UK Guidelines for Eye Screening

UK Guidelines for Eye Screening DOES THE UK CURRENTLY SCREEN THE POPULATION FOR APPROPRIATE EYE CONDITIONS? WHAT IS SCREENING? Screening is a way of identifying those individuals who are at a higher risk of developing a certain health problem; this allows them to have appropriate early treatment and information in order to prevent further deterioration. There are many different screening programmes which are offered by the NHS, for example, Screening for newborn babies, Diabetic Eye screening, Cervical Screening, Bowel Cancer Screening etc. (Nhs.uk, 2017). The screening process uses tests which can be applied to a large number of people and is an initial examination which requires further investigation and follow up. There are many different types of screening, for example, Mass screening (e.g. chest x-rays for TB), Multiple screening (e.g. annual health check), Targeted screening for those at a higher risk of developing specific diseases e.g. battery workers would be at a greater risk of developing cancer or problems with their nervous system (Anon,2017) and lastly Opportunistic screening. Opportunistic scr eening relates to identifying those at a higher risk to see whether they actually have signs of a condition as we carry out the pre-screening process/sight test, for example, we tend to check the pressures and fields of the people (maybe should write of patients over..) over the age of 40 in order to check for any signs of glaucoma, however, this cannot be classified as screening as it is opportunistic (Anon, 2017). Within this essay I will mainly be discussing Diabetic Eye Screening and Amblyopia Screening, I will be analysing how well these relate and correspond to the criteria set by the WHO guidelines for screening, how the screening programmes could be improved and what screening programmes are out in the world which could benefit us if brought within the UK. A full discussion of the classifications of diabetes or amblyopia is beyond the scope of this essay. 10 CRITERIA 1968 WHO GUIDELINES FOR SCREENING There are 10 main criteria/principles that a screening programme should meet in order to be an effective, practical and appropriate way of screening within the UK. These were brought about in 1968 by Wilson and Jungner (WHO) (Patient.info, 2017). Further down in this essay how well Diabetic Eye Screening and Amblyopia screening match the 10 criteria will be discussed, table 1.1 summarises the findings and a potential condition that we could screen for in order to enhance appropriateness of screening for eye conditions within the UK (Gp-training.net, 2017): (TABLE 1.1) 1968 WHO GUIDELINES DIABETIC EYE SCREENING AMBLYOPIA SCREENING AMD 1. The condition being screened for should be an important health problem à ¯Ã†â€™Ã‚ ¼ ? à ¯Ã†â€™Ã‚ ¼ 2. The natural history of the condition should be well understood. à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ 3. There should be a detectable early stage à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ 4. Treatment at an early stage should be of more benefit than at a later stage. à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ 5. A suitable test should be advised for the early stage. à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ » ? 6. The test should be acceptable. à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ » à ¯Ã†â€™Ã‚ » 7. Intervals for repeating the test should be determined. à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ ? 8. Adequate health service provision should be made for the extra clinical workload resulting from screening. à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ ? 9. The risks, both physical and psychological, should be less than the benefits. à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ 10. The costs should be balanced against the benefits à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ ¼ à ¯Ã†â€™Ã‚ » DIABETIC EYE SCREENING It is estimated that within the UK, 4.5 million people have diabetes and around 1.1 million people have yet to be diagnosed (Anon, 2017). It is essential that we screen individuals who have diabetes as the development of Diabetic Retinopathy is one of the major complications of diabetes and early diagnosis can lead to appropriate and effective treatment (Hamid et al, 2016). This Diabetic Eye Screening (DES) is separate from a sight test and is to be carried out annually. If a woman is pregnant she will be offered additional tests as the development of gestational diabetes is common i.e. diabetes which only occurs during pregnancy, however, if the mother already has diabetes she also has a higher risk of Diabetic Retinopathy development (Nhs.uk, 2017). 1.1 Attendance at Diabetic Screenings Forster et al. (2013), evaluated whether patients who did not attend their DES were at a greater risk of sight-threatening diabetic retinopathy (STDR).   They carried out a longitudinal cohort study over 3 years (2008-2011) in which diabetic residents were invited for the screening. Forster et al found that 5.6% of the patients who did not attend in 1 year for their DES developed STDR. 2.6% patients who previously had no retinopathy at their first screen had developed STDR when they did not attend in 1 year and 5.7% of participants developed STDR when they did not attend for 2 consecutive years. With participants who previously had mild non-proliferative retinopathy at their first screen, 16.8% of these developed STDR when they did not attend for their DES in 1 year and 17% developed STDR when they did not attend for 2 years. (is this in your own words if not results should be quoted just to avoid plagerism)The results found for referable maculopathy also followed the same pat tern but the affected participants were smaller. This longitudinal study has its benefits as a large number of data can be collected however as it is over the period of 3 years, there is a risk of individuals dropping out of the study and therefore data for one year may not be comparable to the data from the next year as there would be subject differences. The findings of this study suggest that there is importance for DES and it can be deemed as an appropriate eye condition to be screened for within the UK as it does allow early detection of diabetic referable retinopathy and the greater the time between the DES the greater the risk of the development of STDR. However whether we need to screen individuals annually could be further discussed (Forster et al, 2013). 1.2 Improvements for DES Screenings To improve how we currently screen within the UK for appropriate eye conditions we could consider, increasing the time between the DES by making them biennial i.e. every 2 years. Forster et al found that participants had a 10.84 times higher chance of referable retinopathy if they had not attended their screening for 2 consecutive years, compared to those participants who were screened for every year.(I think should be kept in but change to own words if not already.) He found that for those patients who attended every 2 years had no significant increased risk of referable retinopathy compared to those who attended annually. A number of benefits can be seen from increasing the time between the screenings. Firstly this would mean that less DES would be carried out, this frees up time and space; in practices, this allows more time for regular sight tests and at the hospital, it allows more space for other important appointments. Reducing the number of DES also means that fewer professio nals would be required for these screenings; this would cut down the costs made by the NHS. Some could argue that this could lead to a cut down in the number of optometrists who specialise in the DES, however, this would allow the current professionals specialised in the DES or the ones that do carry out the training to become more skilled and have more focused knowledge on DES. Scanlon et al. (2013), found that those who were not screened promptly after being diagnosed with Type 2 diabetes had a raised rate of detection of referable diabetic retinopathy. The study didnt show whether those who were screened at a later date had a more severe form of diabetic retinopathy or whether it was anything to do with patient compliance but it did indicate that screening patients within the Quality standards set by NICE were more beneficial for the patients (Scanlon, Aldington, and Stratton, 2013). This supports that the UK does currently screen appropriately for eye conditions such as Diabetes and in a timely manner, as the earlier we screen a patient after being diagnosed with diabetes, the less of a chance for the development of severe/unnoticed diabetic retinopathy, as the development of DR is most prominent within the first two decades of developing the disease (Fong et al, 2017). In the UK, patients information once being diagnosed with diabetes is transferred via their GP to the Diabetic Eye Screening Services as soon as they are diagnosed, this allows appropriate treatment and screening for the patient immediately. We cannot solely rely on this study as it does not include any facts or figures regarding how raised the risk is for referable DR if a DES is not carried out every year. Therefore to improve screening within the UK; following Forster et al study, we could increase the time between the screenings i.e. make it biennial. The Health Improvement and Analytical Team of the Department of Health found that it would be more cost effective if the screening intervals were increased from one year to another when carrying out a cost-utility assessment for those who have low risk of development of Diabetic Retinopathy; these being defined as those who have been graded to have no background retinopathy in either eye, therefore one way of improving the screening in the UK could be by increasing the intervals between the DES (James, 2000). Currently, within the UK, Diabetic eye screening is offered to individuals who are 12 years and older. They are contacted by their local Diabetic Eye Screening service informing the patient as regards to what practices are available for them to attend for their screening i.e. a local opticians, hospital or clinic. Hamid et al. (2016) carried out a retrospective analysis of 143 patients aged between 7 and 12 in order to see whether DES should be carried out on children under the age 12. 73 of these patients were below the age of 12 and the other 70 were 12 years of age. He found that both these groups had a similar prevalence of background diabetic retinopathy (early stage of diabetic retinopathy) and none had STDR. From Hamid et al results, it can be seen that there would be no benefit to starting the DR at an earlier age as the same results are found in both groups, therefore supporting the current English protocol of starting DES at 12 years of age.   A DES test within the U K is fairly easy to carry out and requires the patient to be dilated; once the patient is dilated they are unable to drive for roughly 4-6hours in order for their pupils to return to normal.(this could be referenced from somewhere see if you can find from article or anything on how its done then reference that) This could be considered as some inconvenience to the patient as they may be required to take a day off work or prevent doing specific tasks that day however as the DES is carried out annually it is only a matter of a few hours, which could easily be rearranged or time off work can be taken. The risks of the drops are very low; a few symptoms could be experienced for example pain, discomfort, redness of the eye, blurry vision and haloes around lights which can lead to Angle Closure Glaucoma. ACG can be treated and the benefit of carrying out the DES is much greater and outweighs the risks. 1.3 DES Screening In India Currently, in India, in addition to the current Diabetic eye screening that is being carried out in practices, they are also going to be trialing (think it needs double ll m grammerly says youve spelt it the American way) Mobile DES services. This will benefit patients in several ways; firstly those who are not able to leave their homes are able to get screening and treatment readily. Furthermore, not all clinics have the appropriate equipment required in order to carry out DES, therefore, with the Mobile DES services patients are able to still get the adequate healthcare required. This is yet to be trailed therefore the success rates are unpredictable. If in the future, this helped patients get the adequate screening and healthcare required in India, then this could also be trialled within the UK in order for improving eye screening for appropriate conditions (Kalra et al, 2016). AMBLYOPIC SCREENING The common vision defects in children aged around 4-5years tend to include amblyopia, strabismus (squint) and refractive error (short or long sighted). (is this referenced from tailor et al like the next sentence, if not then needs a reference) An estimation of the prevalence of amblyopia in the UK varies between 2% and 5% (Tailor et al, 2016). Amblyopia is well understood and occurs when the nerve pathway from one eye to the brain does not develop adequately during childhood (Medlineplus.gov, 2017). Individuals are said to have an amblyopic eye when their vision is worse than 6/9 Snellen or 0.2 LogMar in the affected eye.(reference needed)   The UK National Screening Committee along with the recommendations from the Health for All Children agreed that orthoptic-led services should offer to screen for visual impairments for children aged 4-5 years (Legacyscreening.phe.org.uk, 2017). If the amblyopia is treated while the visual system is plastic i.e. still developing within the critical period (first seven to eight years of life), then this can be an effective way of restoring normal vision. Untreated amblyopia can have a negative impact on an individuals adult life; within the UK it was found that only 35% (36 out of 102) of people were able to continue their employment after losing the vision in their non-amblyopic eye (Rahi, 2002). 2.1 Testing The tests for amblyopia can include monocular visual acuity testing, plus or minus assessment of the extra-ocular muscles, colour vision testing, and binocular status (Stewart et al, 2007). The screening process can vary depending on the density of the amblyopia and age of the patient i.e. this would alter the treatment required. Patching seems to be the most common treatment for amblyopia and is seen to have improvements in vision if it is carried out adequately i.e. compliance is required. Stewart et al. (2007), researched the benefits of patching in which they found 40 children who were patched for 6 hours had an improvement in 0.21 to 0.31 log units of vision compared with another 40 children who were patched for 12 hours had a 0.24 log unit improvement. This supports the idea that patching can be carried out for fewer hours and still produce a similar enhancement in vision. However, when compliance was monitored there wasnt much of a difference between the hours, for the patient s prescribed 6 hours they tended to vary between 3.7 to 4.7 hours and the 12-hour patching children varied between 5.1 and 7.3 hours (Stewart et al, 2007). (maybe some more critical analysis of this study, I know youve got sample size and randomisation but if you can may add some more) These results suggest that Amblyopic patients can be patched for fewer hours and still have the same improvement in vision, however, compliance is necessary. Following on from this study when a randomised trial was carried out in order to see the effectiveness of Atropine and patching as a treatment of Amblyopia, it was found that visual acuity in the amblyopic eye improved for both, therefore supporting patching and atropine as adequate treatments for Amblyopia (Stewart et al, 2007). In this study equal, sample sizes were used and patients were allocated randomly, this allows the removal of subject bias and allows comparisons between the subjects and therefore more reliable results can be obtained. Furthermore, it was found that the younger the child, the less the occlusion in hours that would be required, therefore, the earlier we test the child for amblyopia the better the treatment (Stewart et al, 2007). 2.2 Problems with Patching Referring back to the 1968 guidelines in Table 1.1, patching may not be deemed as an acceptable form of treatment. When a randomised trial was carried out on 4 year old and 5 year old children it was found that they had experienced short term distress and were more upset when having to wear a patch alongside glasses than wearing glasses alone (Williams et al, 2006). Children also reported having been bullied whilst wearing a patch causing emotional problems which in turn led to long term adverse consequences. Williams et al. (2006) carried out a prospective study, in order to test their hypothesis by comparing children who had been screened preschool and required a patch and those who had not. 95% confidence limits were calculated and it was found that the risk of being bullied was the same for those who wore glasses and had been screened preschool and not. However, when comparing the preschool and school children and the rates of bullying whilst wearing the patch it was found that t here was almost a 50% reduction in the group of children who had been screened preschool (Williams et al, 2006). From these results, it can be concluded that pre-school vision screening would reduce down the bullying experienced by the children whilst wearing the patch therefore in order to improve screening within the UK we could potentially screen the children earlier to prevent the psychological stress that the child has to experience. During this study, the data was collected via an interview with the children. Childrens responses could vary depending on who was interviewing the child, the gender of the child (girls would be more(not would-they may be more likely to) likely to admit to being bullied) and other factors too(what other factors-either state them or leave it at the last point); therefore these results could not fully represent whether the child had experienced bullying and this factor should be taken into account when viewing the results. 2.3 Screening for Amblyopia within Japan Currently, outside of the UK, there are different screening processes which occur. The screening process for Amblyopia within Japan starts at the age of one and a half years old and then the children are later screened at 3 years of age by paediatricians. In The School Health Law based in Japan, the Visual Acuities of children ranging from 6 years old to 12 years old are taken by the school teachers then the children are screened by Ophthalmologists to screen for the eye diseases and amblyopia (Matsuo and Matsuo, 2005). Several studies over the years have been collected in order to compare the number of strabismus patients identified in different countries. Comparing these different studies it can be found that overall there were fewer children in Japan who developed strabismus, only 1.28% of the sample. Within the UK when a similar study was carried out it was found that 4.3% of the total number of children screened developed strabismus, this being much larger than those who develop ed it within Japan (Matsuo and Matsuo, 2005). This variation in results may suggest that the screening process in Japan is a lot more thorough compared to the UK and as children in Japan are screened for fairly early on in life, they are continuously kept an eye on, this could increase the detection of the early developments of Amblyopia and therefore appropriate treatment is also given fairly early on. (but is it screened more thoroughly in japan only because japanease children are more prone to amblyopia- is the prevalence of amblyopia higher in japan-if so then that might be why they screen earlier-find out) However, we cannot solely base the development of strabismus on the way we screen the children as there could be other factors as well. One way in which we could modify screening within the UK could be by screening children at an earlier age and more often as well; this would allow early detection of Amblyopia and therefore early appropriate treatment, reducing the number of strabismic individuals. Tailor et al. (2016) identified that a large area of controversy when discussing screening for Amblyopia is that it is currently not clear whether screening children earlier is associated with better outcomes and also whether it is more cost efficient or not, however it is widely agreed that starting screening for amblyopia at the age of 4 to 5 years old it seems to be clinically effective and also cost efficient at the moment therefore further research needs to be carried out in order to see whether we should move the screening for Amblyopia to an early stage or not (Tailor et al, 2016). IMPROVING SCREENING WITHIN THE UK AMD Within the UK to improve screening we could also screen for further conditions such as for Age-Related Macular Degeneration. AMD is an important health problem and accounts for 8.7% of all legal blindness worldwide. The development of Choroidal Neovascularisation (CNV) is the main cause of severe vision loss which leads to the development of Wet or Exudative form of AMD (Schwartz and Loewenstein, 2015). AMD development is pretty well understood by professionals and it can lead to changes in your central vision and also have an impact on the quality of an individuals life. Patients with AMD have reported more difficulties when performing tasks such as reading, leisure activities, shopping etc. (Hassell, 2006). There is currently no treatment for the dry form of AMD, whereas wet AMD is currently being treated using intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents which lead to an improvement in 30-40% patients visual acuity (Schwartz and Loewenstein , 2015). In Table 1.1 an extra column has been added in order to compare how well AMD screening would relate to the WHO criteria if it was to be screened for within the UK. 3.1 Techniques It has been found that the treatment of AMD at an earlier stage is of more benefit than at a later stage. Treatment of CNV within 1 month was found to have a greater gain in visual acuity than treatment which was given after this timeframe (Schwartz and Loewenstein, 2015). If AMD patients were left untreated for a year they would lose two or three lines of vision on average therefore the earlier the detection of AMD the more beneficial (Anon, 2017). The screening process could involve an Optical Coherence tomography (OCT) and a fluorescein angiography (FA) alongside clinical examinations, for example, Amsler charts, Nosefield Perimetry, Near Visual Acuity etc. In Table 1.2 these examination techniques have been presented in a table and the Pros and Cons of each technique can be seen. TABLE 1.2 (Schwartz and Loewenstein à ¯Ã‚ »Ã‚ ¿Int J Retin Vitr (2015) 1:20) 3.2 Screening Criteria If screening programs were to be carried out within the UK for AMD, we would need to consider a few factors. Firstly, at what age would we start to screen individuals for AMD and how often these screenings would take place would need to be considered(-dont need highlighted bit). AMD is most common in individuals who are over the age of 65, however, can be seen in some in their forties or fifties, not only is it affected by age but smoking, family history, UV exposure and diet can also be risk factors for the development of AMD (Rnib.org.uk, 2017). There could be a few different criteria in which individuals would qualify for the screening process of AMD, a few of these criteria could potentially be: Any individual over the age of 60 years old. Any individual over the age of 50 years old with a family history of AMD. Any individual who experiences one or more of the following symptoms: difficulty reading with spectacles, vision not as clear as previously or if experiencing straight lines becoming wavy or distorted (Rnib.org.uk, 2017). Once this screening process is carried out the recall period could vary depending on the patients health, family history, and lifestyle, this could vary from yearly up to a 5 year recall period for those that are normal; have no family history of AMD and good lifestyle. If an individual is diagnosed with Dry AMD then these screening processes would occur much more regularly in order to monitor the health of the eyes and to detect Wet AMD at an early stage. A benefit for the proposition of screening for AMD within the UK is that it would lead to more jobs and professionals to be specialised within AMD. 3.3 Time Efficient       There are a few flaws with screening for AMD. If OCT images were not clear enough patients may need to be dilated, this would mean that the patient would not be able to drive for approximately four to six hours, which could result in the patients having to take a morning/afternoon or a day off work.(maybe you can find a study where people are asked about what they dont like in dilation and it might be they dont like taking time off-then can reference that here) If all the above techniques mentioned in Table 1.2 were to be carried in the screening process for AMD, this in itself would be quite a lengthy process and would also require time to be taken off unless it was carried out on an individuals none working day. Screening for AMD would involve Fluorescein Angiography this may not be accepted by some patients as it is an invasive process and requires fluorescent dye to be injected into their bloodstream. Therefore suitable techniques would be required in which the patient would cons ent to if screening for AMD was to be carried out within the UK. Furthermore, currently within the UK, only half the adult population (48%) have heard of AMD therefore screening for AMD within the UK could be a challenge as public awareness of this disease is very limited therefore the public may be unable to recognize any symptoms or changes in their vision being related to AMD (VISION 2020, 2017). The development of CNV can be very rapid and therefore patients may remain asymptomatic or mechanisms within the brain could lead to overcome the noticeable change in their vision during the early stages of this disease, therefore, it would be difficult to screen the patient in their early stages of AMD (Rnib.org.uk, 2017). Further information should be given to individuals in which they are informed of what symptoms to look out for and also what to do in these instances. 3.4 Costs Practicality Currently within the UK if patients require a private OCT scan this can vary in price ranging from thirty-five pounds (C4 SightCare) to eighty-nine pounds (Leightons Opticians). Free OCT scans may be carried out in hospitals settings or learning institutes, for example, The University of Manchester (Gteye.net, 2017).   If we were to routinely carry out OCT scans for everyone as a technique during AMD screening then this can be very costly if funded by the NHS, in addition, if this was to be carried out privately then patients may not be willing to pay that much for the AMD screening process and therefore the success rates for screening for AMD within the UK would be less as patients wouldnt attend the screening. Furthermore, other techniques such as fluorescein angiography can be costly to be carried out for example if patients require this to be carried out privately they may end up paying up to  £103 (Anon, 2017). Another issue arising with the potential to screen for AMD would be regarding the practicality of the screening process; the equipment and machinery are fairly large and would require the practices to have adequate space in order to carry out these screenings. In addition, the equipment itself is very expensive and companies may not want to invest in such equipment if there turnover isnt worth it. In order to overcome this, we could potentially just carry out AMD screening within a hospital setting however it would still depend on the amount of space available to carry out these processes. Overall screening for AMD is quite a lengthy process and if it was to be carried out within the UK it would require a lot of work in order to make the screening process affordable and time efficient too. CONCLUSION Overall, within the UK we currently do screen for appropriate eye conditions these including Diabetic Eye Screening and Amblyopia. We could further increase this by screening for conditions such as Age-Related Macular Degeneration, as it is a very serious eye condition and early detection and treatment is beneficial. However, there are quite a few different factors which need to be considered if screening for AMD was to be carried out as mentioned above. Also, there are currently limited studies on AMD and therefore further research should focus on AMD and the benefits of continually screening the patient. Currently, as screening is being carried out for Amblyopia, this could be an eye condition that doesnt necessarily need screening for. A Cochrane review(do you need to reference which one) found that there is currently not enough evidence to determine whether the number of children with amblyopia was reduced due to the screening programs or not. The main reason for this was that de finition of Amblyopia is widely debatable and there is a lack of universally accepted definitions of amblyopia, which makes the data collected from different studies difficult to compare. However, it is much easier to leave a screening process in place rather than to remove it as a whole as further complications can arise and screening for this is somewhat beneficial.   From the discussion within this literature, it can be seen that we do currently screen for appropriate eye conditions within the UK. REFERENCES Nhs.uk. (2017). NHS screening Live Well NHS Choices. [online] Available at: http://www.nhs.uk/Livewell/Screening/Pages/screening.aspx#what-is. Anon, (2017). [online] Available at: https://www.med.uottawa.ca/sim/data/Screening_e.htm. [Accessed 5 Feb. 2017]. http://www.hsa.ie/eng/Publications_and_Forms/Publications/Chemical_and_Hazardous_Substances/Safety_with_Lead_at_Work.pdf [Accessed 9 Feb. 2017]. Patient.info. (2017). Screening Programmes in the UK. Find S

Barrio Boy Essay

1. Author Information The author of Barrio Boy, is Ernesto Galarza. Ernesto was born in Jalcocotan, Nayarit (which is in Mexico) on August 15, 1905 and died in 1984. During Galarza’s early childhood, he lived in a small village of Jalcocotan, all while he learned respect for the things he had. Ernesto came to the United States at a young age, during the Mexian Revolution which happened in the early 1900’s. While Ernesto was growing up, he helped out his family in harvesting their crops. He worked in the harvest crops of Sacramento, California. Working in these conditions inspired his views on the way Mexicans were treated as farmworkers. He soon became concerned about the way that the Mexican agriculture workers were treated poorly, and lived in bad condtions all while being a school boy. During these hard times, a baby died, from drinking the polluted water they were given. When the Mexican people found out about this, they decided to ask Ernesto to lead the village in a protest, because Ernesto had been taught English in school. Galarza showed his student activism towards Mexian-American in the early 1929’s, which was when he vocalized his views on the way that the Mexian-American’s were being treated. He finished up high school, and after graduation he continued on with his education. He went to Stanford University, where he was the first Mexican-American to ever be admitted. Mr. Galarza earned his Ph. D. in history and political science at Columbia University. After World War II, Dr. Ernesto Galarza soon became a labor organizer because of his endorsement of the AFL-CIO, he was also named the National Farm Labor Union’s executive secretary. Galarza was deeply committed to the education of young people, and the thought that everyone should have an opportunity to  get a good education. Which might be the reason that he started to write literature for children. Ernesto Galarza was the author of numerous books which included topics on social and economic values, expecially toward the Mexican-American society. Galarza’s wife was Mae, who developed a bilingual education program, which is now a model for other programs. Along with all of Galarza’s accomplishments, he translatted the ‘Mother Goose’ stories into Spanish, and with that book, he also wrote Barrio Boy, which originated from stories that he told his daughters. And in 1976, Ernesto Galarza became the very first Mexican American to be nominated for the Nobel Prize for Literature. II. Setting The begining of the book took place in a quaint village in Mexico, called Jalcocotan or Jalco for short. Jalco was around the mountains of the Sierra Madre de Nayarit. The nearest city from Jalco was Tepic, from Tepic it was near impossible to get to Jalco. You would have to go down mule tracks, on either a mule or on a burro, and the whole time just hold on the best that you could. The indians that founded Jalco wanted it to be difficult to get into this village, which is why they choose the small rocky places and the gullies surrounding Jalco. They thought of Jalco as ‘some natural storm cellar’, so that they wouldn’t be hit with the hard hurricanes that sometimes occured. Jalco is where Ernesto Galarza grew up, and he considered himself and anyone growing up in the puebl ‘jalcocotecanos’. In the book he talked about how great Jalco was because it gave protection from outsiders, and it only had one street. This street was an open stretch of a mule track, but it had been widened through out the years, to be able to ‘park six automobiles hub to hub’. In Jalco, there was a line of houses, or cottages on each side. Roofs, were made only of thatched palm, and there was no windows, while the backs of the houses were called corrales, because ‘they were narrow alleys that led uphill to the edge of the forest on the upper side of the village’. Ernesto had to move to Tepic. They thought that bolas were forming, which the book gave deffinition to as: ‘any group of persons who got together to overthrow the establishment or to inglicht upon it anguish or alarm; when armed and operating in the mountains, they were more accurately called â€Å"guerillas.† ‘. and they thought that they would soon be coming to Jalco the revolution was going to move to Jalco. Gustavo had been chosen to go to Tepic, and see what was going on over there. The night that he left, there was a major comet that Don Cleofas said foretold that something very impacting was soon to happen, but specially he said this comet meant that La Revolucion was coming our way. Gustavo came back to Jalco a few days after the comet. What he saw there was guards, and men being taken to regiments, which made Ernesto’s family decided to move into Tepic where they would all get jobs and find a place to live. The revolution scared Ernesto’s family, and everytime they thought that the revoultion was gettin close, they packed up their stuff, with a lot of thought involved, and moved to the next city. The book says that the ‘city was peaceful while we lived there but in the vecindad there was the talk and the feeling of trouble. My mother lived in dread that Jose would be picked up and taken away as a draftee to fight for Don Porfirio’. After they found out that no one could enter or leave Tepic without being stopped bu the patrols, and how regiments were getting quartered around the village in Tepic, they decided to go to Acaponeta. In Acaponeta Ernesto said that the most important place was the railway station, which he stood far away from the tracks and watched the people get on and off of the train, and watch the train go off into the distance. The train stain was also the center of the revolution, because there were soliders in the boxcars, and Ernesto and his mother could see how the revolution was evolving. A letter came in from Gustavo that said for Ernesto and his mom to go to Urias, from Acaponeta. Gustavo said that he would send a money order to them both to help transport them from Acaponeta to Urias. Gustavo’s letter also said that Esther would also go to Urias to meet up with them, because they were also sending him money. A few days later they left on a train from Acaponeta, to go to Urais, where they meet up with Gustavo and Jose. They stayed in Urais for a while, but when Dona Florencia found a room for rent, they were off to Mazatlan. Mazatlan was the next city over to Urais, so it really wasn’t too big of a move for Ernesto, and in the book it said, ‘The down payment on teh rent was made and Jose went back to Casa Redonda for out things.’. The place that they lived in was only one room, and had a red tile roof, and brick floors. Then three more letters came from Gustavo, where he wanted to get all the family together, only this time in America. Gustavo and Jose wanted to have all the family together in Sacramento, California because that’s where Jose had to work on the railroad. Ernesto and his mom had to wait in Tucson, before they could continue their journey, so they could get another pass and so money could be obtained. While they were in Tucson Ernesto had a great time with the hotel and the toilet, it says in the book, ‘That night I got up many times to go to the toilet, until i was ordered to go to bed.’. When they got back on the train for the last time, they finally entered their destination of Sacramento. The book describes them entering Sacramento as, ‘A brake man opened the door at the front of the coach and called, â€Å"Sach-men-ah,† by which we knew he meant Sa-cra-men-to, for we had passed a large sign with the name in black and white at teh entrance to the corporation yard. From there, the book setting is in Sacramento, and describes the different things that Ernesto Galarza learns while in school, and while he’s out on the farm. III. Characters The main character of the book was Ernesto Galarza (big surprise). In this book, Ernesto Galarza is not very physically developed in the beginning, but towards the end of the book he was on his way to manhood. Emotionally, Ernesto Galarza is strung everywhere, depending on the time of the book. â€Å"Police and firemen swarmed around for a while. We never called the police, they just came.† is one excerpt from the book where he had to be  very emotionally strong, because he had to realize the bad neighborhood that he was in, and how his family was taking it. They were doing the best that they could possibly do, and he knew how bad that made them fell. Another time that Ernesto showed how emotionally impact he was, was when he had to move out of his home town of Jalco, and into different places with his family. Moving is hard on anyone, expecially if you have lived there you’re whole life, the hardship of having to move from city to city in Mexico was really bad for Ernesto Galarza, because this family had to ask other family members if they could stay in their houses, and they had to start from scratch. Which really shows how emotionally strong he was. Ernesto Galarza had to be mentally strong, to see how bad things really could be. To see your neighbor that’s a child dying, you have to get mentally stronger than the average person. Ernesto Galarza also had to take a place in watching the rituals for those who are really sick, and then had to participate because his family thought that that the more people involved in the ritual, the better the outcome. Ernesto Galarza was also shaped into a better mentally strong person through this story because he experienced many rascist situation in reverse. In the book, Ernesto Galarza wanted to send a letter to his mother, but he had to make it a telegram because it had to be in english. At the bottom of the telegram, Ernesto Galarza signed it ‘Little Ernie’ but the clerk made him change it to ‘Ernesto’. This made Ernesto Galarza think about everything, and develop himself better and become more strong mentally. Other than Ernesto, there were a few other main characters which include Gustavo, and his mother. Gustavo wrote his family letters, and money. Gustavo was very physically developed because he had to work very hard labor, such as the railroad tracks. While his mom wasn’t too physically developed because she was a woman, but she always did what she could to help out. Emotionally Gustavo was very strong, and expressed a lot of concern. Gustave  never really expresses a lot of his feelings because he’s pretty quiet. Ernesto’s mom was always wanting to do the best thing for her kids, no matter what. She was willing to take all of her things and move them just for the sake of her children. Gustavo mentally wanted to get all of his family in one spot, because family was very important to him. Through-out the who book Ernesto keeps getting these letters from Gustavo and Jose explaining what he had to do to find, or reunite with his family, and Gustavo and Jose took care of their family by giving them money to help them out on their journey. Galarza’s mom was very mentally strong to be able to go from place to place, with all the worries that she had on her mind, like the time she stayed up all night before they left. IV. Plot Barrio Boy, had a lot of Man Vs. Self, and Man Vs. Society. Man Vs. Self: There were so many times that there was a man vs. himself, but one time specifically was when Ernesto had to learn English. Ernesto just had to concentrate, and believe in himself that he could learn how to read and write English before he actually could. Ernesto’s mom helped him in his work, by his mom calling out the combinations she had written him on tope of the slate. Man Vs. Society: Like man vs. self, there were a lot of man vs. society too, but one time in particular was when Ernesto ventured out of the alley and down the street, and was chased home by three American boys. This shows how difference societys act towards different people, Ernesto didn’t even understand what the boys were yelling at him, he just understood that it wasn’t very nice. The book was mainly about how Ernesto had to move from Jalco and to city to city, to try and be with his family. The reason that his family was split up was because of the Mexican Revolution. During the book, Ernesto’s family  wanted to be as far away from the revolution that they could be, no matter how many times they had to move. Gustavo and Jose kept sending Ernesto and his mother money to get from to place in this book, because they wanted to get all of their family in one place. They tried a lot of villages and cities in Mexico, until they finally decided to go to the United States. They choose to migrate to Sacramento, California because Jose was working on the railroad there. The rising action in this book was all the traving Ernesto did. On each train, he was exposed to different experiences and different people. The main action of this book was when they finally arrived in Sacramento and was reunited with their family, because that’s what the story was talking about through-out. There, was also where the falling action occured, which would be that when he got there, he had to work and help support his family, and watch his little sisters. The resolution would be that he went to school, and made something of himself. V. Theme The life lesson that was taught in this book would be that don’t take anything forgranted. In Ernesto’s book, he goes through a lot of conflicts with himself and with the circumstances that he has to live in. The biggest conflict was having to move from place to place trying not to get caught up in the Mexican Revolution. Although Ernesto was in a horrible situation, he always seemed to turn it around for the better, and look towards the more positive out look. Everyone has a choice on whether or not they want to be in a good mood or not, they decide whether they want something to bother them or not. In this book, it teaches you how to take a more positive approach to everything you do which also reflects how you shouldn’t take anything forgranted. Ernesto never loses his positive approach, and keeps his head up high, which is what everyone should do. VI. Evaluation This book, along with everyother book has its ups and its downs. Barrio Boy was a very capturing story about immigration and coming to the United States. The book itself gives you the feeling that you’re hearing the stories told time and time again by your grandparents. Ernesto uses a lot of detail in this book which gives you a clear picture of what he’s talking about. As an autobiography, Ernesto Galarza did a good job. If the reader has a sense of history and knowlege of Mexican-American culture, then they’ll read with ease. The Barrio Boy book had very interesting subject matter, however the writing itself sometimes is a bore. Ernesto Galarza dwells on facts very insignificant to the purpose of the story and therefor the reader must wade through all of that to pull out the important history he’s retelling. The first 70 pages was pure talk of Ernesto’s family, and how they lived in Jalco. It included some interesting details on what they did, but it was all pretty irrelevant to the story at hand. This alone turns the reader off, and makes them want to put the book down. Another thing that turns the reader off is that you never learn about the rich history of the Mexican-American Herritage in this country. Ernesto could have also used more English terms in this book. Readers don’t like to have to flip to the back of the book, to understand what they are reading exspecially if it’s already drawn out. If you like to read about culture, especially Mexican-American culture you might find this book to be enjoyable. If you have problems reading books for anything other than pleasure you might want to pick up another book about the Mexican culture in the United States, you might want to try Rain of Gold, by Victor Villasenor.

The Case Of Daniel Handley - 1866 Words

The Case of Daniel Handley Abstract On October 7, 1994 in Beckton, London, England, while Daniel Handley was working on his bicycle, he was approached by two men in a Peugeot 405, who claimed to be lost and sought direction from Daniel on their map. Meanwhile, their fantasy was to abduct a young fair haired, pre-teen buy and sexually abuse him and kill him to hide their crime. With the map placed in the back seat of their car, as Daniel leaned in to look at it, he was pushed into the car and they drove off. At their flat, both men sexually abused him while the other videoed the activity. Then, Daniel was taken to a layby by Hungerford in Berkshire and strangled to death with a rope. His body was dumped in a shallow grave near Bristol and found in March 1995. This paper is to look at why child kidnapping and abuse happened and still happens to this day. To also look at â€Å"what kind of person would take pleasure from raping and killing a ten-year-old boy?† Keywords: child abuse; kidnapping; sexual abuse; strangulation; England THE CASE OF DANIEL HANDLEY 3 The abduction, sexual abuse, and strangulation of Daniel Handley in Beckton, London, England on October 7, 1994, caught the nation by surprise. Law enforcement personnel and all concerned citizens frantically joined hands searching for him, until his body was found on March 1995, in a shallow grave, near Bristol, England. Two men, Tim Morss, aged 31 and Brett Tyler, aged 29, who met in prison forShow MoreRelatedThe Case Of Daniel Handley 21872 Words   |  8 PagesTHE CASE OF DANIEL HANDLEY 2 The Case of Daniel Handley Abstract On October 7, 1994 in Beckton, London, England, while Daniel Handley was working on his bicycle, he was approached by two men in a Peugeot 405, who claimed to be lost and sought direction from Daniel on their map. 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Poverty in America - 1093 Words

Poverty in America Poverty, the state of being extremely poor, exists all over America! There are several different types of poverty, and the causes of poverty. Most people think of poverty as just somebody who is homeless and has no job, somebody who has no money to support the basic needs of life, and wears ragged clothing and lives under a bridge. What people don’t know is there are people living in poverty that have jobs and make money but live so poorly that they are categorized with people that live in absolute poverty. There is two main types of poverty, absolute poverty, and relative poverty. Absolute poverty is when a house hold takes in less than one U.S. dollar a day, meaning that they will not be able to buy food nor be able†¦show more content†¦Resulting in the person addicted to the drug to keep going always going back to buy more and more of the substance. Besides the fact of it messing up your life and driving you into poverty, it can also effect the people around you an d drive them into financial troubles if they decide to help you out and provide you with money. Children living in poverty are a very big issue in my opinion! Nearly 16 million children in the United States which is around 22 percent of all children are living in families with incomes below the federal poverty level, which is around 20,000 dollars a year! Families need about twice that amount of income to cover the basic expenses of living. Most of the children have parents who work, but have really low wages and their employment is very unstable leaving them struggling to make ends meet. Children that live in poverty can really affect their ability to learn, contribute to society and have emotional and behavioral problems. Children that grow up in poverty also have poor health and mental issues. Poverty is one of the single greatest threats to a child’s well-being. 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