Compare the State and National government Essay

In many ways, the structure of state governments and the national government mirror each other. In this forum section, each student is to research one state government and compare it to the national government. Next, explain to the class if you think that the state you researched has a good form of democratic government. Hint: an encyclopedia at home, at a library or an internet search would help. Lastly, please remember to cite your research source. Each state has its own constitution based on its distinctive history and needs. A state’s constitution is similar to that of the national Constitution; nevertheless, the laws made in individual states cannot conflict with the national Constitution or national laws. Ive decided to research the New Jersey State government and compare it to the national government. The government of the State of New Jersey, like that of the United States, is divided into three branches. Those three branches are the legislative, the executive, and judicial. The chief function of the Legislature is to enact laws. The Legislature consists of two Houses. Those 2 houses are a 40-member Senate and an 80-member General Assembly. The Senate and Assembly chambers are located in the State House in Trenton. The Executive Branch carries out programs established by law. The chief of the executive branch is the governor. The governor’s office is located in the State House in Trenton. The governor signs bills into law or vetoes them. He can also recommend laws and call the legislature into special session. The governor has the power to grant pardons and is the only person with the authority to call in the National Guard. The Judiciary Branch punishes violators, settles controversies and disputes, and is the final authority on the meaning and constitutionality of laws. The Judicial Branch decides how state laws should be applied. The governor appoints judges to the Supreme and Superior courts with the Senate’s approval. I believe that NJ has a good democratic government. I can appreciate the way each branch of government keeps and eye on the other branch through checks and balances. I think its great that we have the power to elect people into office and that there are several types of offices where the people all work together. Works cited Usinfo.state.govNj.gov

Madam Cj Walker Essay

Madame C.J. Walker was America’s first self-made female millionaire. She amassed her fortune through hard work, innovative ideas, and a fierce dedication to her craft and her people. Contrary to most historical accounts, Madame C.J. Walker did not invent the pressing comb. Per her own words, Madame Walker started the â€Å"hair-growing† business, borne out her desire to remedy her own hair loss. In 1910 Madame C.J. Walker moved her ever expanding â€Å"Special Correspondence Course† business, founded on her System of Beauty Culture, to Indianapolis. There she purchased and paid for her home adjoining which was a factory and laboratory. On September 2, 1911 she petitioned the Indiana Secretary of State to become incorporated and on September 19th, 1911, said petition was granted, marking the genesis of the Madame C.J. Walker Manufacturing Company of Indiana, Inc. wherein Madame Walker was the President and sole shareholder of all 1,000 shares of stock. She was also an early civil rights advocate on behalf of Black people, and an avid financial supporter of what today we call HBCU†s or Historically Black Colleges and Universities. By the time of her passing in 1919, Madame C.J. Walker had built one of the largest black owned manufacturing companies in the world, an international network of over 15,000 Madame Walker agents, beauty schools in three states, and a 32 room mansion at Irvington-on-the-Hudson, New York. Madame’s only child, A’Lelia Walker became President of the Madame C.J. Walker Manufacturing Company of Indiana upon her mother’s passing. Per Madame’s will, two-thirds of the stock of the Company was placed in a Trust, over which were five Trustees. The other one-third of the stock of the company was bequeathed to her only child. When A’Lelia died, the one-third share of stock she owned was â€Å"split† between two people, each receiving onesixth share. The majority two-thirds remained in the Trust. Over six decades later, in 1985, the Trustees petitioned the Marion County Probate court to allow them to sell the stock and assets of Madame Walker’s company, including inventory and historical documents, to a man named Raymond Randolph. The owners of the remaining shares of stock also agreed to sell their shares to Raymond Randolph. Thus, on December 20th, 1985, Raymond L. Randolph became the first person since Madame C.J. Walker herself to own all 1000 shares of stock in the Madame C.J. Walker Manufacturing Company of Indiana, aka the Madame C.J. Walker Manufacturing Company.

Beck Anxiety Inventory

Beck Anxiety Inventory Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by circling the number in the corresponding space in the column next to each symptom. Not At All Mildly but it didn’t bother me much. Moderately – it wasn’t pleasant at times Severely – it bothered me a lot Numbness or tingling 0 1 2 3 Feeling hot 0 1 2 3 Wobbliness in legs 0 1 2 3 Unable to relax 0 1 2 3 Fear of worst happening 0 1 2 3 Dizzy or lightheaded 0 1 2 3 Heart pounding/racing 0 1 2 3 Unsteady 0 1 2 3 Terrified or afraid 0 1 2 3 Nervous 0 1 2 3 Feeling of choking 0 1 2 3 Hands trembling 0 1 2 3 Shaky / unsteady 0 1 2 3 Fear of losing control 0 1 2 3 Difficulty in breathing 0 1 2 3 Fear of dying 0 1 2 3 Scared 0 1 2 3 Indigestion 0 1 2 3 Faint / lightheaded 0 1 2 3 Face flushed 0 1 2 3 Hot/cold sweats 0 1 2 3 Column Sum Scoring – Sum each column. Then su m the column totals to achieve a grand score. Write that score here ____________ . Interpretation A grand sum between 0 – 21 indicates very low anxiety. That is usually a good thing. However, it is possible that you might be unrealistic in either your assessment which would be denial or that you have learned to â€Å"mask† the symptoms commonly associated with anxiety. Too little â€Å"anxiety† could indicate that you are detached from yourself, others, or your environment. A grand sum between 22 – 35 indicates moderate anxiety. Your body is trying to tell you something. Look for patterns as to when and why you experience the symptoms described above. For example, if it occurs prior to public speaking and your job requires a lot of presentations you may want to find ways to calm yourself before speaking or let others do some of the presentations. You may have some conflict issues that need to be resolved. Clearly, it is not â€Å"panic† time but yo u want to find ways to manage the stress you feel. A grand sum that exceeds 36 is a potential cause for concern. Again, look for patterns or times when you tend to feel the symptoms you have circled. Persistent and high anxiety is not a sign of personal weakness or failure. It is, however, something that needs to be proactively treated or there could be significant impacts to you mentally and physically. You may want to consult a physician or counselor if the feelings persist. Beck Anxiety Inventory Scoring August 4, 2009 | Posted by SWilson After rating each of the twenty-one anxiety symptoms on the Beck Anxiety Inventory from 0 to 3, the ratings are totaled for the individual’s Beck Anxiety Inventory score. If you’d like to see how you would score, you may rate the twenty-one anxiety symptoms in the Beck Anxiety Inventory sample. The Beck Anxiety Inventory sample is in the post titled â€Å"The Beck Anxiety Inventory.† The Beck Anxiety Inventory scoring is sim ple. The person’s total score will fall within one of the ranges for the Beck Anxiety Inventory scoring. If the person’s score is under twenty-one, the person is considered to have a very low amount of anxiety. A score between twenty-two and thirty five demonstrates moderate anxiety. A person with moderate anxiety can often benefit from stress management to relieve anxiety.

Management in Nursing Essay Example | Topics and Well Written Essays - 4500 words

Management in Nursing - Essay Example Absenteeism and turnover negatively impacts on the healthcare organization’s bottom line in several ways, which include reduced quality of patient care, enhanced contingent staff costs, enhanced staffing costs, loss of patients, and enhanced accident rates. Costs may stem from replacement costs associated with the turnover. Turnover will require hiring replacement staff, which incorporates recruitment costs ranging from advertisement placement, and costs flowing from payments to employment agencies. Absenteeism may as well have an indirect cost implication as the new recruits will require training in the facility’s policies and work procedures. The higher the turnover level, the more training  required, and subsequently the higher the training costs that the organization incurs. Similarly, the recruits’ unfamiliarity with the organization’s policies and procedures may render them less efficient and less productive (Rowland and Rowland 1997, p.533). Furth ermore, high rates of absenteeism and turnover may yield extensive periods of understaffing; the â€Å"short† staffing conditions may force the existing staff to work overtime, which is comparatively more expensive. High absenteeism and turnover rates could be detrimental to patient’s health and wellbeing owing to disruption in continuity of care and personal relationships between nurses and patients. While it may be essential to highlight that low levels of turnover may be beneficial as they mirror the adjustment of an organization to its workforce and vice versa, extensive absenteeism and turnover is costly, as well as disruptive to the organization’s functioning. # 2 Providing privacy for patients is an important consideration for health service planner and providers. What factors should be considered in regard to privacy when providing nursing care? Medical privacy is an essential consideration for health service providers as it influences practice. Individu als may avoid treatment in case they are not confident that the information about them will remain confidential. Similarly, patients who seek treatment may withhold critical information out of concern for privacy. Patients have reportedly engaged in behaviors fashioned at protecting their privacy such as avoiding their regular doctor, requesting the healthcare personnel not to record their health information, or â€Å"fudging† diagnosis (paying out of pocket in order not to file insurance). This may be detrimental as it may prevent patients from receiving full and appropriate treatment (Douglas, et al. 2009, p.257). Guaranteeing privacy may remedy these concerns, besides promoting effective communication between physicians and patients, enhancing autonomy, and averting economic harm, discrimination, and embarrassment. In an institutional setting, healthcare professionals (in this case nurses) may be anxious on matters regarding privacy and confidentiality as they have an obli gation (moral) to protect the rights of patients entrusted to their care. This duty heralds patient-nurse relationship as one of the supporting factors that should be considered. There are a several factors that apply with regard to privacy when availing nursing care such as individuality and diversity, as individuals have their own distinct values, attitudes, beliefs and preferences. The most significant factors supporting privacy hinge on social

Public and Private Language by Richard Rodriguez Article - 2

Public and Private Language by Richard Rodriguez - Article Example According to Rodriguez, being familiar with the public language is more advantages to the private language. He notes that lack of public language may deny an individual his/her self esteem; therefore, he emphasizes for a need of bilingual education especially for the persons who do not share the public language with their immediate surroundings. From his personal and family experience, Richard Rodriguez explains how language or confidence of expression in public affects personal confidence, especially in the social life. He perfectly achieves this claim by using different experiences especially his personal experience and the experience his father had once they (his sister, brother, and himself) had perfected the public language. According to Rodriguez, he had no confidence in the classroom nor could he play or associate with neighborhood kids. Since his siblings and Rodriguez could not communicate freely with others, they come home too early and could lock themselves indoors unlike when they had been acquainted with the public language. Additionally, he perfectly rotates the events and they (children of the family) become fluent to the language than their parents. Rodriguez notes that as they became fluent in English to their private language, things started changing in their family as their parents started having difficulties in communicating with them. Hence, their parents especially his father opted to remain silent whenever the public language speakers were in the house. To denote how language affects an individual’s public confidence or individuality, Rodriguez compares his father’s communication and confidence levels when interacting with fallow Spanish and when interacting with the public. Rodriguez states that his father grew quiet in the house, a situation that his mother relates to his father’s childhood life. He notes that his mother explained that both of his father’s â€Å"parents died when he (his father) was eight. H e was raised by an uncle who treated him as little more than a menial servant. He was never encouraged to speak. He grew up alone; a man of few words (Rodriguez 54).† However, Rodriguez emphases that this silence is nothing to do with his father’s childhood experiences, but to the power of language that brings the confidence of communication and interaction with other persons. Rodriguez noted his father was neither shy nor few of words. For instance, Rodriguez says that when his father was using Spanish and interacting with fellow Spanish men, â€Å"he was quickly effusive. Especially when talking with other men, his voice would spark, flicker, flare alive with sounds. In Spanish, he expressed ideas and feelings he rarely revealed in English. With firm Spanish sounds, he conveyed confidence and authority; qualities English could have never revealed in him (Rodriguez 54).† It is worth noting that using the above experience as examples indicate how perfectly Rodrig uez has managed in developing ideas in supporting his theme. It is worth noting that Rodriguez in his article tries to address varied audients both young and old. The only main concern he had is to communicate the power of public language that he wants everybody to develop. However, he also addresses the necessity of sticking to some of the private languages. In different occasions, he did meet or encounter persons who reminded him of his youthful days when he had not been Americanized.

Facilities Management Essay Example | Topics and Well Written Essays - 1000 words - 1

Facilities Management - Essay Example Use of ‘going green buildings’ will serve to address these measures and concerns. (Cooper, ‘The Future is Bright Green’) The article provides a clear definition of the requirements of what developers should encompass in designing a green building. The building should ensure improvement of interior air quality, reduction of green house gas emission, conversion of waste to energy, reduction of water consumption, improvement of energy efficiency and reduction of waste through reuse or recycling. With these factors in mind, buildings will enhance productivity as a result of their environmental friendly nature and the wellbeing of people, both inside and outside the buildings. These factors have facilitated the development of ‘intelligent’ buildings which are adaptable and easy to use and manage. The article further demonstrates how the initiative has been embraced by shopping centers. The buildings are designed in the image of ‘going greenâ₠¬â„¢, as they are green in nature. These latest design and technological developments have ensured that buildings have increased their asset performance as well as their value (Cooper, ‘The Future is Bright Green’). The initiative reduces the element of the building depreciating and thus the building is a good value for investment. As a result of the success of green building in shopping centers, developers are eager to spread the development of these ‘intelligent’ buildings to other retail sectors that would be better suited for this initiative. The measures are mainly intended for the offices as it has been revealed that the use of the going green initiative would best be implemented in the office sector. The high level of interaction between people, machinery and systems in the offices, has called for the office sector to integrate going green measures, so as to improve the performance and effective operations of workers (Cooper, ‘The Future is Bri ght Green’). The success of the green buildings in shopping centers serves as evidence that the measure is applicable in buildings that require a lot of systems and people to co-exist, hence applying the initiative in offices would be easy and effective. In conclusion, green buildings have proven to be a success in shopping centers, and as a result, it is very ideal for the technology to be applied in the other sectors. It is important for buildings to become part of the ‘future is bright green’, as this will provide a catalyst effect to going green initiative, which seeks to protect the environment. In so doing, the world will be a healthier place to live (Cooper, ‘The Future is Bright Green’). It is evident that the effects of green gas emissions, has facilitated the death of humans and parts of the environment. Risk-Based Maintenance The article is an illustration of how risk assessment is applied in the operation of a manufacturing plant. It reve als the measures that can be applied as well as their application in increasing the level of production. Application of risk assessment by a maintenance manager can help a firm save a lot of money by reducing its production costs. In the article, risk maintenance is demonstrated using scenarios of how the application of risk assessment measures would serve to improve operations. Important equipments and machineries should be grouped, and their risk priorities established so as to ensure that they are kept running at capacity. (Barr, ‘

Implementation Challenges and Methodology for ERP Implementation Essay

Implementation Challenges and Methodology for ERP Implementation - Essay Example The researcher states that the major benefit associated with the implementation of ERP within organizations is its ability to increase the productivity of the organizations, through increasing the timely, continuous and widely applicable real-time business information. This enables organizations to plan well for their different operations. Nevertheless, the implementation of the ERP can be marred by varied challenges, which combine to reduce the chances of the implementation success. This, therefore, requires that the implementation of ERP should apply a methodology that minimizes such challenges, and thus delivers the expected benefit of the ERP system to the organization with minimal associated costs. The methodology applied to implement an ERP should, therefore, be loaded with the essential critical success factors, to ensure that the organization is able to start enjoying the benefits of an ERP system from the very beginning and that such benefits are sustainable. The discussion analyses ERP implementation as a global technology transfer project, which can enable Roll-Royce to transform from its initial legacy system into enjoying the full benefits of the ERP thought its multinational operations. Technology Transfer refers to a process by which the knowledge and information that is embedded within a technology by the technology creator are put into practical use by the user of the technology. Therefore, the implementation of the ERP system in Roll Royce does not only entail the application of the ERP equipment, but also the know-how. Therefore, the challenge facing the global implementation does not only entail the challenges of the conveyance process from the vendor/creator of the ERP system to the organization, but also the subsequent challenges involving the adoption, possession, and promotion of the ERP by the organization.

Case study Example | Topics and Well Written Essays - 3000 words - 1

Case Study Example In the theme the differentiation exists in terms of rides and attractions being offered, the faà §ade and architecture; and the employees and food being served. Thus, this uniqueness and control of environment makes Disney an enthralling experience. (Project 2006) Hence, when Disney decided to expand its business, it came up with two options for opening the theme park: Barcelona and Paris. However, due to the benefits in form of subsidies and tax incentives being offered by the French government; Paris was the final choice. Another major reason for opting for Paris was the market potential that the city offered. Within a 160 km radius of the proposed site for Euro Disney a population of sixteen million lived. Not just this, the presence of an efficient transportation network made Paris an ideal location. Even if Euro Disney would have had a lower penetration in the market as compared to its sister parks in California and Florida; the market size was huge giving a higher utilization of the capacity. Another attractive feature for opening a theme park in Europe was that the Europeans had a different pattern of spending their vacations. Not only is the time period of the holidays which Europeans enjoy longer than the American citizens. But the Europeans also take frequent smaller breaks throughout the year. Disney also kept in few the family size and the disposable incomes which the target audience was composing of. And thus, kept keeping these trends in mind Disney started its new venture. Another smart thing which Disney did when starting this venture was that it financed this project in a way that the risk was minimized. Disney floated a new company in the market called the Euro Disney SCA. Through this company the financial arrangements were made in a manner that the Walt Disney group had a 49% holding where as the rest of the share was generated by raising capital from the public. Further more, Disney was

Employee Empowerment Essay Example | Topics and Well Written Essays - 2750 words

Employee Empowerment - Essay Example This implies that lower level managers and supervisors are expected to implement decisions made by top-level managers, which increases rigidity. Employees of the company are expected to follow strictly their supervisors and managers decisions without question. According to the employees, delegating some decision-making powers to them would enable them act promptly to improve the efficiency and manufacturing processes of the company for better performance. However, due to the bureaucratic nature of the company, the managers and the supervisors deny the employees such powers. The overall effect has been that the employees of the company are demoralized resulting in high labor turnover and subsequently the poor performance of the company in terms of productivity. It is based on this situation that the employees of this organization have made an appeal that they be reasonably empowered. Current Literature about Employee Empowerment Employee empowerment is a subject of great concern to bu siness and human resource managers. Employee empowerment refers to the strategy or philosophy that involves allowing workers to make decisions that affect their work according to Linda (1997, p.202). Bowen and Lawler (1995, p.35) on the other hand define employee empowerment as the act of enhancing employees’ involvement in organizational processes and decision-making. It basically involves delegating some decision-making powers to employees on matters affecting their jobs so as to ensure that organizational goals are achieved. Some of the ways of empowering employees include: allowing employees to take part in the decision-making process, delegating powers to them and offering them leadership positions (Wooddell 2009, p.16). Employee empowerment can be used to improve productivity, performance, service quality, customer and employee satisfaction, and the efficiency of an organization. Demirci and Erbas (2010, p.143) argue that companies need to manage and improve their emplo yees’ performance. This is achievable through empowerment. Empowerment, according to Demirci can be formulated through by considering four main dimensions namely: knowledge, power, information, and rewards. Alternatively stated, empowerment is the product of the four elements, information, knowledge, power, and reward. The dimensions are derived by taking into consideration the power of empowerment in enhancing the efficacy of employees. Lack of any one of the four elements might lower the overall degree of empowerment according to Shulagna (2009, p.49). Organizations now widely appreciate the fact that bureaucratic leadership in which where decision-making is squarely placed on the hands of top-level managers hampers flexibility and timely execution of duties down the line. On the other hand, it has been established that placing all decision making responsibility on the hands of lower level employees is a recipe for chaos and purposeless conflict (Bowen and Lawler 1995, p.78 ). Taking note of these facts, it is crucial for organizations to ensure that employees are engaged in decision-making by being empowered. The organization needs to develop a culture where employees are given the right to participate in decision-making especially on issues touching on their work. This will help in improving the effectiveness of the organization. Bowen and Lawler (1995, p.80) note that employee empowerment is an extremely powerful tool that organizations in the modern business environment need to implement as a way of improving their performances. One of the main results of employee empowerment is job satisfaction according to Wooddell (2009, p.15). Studies have shown that employee empowerment has a direct relationship with job satisfaction. In this regard, empowerment increases the satisfaction

Business Types of Ownership Essay Example for Free

Business Types of Ownership Essay

Early Intervention for Child with Visual Impairment

Early Intervention for Child with Visual Impairment Discuss the role of early intervention for children with visual impairments Introduction The whole area of visual impairment is a complex and difficult field. Children may either be born with a degree of visual impairment or they may acquire visual impairment at some stage after birth. Some defects may be comparatively obvious and easily detectable other may be very subtle and not obvious for some time. Visual defects may occur as a single lesion or may be part of a larger spectrum of congenital or acquired problems. They can be directly referable to the eye itself, as in the case of infantile cataracts, or may be as a result of more diffuse trauma such as cerebral palsy or perhaps a genetic error of metabolism or even infections such as meningitis. In this essay we intend to consider the role and value of early intervention together with an assessment of the value of screening which is obviously part of the same consideration. The mechanism of examination of the issue will be by means of a critical review of some of the relevant literature which has been recently published on the subject Screening There are many definitions of screening. Perhaps one of the best for our purposes comes from Wald (1) The systematic application of a test or enquiry, to identify individuals at sufficient risk to benefit from further investigation or direct preventive action, amongst persons who have not sought medical attention on account of symptoms of that disorder Screening is a common practice in many areas of the NHS. Whenever it is discussed, it is usually accompanied by prolonged discussions relating to cost-effectiveness and efficacy. With specific regard to visual impairment, screening for conditions that can produce visual impairment at an early age is utterly essential because of the development in early life of the visual processing pathways in the visual cortex (see below). (2) There is a window of opportunity for correction, which rapidly closes depending on the nature and severity of the visual impairment. Because of the dire implications for vision in later life, the cost effectiveness of such screening procedures are seldom applied in this area. This does not mean to say that considerations of efficacy are not valid (see below), but simply that it is not possible to put an appropriate value on a person’s sight. (3) Clearly the purpose of a screening programme is to try to identify those individuals who may be at risk of developing a potentially treatable condition. It is not a diagnostic service. There will usually be both false positives and false negatives. The importance of the National Screening programme is to identify those individuals who would benefit from further specialist assessment. A good place to start is the paper by Rahi (4). This study was designed to consider the efficacy of the screening programme in detecting a comparatively straightforward, although not necessarily easy to detect, lesion – the congenital and infantile cataract. The study was a cross sectional design study with an entry cohort of nearly 250 children under the age of 15 yrs. The object of the exercise was to ascertain the proportion of these children who were detected and treated at 3 months and I year of age. The significance of this study is that it highlights either the difficulty of diagnosis (or possibly the inefficiency of the system) as the results were poor by any interpretation. The paper itself is quite detailed and comprehensive, but the results that are relevant to our considerations in this essay are that only 35% of congenital cataracts were diagnosed at the routine new-born examination and only another 12% had been diagnosed by the time of the 6-8 week examination. Only 57% of the cohort had been seen and assessed by an ophthalmologist by the time they were 3 months old and a further 33% had not been examined or assessed by the time that they were one year old. The authors comment that their study showed that the prime reason for getting an assessment was because of the carer’s concerns in about 40% of all cases. We shall consider the importance of early assessment, accurate diagnosis and appropriate treatment later in this essay, but it is clear from these figures that all three of these eventualities are denied to a very substantial proportion of children and infants with possible adverse consequences for their subsequent visual acuity. In all areas of medicine, we should ideally work from a rational and verifiable evidence base. (5) Given the fact that we can point to evidence that shows that a significant proportion of children with one (at least) visual defect are not routinely detected, we should examine the evidence base for the assumption that early detection is important. For the sake of clarity we will initially confine our considerations to the circumstance of infantile cataract. We do know that infantile cataract is an important and potentially avoidable cause of visual handicap.(6) The resultant stimulus deprivation of the optic tract and visual cortex (7) caused by the inability of the retina to receive normal images, because of the distortion caused by the cataract, produces various degrees of amblyopia.(8) There is a substantial body of evidence to show that in order to optimise the eventual outcome, particularly with the denser forms of cataract, that corrective surgery needs to ideally have been carried out before the age of three months.(9) Because of the developmental importance of the early visual stimulus it is reasonable to assume that the earlier that corrective treatment can be implemented, the better the result is likely to be (10) Although we have initially considered the impact of early screening for the condition of infantile cataract, it follows that other conditions can equally well be screened with the same rationale for early treatment. If we accept that early treatment is the â€Å"gold standard† in childhood visual impairment (11), then it is possible to predict some populations of high risk births that will clearly need increased surveillance. Many of the genetic disorders which can cause visual impairment can be predicted (at least in statistical terms) and the children specifically assessed at birth (12) The majority of the papers examined with regard to infantile cataract are of the same opinion that early treatment is vital to secure any hope of reasonable visual acuity. The evidence base for some other conditions of visual impairment is nowhere near as clear, and in some places, frankly contradictory. If we consider the implications for other conditions of visual impairment in childhood we should consider the paper by Clarke MP (13) which specifically considers the efficacy of treatment of a unilateral visual impairment in the 3-5 yr. old age range. This is particularly relevant to our considerations here because the trial itself was well constructed and has a meaningful outcome. In broad terms, nearly 200 children who were identified as having a degree of unilateral visual impairment were allocated into two groups. One group had â€Å"appropriate treatment† the other had no treatment. The authors note that all children had treatment after the six month observation period. the children who received â€Å"full treatment† with glasses universally had better visual acuity than those who did not receive treatment. Interestingly, the mean treatment effect between the two groups was only one line on the Snellen chart. The degree of improvement was proportional to the degree of original impairment. The specific conclusions of this particular study are worth quoting verbatim:- Treatment is worth while in children with the poorest acuity, but in children with mild (6/9 to 6/12) unilateral acuity loss there was little benefit. Delay in treatment until the age of 5 did not seem to influence effectiveness. It is worth considering these conclusions in more detail as they have distinct relevance to the need for early intervention. The authors point out that there is a tendency for amblyopia to undergo a degree of spontaneous improvement which is consistent with the results of another trial (14). It is also fair to point out that other trials do not concur. Simons K (15) suggest that untreated amblyopia will deteriorate with time. The authors feel that, on balance, they recommend the continued wearing of glasses until the age of 7, even if the visual acuity returns to normal before this time, to prevent the development of refractory amblyopia. (16) When the authors compared the results of their study with children from districts who did not receive pre-school screening, the follow up study showed that deferring their treatment did not limit their potential for improvement and, very significantly, it nearly halved the number of children that needed to wear eye patches at all. (17) On the basis of this evidence the authors felt able to conclude that it is the acuity at presentation rather than the chronological age of the child, that is the most important determinant of eventual outcome. This is consistent with a similar study by Hardman-Lea SJ (18) They actually quantified this by stating that:- Children with a moderate acuity loss of 6/18 or worse showed a clear cut response to treatment, which itself arguably justifies screening to identify and treat these children. In contrast, children with mild acuity loss, who represent over half those identified with unilateral acuity impairment at screening in this and other studies, received little benefit from either treatment. This level of impairment, though often excluded from studies, is still commonly treated in routine clinical practice. We argue that children with 6/9 in only one eye should no longer constitute screen failures and do not justify treatment, even with glasses. Rather disturbingly the trial threw up one (probably statistical) anomaly:- The glasses group with moderate initial acuity, in whom patching treatment was deferred, showed no overall gain in acuity at post-trial follow up. While this is probably a random effect, it raises the question whether prior refractive correction might in some way limit the effectiveness of subsequent patching. Clearly this cannot be regarded as based on firm evidence, but raises the spectre that early treatment may actually be detrimental. If we consider a more technically sophisticated study (19) Weiss A et al 2004) that looked at visually evoked potentials (VERs) in amblyopic children and compared the ages of instigation of treatment (patching) and the detectable effects on the VERs. This is an extremely complex paper but careful weighing and critical analysis of the results shows that, as far as amblyopic children are concerned, the critical window for demonstrating and exploiting cortical neuronal plasticity extends up to the age of ten.( also 20). Although this paper specifically does not comment on the fact, an earlier paper by the same author (21) points to the fact that the plasticity, and therefore adaptability, progressively diminishes from about the age of five onwards The PEDI Group (22) complicate the findings further with their contention that treating amblyopic children in the 3-7 yr. age range did not produce significantly different clinical outcomes when compared to an older age range Screening, in general terms, has been overhauled by the National Screening Committee (23) which has sought to apply the classic Wilson Junger (24) criteria to all aspects of NHS screening. Within the recommendations of this body, various specialist organisations have produced their own guidelines. In the UK, the need for early visual impairment screening is recognised. Clearly this is different from being done efficiently in all cases. The most authoritative guidance that is currently available in this country is that which is based on the recommendations of the two national working parties who produced a joint report. The Royal Colleges of Ophthalmologists and Paediatrics and Child Health (25) The current recommendations include an inspection of the eyes together with an evaluation of the red reflex at birth and then a fuller assessment which would include an examination for the presence of squint and visual behaviour generally at about 6-8 weeks. (26) Later on in childhood there are other specified screening procedures which are designed to detect abnormalities such as strabismus, abnormalities of colour vision and reduced visual acuity although an examination of the literature would suggest that the pick up rate is surprisingly small (27). This particular author suggests this is mainly because the vast majority of cases are brought to the attention of the primary healthcare teams by the carers before screening is carried out. In this essay we have conducted a brief overview of some of the relevant literature in the field of early detection of visual impairment. The results are disappointingly confusing. Some areas appear to have a fairly clear cut and universal agreement, others seem to produce well constructed studies that offer seemingly mutually exclusive results. (28). The area of the infantile or congenital cataract appears to be one of those areas where there is fairly universal agreement that early treatment is beneficial, but the biggest stumbling block appears to be the comparative inability to pick up or detect the abnormality in a clinical screening setting. Although we have not presented firm evidence, as it is not directly relevant to our discussions, there is also the problem that surgical intervention, although obviously helpful in terms of preserving vision, may actually have a down side that iatrogenic glaucoma is a possibility in later life. (10) The converse situation appears to apply to the amblyopic patient, or the patient with strabismus. We have presented evidence that appears to be frankly contradictory. Although it appears easier to detect these abnormalities in the older child there is considerable disparity in opinion about whether early treatment is either beneficial, or in the case of one of the papers presented, even helpful. It is clearly difficult to form an opinion with any sort of firm evidence base in these circumstances. 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