. There are also times where family members are frustrated that they need to repeat the same information to differen healthcare professional staffs and they receive conflicting data from different health personnels that confuses them. The last difficulty that most client and families experience are the issues they undergo after hospital discharge. Since in most cases where TBI was classified as mild trauma, it is often overlooked by healthcarers that parents or guardians are not yet equiped with enough knowledge to handle or provide the proper care that the client needs. This can affect the speed or process of the clients’ recovery or can even worsen the situation. Current Best Practice to manage Traumatic Brain Injury in New Zealand The current practice in New Zealand to manage Traumatic Brain Injuries are the acute phase provision and rehabilitation. In most cases, TBI clients are cared by general practioners, emergency departments, accidents and medical provisions, ambulances, sport coaches and teachers at schools. Any suspected serious brain injuries are assessed in the nearest hospitals that provide services for assessment and treatment immediate results of TBI. There are still small number of TBI clients who are trasnported to tertiary hospitals for neurosurgical procedures. Most cases are assessed in the Emergency Department where patients are not admitted or only stay in the hospital for a short period or time. The next stage of TBI management is rehabilitation. There are several range of rehabilitation available in all major centers in New Zealand. The rehabilitation depends on the care the client needs. Clients who suffered from mild TBI are given assessment and Residential rehabilitation. This type of service provides support for mild TBI clients at the comfort of their own home. The aim of this programme is to help clients gain their maximum independence. There are DBH and Non DHB provisions that operates in New Zealand to support people with mild TBI for an early and timely assessment and rehab. Nowadays, there are seven concussion clinics in New Zealand for clients with mild TBI. On the other hand, people with moderate to severe TBI can access Non- Residential Rehabilitation. ACC offer two provisions for clients with severe TBI. These are Active Rehabilitation and Residential Support Services. Active Rehabilitation Services means client with moderate serious TBI are being cared in a community based facility. These are for clients that are medically stable but need support due to their cognitive or physical disabilitites. This service is not age specified except the Wilson Center that only caters TBI cases among children. The aim of this provision is to help clients to eventually re-enter or to go back to community. The duration of care on this type of rehabilitation may varry from few weeks to few months. Residential Support Services let clients to live in a home like environment as they get medical assistance 24 hours a day. This provision offer care for those who have serious TBI and are expected to recover on long period of time. The goal of this rehabilitation is to encourage independence while maintaining a safe environment for people who can’t live independently due to the consequences of TBI. This type of of rehabilitation is also called as â€Å"slow-stream† rehabilitation. Clients in these type of rehab are not necessarily expected to improve their levels of independence in a rapid or fast phase. Healthcare professional in this setting supports not only the medical needs of the clients but the physical and emotional needs as well. This provision is not maily focus on severe cases of TBI but for those who are unable to rehabilitate to the society. This type of rehab is only accessible to New Zealand residents who are under 65 years old and doesn’t have a l ong term disability that is not covered by ACC. Recently, a new project to best handle TBI rehabilitation was created. The Traumatic Brain Injury Residential Rehabilitation (TBIRR) project. This project replaced the Active Rehab services and Residential Rehab services. TBIRR have 3 vendors that brings a more qualified and rapid interventions. The North and upper South islands of NZ have two sites in Auckland and Wellington. The Canterbury and West Coast have a center based in Christchurch which is the Laura Ferguson Trust and the ISIS Center which is located in Dunedin covers the lower South Islands. According to Mr. Miller, â€Å"The new service recognises that early, intensive rehabilitation is crucial to a successful recovery, but the support provided must also be individually tailored and reflect clients’ changing needs as they become less dependent on full-time care.† Best Practice to manage the issues related to Traumatic Brain Injury Ministry of Health conducted researches and surveys to identify the gaps or rooms for improvent in providing care for trauma cases. According to MOH, the survey suggested that a specialisation in Traumatic Brain Injury will be the best practice to properly address the treatment and rehabilitation issues. More consumers supported the idea that it will be better if there will be TBI experts that will focus on TBI clients’ needs rather than the convenient widespread services that healthcare facilities currently offer. However, New Zealand healthcare providers are still reluctant to follow this practice because it suggests â€Å"centralization†. â€Å"References: Cavit, M. and Foster, A., (n.d.). Traumatic brain injuries among Corrections populations: implications and intervention strategies. Rectived from http://www.rethinking.org.nz/assets/Newsletter_pdf/Issue_81/06 TBI in Corrections Populations NZ 2010.pdf . Mayo Clinic Staff, 2014. Disease and Conditions. Traumatic Brain Injury. Retrieved from http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/prevention/con-20029302. Ameratunga, S. , Abel, S. , Tin tin, S. , Asiasiga, L. , Milne, S. and Crengle, S. (2010). Biomed Central. BMC Health Services Research Article, Children addmitted to hospital following unintentional injury: persperctives of health providers in Aoteroa/ New Zealand. New Zealand Guidelines Group (NZGG) , 2007. Evidence- Based Best Practice Guidline. Traumatic Brain Injury: Diagnosis, Acute Management and Rehabilitation. The Brain Injury Association of New Zealand Inc. Brain Injury New Zealand. [Online] 2007. [Cited: Feb 17, 2010.] http://www.brain-injury.org.nz Ministry of Health. Tatau Kahukura: Maori Health Chart Book, Public Health Intelligence Monitoring Report No. 5. Wellington : Ministry of Health, 2006 Well Said, 2013. New approach aims to enhance rehabilitation after traumatic brain injury. Retrieved from http://wellsaid.co.nz/noticeboard/notices/new-approach-aims-to-enhance-rehabilitation-after-traumatic-brain-injury/†

Prefrontal Cortex :: Neurology Brain Medical Essays

Prefrontal Cortex The prefrontal cortex is the most anterior portion of the frontal lobe. It responds mostly to stimuli signaling the need for movement, however it is also responsible for many other specialized functions. It receives information from all sensory systems and can integrate a large amount of information (Kalat 2004). Studies have shown that the prefrontal cortex is responsible for working memory. Working memory is defined as "the information that is currently available in memory for working on a problem" (Anderson 2005). The prefrontal cortex (PFC) also controls behaviors that depend on context (Kalat 2004). For example, if my cell phone rings when I am at the mall or grocery store I would answer it. If it rings while I am at the movies or in class I wouldn't answer it. People with frontal lobe damage often exhibit inappropriate behaviors due to the inability to recognize context. Other studies indicate that the PFC is also responsible for regulating emotions and decision-making. A study was conducted in which participants were presented with three dilemmas. One dilemma was called the Trolley Dilemma: a trolley is headed toward five people standing on the track. You can switch the trolley to another track killing only one person instead of five. Subjects were asked to decide between right and wrong. Brain scans of the participants show that contemplating the dilemmas activates the prefrontal cortex and other areas that respond to emotion (Kalat 2004). Sustaining a lesion to the prefrontal cortex produces a wide variety of side effects. The effects range from minor to severe. You can get a lesion by head trauma or stroke (CJ Long 2005). Possible deficits associated with minor lesions of the prefrontal cortex: - Inability to respond quickly to verbal instructions - Speech dysfluency - Disturbances in understanding complex pictures or words - Difficulties with problem-solving - Deficits in complex tasks requiring inhibition of habitual behavior patterns With more extensive lesions the person experiences greater behavior deficits. These deficits include: perseveration, which is the inability to make behavioral shifts in attention, movement and attitude, decreased creativity, poor recall of verbal and nonverbal material, difficulty writing, and deficits in comprehension of logical-grammatical constructions (CJ Long 2005). Other effects of extensive lesions: - easily distracted - disturbances in memory - defects in time sense - decreased anxiety - less critical of oneself - difficulty with unfamiliar analogies - impulsivity

The Terminator Essay -- Film Movie Terminator Essays

The Terminator James Cameron’s 1984 film, The Terminator, is about a cyborg, called a terminator, that is sent back into the past to kill Sarah Connor, the mother of John Connor, the leader of the human resistance. A soldier, named Kyle Reese, is also sent back to protect Sarah (Terminator). In the film’s 1991 sequel, Terminator 2: Judgment Day (T2), the Terminator returns, not to kill Sarah, but to protect young John from the T-1000 (T2). During the course of these two films, the character of Sarah Connor dramatically changes from weak woman to a warrior woman. She transforms mentally, physically, and emotionally. Not only does she change in this manner, but her role in the films changes as well. Sarah’s purpose and significance as a character changes over the course of the two films. In Terminator, Sarah is of great importance to the story. Without her there would be no human resistance in the future, so it is imperative that she live. The movie revolves around her, as she is the main protagonist in the film. At the end of Terminator, it is she, not Kyle, that destroys the Terminator. Though she is the main protagonist, her purpose in the film was to be a vessel. She was only valued because of her body, her ability to give birth to John. It only mattered that she live so that she could give birth to John. In Terminator 2, Sarah is pushed into the background. She becomes merely a secondary character. Her presence in the movie is not as important. She has already completed her job of giving birth to John and raising him to be able to take care of himself, so there is no reason for her to be there. Her presence even puts John into more danger. John wanted to save his mother from the mental institution, but the Terminator... ...tor films are good for study because of their rarity and the character of Sarah Connor. Works Cited Cranny-Francis, Anne. "The Body in the Text." Internet. 10 Dec. 2001. http://www.univie.ac.at/Germanistik/schrodt/vorlesungsmaterialien/the_body_in_the_text.htm. Cunningham, Kim. "Shaping the Stars." People Weekly 10 January 1994: 50-56. Internet. 24 Nov. 2001. http://www.iwu.edu/library/subjres.htm. Pfeil, Fred. "Revolting Yet Conserved: Family Noir in Blue Velvet and Terminator 2." 1992. Internet. 24 Nov. 2001. http://muse.jhu.edu/journals/postmodern_culture/v002/2.3pfeil.html. Terminator, The. Dir. James Cameron. Perf. Arnold Swarzenegger, Michael Biehn, Linda Hamilton. Artisan Entertainment, 1984. Terminator 2: Judgment Day. Dir. James Cameron. Perf. Arnold Swarzenegger, Linda Hamilton, Robert Patrick, Edward Furlong. Artisan Entertainment, 1991.

“Good Old Country People”-Pride Is Stronger Than You Think Essay

â€Å"Good Old Country People† –Pride is Stronger Than Most Think Pride throughout literature has been to a great extent manipulated by writers in positive and negative visible radiations to reflect their intended intent. In the bulk of Flannery O’Conner‘s narratives. characters who have pride exude more haughtiness than they do assurance. and as a consequence these characters condescend towards those of lower criterions. In â€Å"Good Country People. † O’Conner onslaughts pride to be a negative influence on society in which the cardinal character Hulga has so much pride that she condescends towards others. Here. Hulga condescends towards her female parent. Mrs. Freeman. and the bible salesman by handling them as idiots and is finally punished for it by losing her leg. O’Conner defines Hulga’s pride but lets the reader determine and assail how negative it is and hence how appropriate her penalty is for her actions. A clear illustration of the pride in herself that Hulga ( besides known as Joy ) displays is seen by the manner that she believes she is better than the state. â€Å"Joy had made it kick that if it had non been this status. she would be far from these ruddy hills and good state people. She would be in a university talking to people who knew what she was speaking about† ( 175 ) . Hulga clearly indicates in this statement that she would instead non hold to cover with naif state people. and would instead speak to those which are every bit smart as she is. O’Conner merely describes Hulga’s feelings about the state but leaves it up to the readers to make up one's mind whether such feelings are the right 1s to hold. The natural reaction of the reader that O’Conner would be seeking to bring on is one that rejects the feelings. Ideally the reader would see that Hulga is non handling the state people as peers to university pupils and hence see that Hulga is condescending in a manner that makes her experience superior while exudating negative pride. Another illustration of the manner O’Conner lets the reader make up one's mind how negative Hulga’s pride is can be shown when she talks to the bible salesman. When Hulga is confronted by the salesman about non believing in God. the salesman claims that she isn’t â€Å"saved† because of it. Hulga so pompously replies that â€Å"I’m saved and you are damned† ( 182 ) . This statement entirely clearly shows how much better Hulga thinks she is than the naif bible salesman. She thinks that although she doesn’t believe in God she is much smarter than the salesman. and therefore she is blessed for being smart and the salesman is damned for being dense. The reader is so one time once more enticed to dislike Hulga’s personality and the pride that goes along with it. In the terminal she is punished for her iniquitous self-importance when she loses her leg. O’Conner so lets the reader non merely make up one's mind whether the penalty is right after seeing Hulga’s disdainful nature. but besides to what extent Hulga should be punished. Should she stop up acquiring aid back to her place or merely creep her manner back? Throughout â€Å"Good Country People† . Flannery O’Conner finally is assailing pride. and she does do it clear that she is making so. However she does this through the emotional and mental rejection of such pride from the reader.

Hero Cycle from the Odyessy Essay

Homer’s Odyssey provides a clear illustration of Joseph Campbell’s hero cycle through the journeys and characterization of the protagonist Odysseus. The hero cycle is used in epics to describe the journey of the hero from bad to good. In The Odyssey, Odysseus is characterized as arrogant, and and his journey from hubris to humility. The hero cycle is a theme that epics follow. It starts off with a departure then goes to an initiation where they come to an end in their return. Odysseus’ test is to see help him heal hubris. He must learn self-control, and humbleness. He comes to a breaking point because of some of the tasks that he endures, he must overcome them to help him with his need for life change. They start off in a departure phase where Odysseus gets the notification from Menelaus and Agamemnon that he needs to leave their home for Troy even though he does not want to go. He had just had his son Telemachus and he wanted to be there for him. He realized that it was his duty and that he needed to go. Then, in the hero cycle there is usually a supernatural figure that helps them with materials or knowledge. This is a god, monster, superhero, ghost, or fairy tale creature. When Odysseus and his fleet leave and come to their first part of conflict during their journey. When he is on his way he gets his visit from Athena, goddess of wisdom. She is a strategist and often fights in wars. She came to Odysseus on his way to Troy with words for the wise. Then he encounters his first test. This is the battle between the Greeks and Trojans. He was able to survive the war. The Trojan War had lasted 10 years and finally it was over. This is only the beginning of his journey. The second step of the hero cycle is initiation. This is when the tests and climax happen. Odysseus endures many tests with creatures that test him externally and also internally. Along the way Odysseus gets aided by many supernatural beings. He would not be able to go survive without their assistance. After winning the Trojan War Odysseus decide to attack the island of the Ciccones where he lost a ton of me, about six men from every ship he had. This demonstrates a clear act of hubris and stupidity. Odysseus thought he was high and mighty for commanding some of the Greek army to their great victory. After leaving this island he went to the island of the lotus eaters which had his men not wanting to leave the island so he had to tie his men down to the boat. After the island of the lotus eaters Odysseus went to the island of the Cyclopes, where he met Polyphemus. This is a place where he shows that he shows clear acts of hubris. He tells the Cyclopes, after blinding him, that his name was Nohbody, which is very clever. When he and his ships were leaving he yelled to him his real name and guided Polyphemus who was throwing rocks at him with his voice. This was just plain stupid and arrogant. Polyphemus prayed to his father, Poseidon that Odysseus should never return to Ithaca. Following the visit to the Cyclopes was island of Aeolus. He is the keeper of winds. He gave Odysseus a bag of winds and told him to open it when he was close to ithaca. He told his crew to not open it but of course they did thinking he was cheating the crew and they were blown back to Aeolus. Then he goes to the island of the Laestrygonians and they kill the rest of his fleet except for his boat. They end up on Circes Island and his men get turned into animals. He gets them turned back with the help of Hermes words and him coaxing her. He gets the knowledge from Circe that he must go to Hades. He goes and talks to a bunch of people who tell him of his past and future. This is where Odysseus has a change of heart and learns that he must recover from hubris. This is the turning point of his life. When he leaves he goes past the sirens where he demonstrates some more hubris. He then encounters the Scylla, a 6 headed monster where it eats 6 of his men. After escaping him they ended up on Thrinikia where they were not allowed to eat any cattle on the island. They all did except Odysseus and when they set sail the boat got destroyed. This is a start on recovery. Finally Odysseus ends up on Ogygia with Calypso. This is where Odysseus spends seven years able to think about what to do and what to change. The final part of the cycle is the return. This part of the cycle is when Odysseus makes all of his changes in life that need to be made, then puts them to use. When at Ogygia, Calypso gets a visit from Hermes saying that he is able to leave. When he does, he journeys across the seas until he gets to the island of the Phaecians. When here he talks to Nausicaa who helps him see the king, her father, and get a ship for his trip to Ithaca. When he arrives on Ithaca he was told by Athena to be a beggar and not Odysseus. This way he is able to see what it is like without him. When he meets Telemachus for the first time he does not reveal his identity, showing self-control. After he does reveal his identity, he makes Telemachus promise that he will not tell Penelope. Odysseus thinks it would be a bad idea to storm back into the castle and demand his throne. This would mess up everything and would eventually cause a battle. Penelope decides that is time for a new husband so she tells all the suitors to string Odysseus bow and shoot it through 12 axes. No one could do it until the beggar tried, this is Odysseus. He then kills all of the suitors, starting with Alchinous. Penelope still could not believe it so she tests him and says that she will move her olive tree bed that he made for her outside of their room for him to sleep on. This is a symbol of their firm relationship and his throne. He stops her and explains to her that she can’t. Only then, does Penelope truly accept that that was Odysseus. The book ends leaving you with all of the suitor’s families are ok and they go through a settlement, the kingdom is back in order, and Telemachus has finally become a man. Joseph Campbell’s cycle is all about a hero’s journey from good to bad. In The Odyssey this is shown throughout the story and follows the cycle closely. At first Odysseus starts off with being arrogant when Polyphemus is throwing rocks after being blinded by Odysseus and Odysseus is yelling at him and taunting him which guides Polyphemus who is throwing rocks toward their ship. He then after visiting Hades and learning what he must do and how he needs to change his ways he has the option of hearing the sirens song while tied to the mast of the boat or he cannot hear the song and just keep his ears plugged. He of course, chooses to hear the song. Soon after that they are on the island of Thrinikia where he starts to listen and understand what he must do and he was specifically told not to eat any of the cattle on the island. He didn’t but his men did. He survived but his men didn’t. Then when arriving upon Ithaca instead of barging in and demanding his throne back, Odysseus was very humble and patient by acting as a beggar. This shows self-control and when everything is over; you look back at how Odysseus handled things and realize that he has recovered from hubris.