Abraham Lincoln's First Inaugural Essay Example | Topics and Well Written Essays - 750 words

Abraham Lincoln's First Inaugural - Essay Example The nation was at the crossroads with the process of meeting the threat of secession and absorbing the shocks of the related challenges.Abraham Lincoln, the greatest American President, had to face the bitter critics for his style of functioning. In this connection, one important aspect related to his Presidency, is worth profound consideration. Wise people say desperate situations need desperate remedies. Lincoln was not a power hungry individual and he reached up to the office of the President by employing fair, democratic means. Those who accused Lincoln of â€Å"executive usurpation† need to bear in mind this trait of his personality. He acted and used the power of the Executive under extraordinary circumstances, when the nation was in the thick of Civil War. He took office as the President and then his executive branch consisted of a small number of staff but it had expanded substantially by the time his term was over. His critics leveled charges against and labeled him of being despotic for sidetracking a decision of the Chief Justice of the Supreme Court and for the suspension of habeas corpus. His actions were set as precedents by other Presidents at the time of war for increase of Executive authority. The discussion on the legal implications as for the power of the Executive was still at infancy when Lincoln assumed the office of the President. One of the examples quoted was, Lincoln waged war by raising armies but the Constitution directed the Congress to take action on those lines. Roy. P. Basler argues, â€Å"Now, it is insisted that Congress, and not the Executive, is vested with this power. But the Constitution itself is silent as to which or who is to exercise the power.†(601) Unity, integrity and security of the nation were of utmost importance. Actions of Lincoln needed to be judged from the angle of his conscience, and not in which legal frame they would fit into. In his address to the Congress in July 1861, he silenced his critics by stating categorically that he would do anything that he considered right in the interest of the nation in a state of rebellion. Basler substantiates this position and writes, â€Å"It was with the deepest regret that the Executive fo und the duty of employing the war power in defense of the Government forced upon him.†(609) Lincoln’s stand on the Emancipation Proclamation is liable to be interpreted both ways. That he was trying to usurp more powers for himself as the President of USA or was it the situational demand? That was a legal document written by Lincoln himself and it was drafted from defense view point. He did that as the Commander in Chief. He gradually expanded his powers as the President, like the horse that moves ahead, well-controlled by the jeans. That particular Executive decision was supported by indisputable legal stand. Under the umbrella of the legal provision Lincoln proceeded to act to abolish slavery and involuntary servitude. Even otherwise, Lincoln was a rebel against procedures, wherever they blocked national progress. Lincoln was a man of words and a man of action who delivered results to his country. Under any weak and wavering President, the unity of United States of Am erica would have been in peril and the country would have been torn into fragments. He was not inclined to over-reach for the sake of

Human Mental States Essay Example | Topics and Well Written Essays - 1250 words

Human Mental States - Essay Example At this point, I would support the position taken by Doctor 2 about the impossibility of determining whether a person has some mental states. This matter cannot be determined with absolute certainty. However, I still hold onto the view that determining mental states remains a complex issue and could only be subject to matters of observation. The patient has shown some remarkable strength of character including good memory. She also behaves in a manner that is perfectly logical and determinate. It is important to consider some of the factors that determine the existence of a soul outside the condition of an organic brain. This brings into perspective the question of the soul and body. I hold the view that the mind and body are not entirely connected. The mind is independent of the body. The soul relates to the body through some kind of a complex relationship that may not necessarily relate to the organic brain. On this note, it becomes necessary to inquire into the relationship between the immaterial soul and the body. Such an inquiry could also involve a study of the relationship between the mind and the body. A non-material soul could exist even in the absence of the non-organic brain. This is because there is no absolute evidence that links the non-material essences of existence to the material. The relationship could be more complex than the presumed correspondence between the mind and the body. On this matter, it becomes necessary to investigate the precise relationship between the mind and the body from the dimension of their points of contact.

Great Gatsby (FS Fitzgerald), Passing (N Larson), and poems of Essay

Great Gatsby (FS Fitzgerald), Passing (N Larson), and poems of Langston Hughes - Essay Example But let us look again at the mountain.'(1) Larsen's second novel (The Passing) tells the story of two light skinned women: Irene Redfield and Clare Kendry. Clare Kendry is of mixed heritage, while Irene Redfield is fully African American but both are light enough to pass. Clare fully commits herself to passing and marries John Bellew, a white man who knows nothing of her heritage and affectionately and jokingly calls her "Nig" for her "tan" complexion. Irene lives in Harlem, commits herself to racial uplift, and marries a black doctor. The novel centers on the meeting of the two childhood friends later in life, and the unfolding of events as each woman is fascinated and seduced by the other's daring lifestyle. The novel traces a tragic path as Irene finds out about the affair between Clare and her husband and Clare's race is revealed to John Bellew. The novel ends with Clare's sudden death by "falling" out of a window. As for the Great Gatsby,Nick Carraway, a young man from Minnesota, moves to New York in the summer of 1922 to learn about the bond business. He rents a house in the West Egg district of Long Island, a wealthy but unfashionable area populated by the new rich, a group who have made their fortunes too recently to have established social connections and who are prone to garish displays of wealth. Nick's next-door neighbor in West Egg is a mysterious man named Jay Gatsby, who lives in a gigantic Gothic mansion and throws extravagant parties every Saturday night. Nick is unlike the other inhabitants of West Egg-he was educated at Yale and has social connections in East Egg, a fashionable area of Long Island home to the established upper class. Nick drives out to East Egg one evening for dinner with his cousin, Daisy Buchanan, and her husband, Tom, an erstwhile classmate of Nick's at Yale. Daisy and Tom introduce Nick to Jordan Baker, a beautiful, cynical young woman with whom Nick begins a romantic relationship. Nick also learns a bit about Daisy and Tom's marriage: Jordan tells him that Tom has a lover, Myrtle Wilson, who lives in the valley of ashes, a gray industrial dumping ground between West Egg and New York City. Not long after this revelation, Nick travels to New York City with Tom and Myrtle. At a vulgar, gaudy party in the apartment that Tom keeps for the affair, Myrtle begins to taunt Tom about Daisy, and Tom responds by breaking her nose. As the summer progresses, Nick eventually garners an invitation to one of Gatsby's legendary parties. He encounters Jordan Baker at the party, and they meet Gatsby himself, a surprisingly young man who affects an English accent, has a remarkable smile, and calls everyone "old sport." Gatsby asks to speak to Jordan alone, and, through Jordan, Nick later learns more about his mysterious neighbor. Gatsby tells Jordan that he knew Daisy in Louisville in 1917 and is deeply in love with her. He spends many nights staring at the

E-government & social inclusion. Critically assess policies of digital Essay

E-government & social inclusion. Critically assess policies of digital inclusion in the UK Digital Britain Final Report (2009) and compare them with policies in Singapore - Essay Example Digital Britain Report recognizes the fact that Digital Life Skills are central to the sustainability of the UK economy in general and of the marginalized sections of the society in particular (2009). Digital Life Skills are the cardinal participative tools that will eventually determine the success of all the government policies targeted at the upliftment of the socially and digitally excluded segments of the masses. Digital Life Skills stand to be the credentials that enable the citizens to have an equitable access to public services and economic opportunities in the sphere of social inclusion, employment and education. The report establishes beyond doubt that though the proportion of the people lacking in basic ICT skills has gradually dwindled over time, still a considerable chunk of the British population stands to be digitally excluded (2009). This lacuna deprives them of having an effective access to state portals of service and aid, thereby aggravating their sidelined plight in the attribution of opportunities and benefits. Therefore, the report calls for a sincere and concerted effort towards the enablement of digitally excluded segments of the society that are either unable to or do not know how to go online (2009). The report envisages the extermination of barriers that curtail the opportunities for the weaker sections of the society. It unequivocally conveys that the opportunities for the weaker sections of the society can be augmented and increased by the democratization of the ICT skills. This will enable the people to improve the quality of their life, better their employment prospects and uplift their communities. The digital infrastructure and literacy ought to be ubiquitous and universally accessible. This calls for the envisaging of steps that assure the incorporation of the marginalized groups within the ambit of digital

Critical Disagreement Essay Example for Free

Critical Disagreement Essay Few modern writers reveal a more consistent intellectual development than Ernest Hemingway. In both his themes and the meaning he has found in them he has moved steadily and even logically from the earliest work of In Our Time to the significant orientation of The Fifth Column. The logic of this development has for the most part remained unnoticed by critics who have failed to realize that Hemingway, far from being a child of nature, is in fact an intellectual. They have presented him, consequently, as a sort of savage endowed with style, gifted but brainless. A Farewell to Arms ( 1929) takes us to the Italian front and includes a vivid account of the terrible retreat from Caporetto. An American lieutenant in the Italian Red Cross falls in love with an English nurse and she with him. Both have previously suffered more attrition than human nerves can stand, and in their passionate attachment they find a psychological refuge from the incessant horror of war. They escape to brief happiness in Switzerland, but in giving birth to a child the girl dies. The ending is far from inevitable. It is a comment on the looseness of Hemingways artistry that the moving picture version of this novel was equipped with alternative sad and happy conclusions. In A Farewell to Arms it is society as a whole that is rejected, social responsibility, social concern. Lieutenant Henry is in the War, but his attitude toward it is purely that of a spectator, refusing to be involved. He is leading a private life as an isolated individual. Even personal relations, of any depth or intimacy, he avoids; he drinks with the officers and talks with the priest and visits the officers brothel, but all contacts he keeps, deliberately, on a superficial level. He has rejected the world. Such an attitude is possible only to a sensitive and reflective person. Henry is no naive barbarian. He was studying architecture in Italy when the War began; he makes ironical remarks about sculptures and bronzes; his reflections and conversation contain allusions to Samuel Johnson, Saint Paul, Andrew Marvell, and Sir Thomas Wyatt. His flight from responsibility is the ultimate of the flight that Jake and Brett and Mike were trying to effect with drink and bullfights and sex. He is evading responsibility and emotion, taking refuge in simple primary sensations. Successfully, so far as the War is concerned: I was always embarrassed by the words sacred, glorious and sacrifice and the expression in vain . . . Abstract words, such as glory, honor, courage, or hallow were obscene beside the concrete names of villages, the number of roads, the names of rivers, the numbers of regiments and the dates. Characterization Hemingways greatness lies not in the range of his characterization or the suppleness of his style but in the astonishing perfection of these limited objectives. As Wilhelm points out, â€Å"the oppressive weight of death and anxiety in this object composition, subtly framed for the readers perusal, undercuts the scenes mask of well-beingtwo wartime colleagues bonding rather sophomorically in their desire for women. Henry imbues the elements of this expansive still life with symbolic import, foreshadowing events to come. Because objects are frequently used for characterization, Henrys possessions provide visual clues to the reader, but only as fragments in the larger narrative that withhold their essential meaning until the texts conclusion†. (Wilhelm) The very intensity of Hemingways nihilism in his first stories and novels proved, however, that his need for an ideal expression in art was the mark of a passionate romanticist who had been profoundly disappointed. The anguish of his characters was too dramatic, too flawless; it was too transparent an inversion. The symbols Hemingway employed to convey his sense of the worlds futility and horror were always more significant than the characters who personified emotions, and the characters were so often felt as personified emotions that the emotions became sentimental. The gallery of expatriates in The Sun Also Rises were always subsidiary to the theme that the period itself was lost; the lovers in A Farewell to Arms were, as Edmund Wilson has said, the abstractions of a lyric emotion. Hemingway had created a world of his own socially more brilliant than life, but he was not writing about people living in a world; he was dealing in stock values again, driving his characters between the two poles of a tremulous inner exaltation and an absolute frustration. What he liked best was to invoke the specter of damnation. But A Farewell to Arms is a tragedy, and the lovers are shown as innocent victims with no relation to the forces that torment them. They themselves are not tormented within by that dissonance between personal satisfaction and the suffering one shares with others which it has been Hemingways triumph to handle. A Farewell to Arms, as the author once said, is a Romeo and Juliet. And when Catherine and her lover emerge from the stream of actionthe account of the Caporetto retreat is Hemingways best sustained piece of narrativewhen they escape from the alien necessities of which their romance has been merely an accident, which have been writing their story for them, then we see that they are not in themselves convincing as human personalities. And we are confronted with the paradox that Hemingway, who possesses so remarkable a mimetic gift in catching the tone of social and national types and in making his people talk appropriately, has not shown any very solid sense of character, or indeed, any real interest in it. The people in his short stories are satisfactory because he has only to hit them off: the point of the story does not lie in personalities, but in the emotion to which a situation gives rise. This is true even in The Sun Also Rises, where the characters are sketched with wonderful cleverness. But in A Farewell to Arms, as soon as we are brought into real intimacy with the lovers, as soon as the author is obliged to see them through a searching personal experience, we find merely an idealized relationship, the abstractions of a lyric emotion. Against the gaiety, the warmth of A Farewell to Arms, Hemingway portrays, of course, the cumulative degeneration of the human temperament under the conditions of war. The novel is a series of human defeats within one continuous and terrible sequence: the rains, the cholera, the soldiers who mutilate themselves rather than go on fighting, the growing weariness of the Italian army which led up to Caporetto, the degeneration of Rinaldi himself who is symptomatic of the novels pattern, and at its start is so quick and alive. Contrasted against this in turn, in the love of Lieutenant Henry and Catherine Barkley we have another antithesis of increasing joy. The love and the despair are constantly related, intensely intertwined, and in the end almost gain the feeling of life and death themselves: the death preying upon the living organism of the lovers hope, eating into the flesh and destroying the form from page to page. Yet each change of form, each advance of destruction makes the life of the novel more vital, the life we know must yield, but in the manner of its yielding asserting itself beyond its destruction. A Farewell to Arms in this sense lies quite outside of the pattern of Hemingways development which we have been showing. For the feeling of tragedy in the novel comes precisely from the struggle to participate in life despite all the odds, from the efforts of the lovers to fulfill themselves in a sterile world, from the exact impact of the human will which Hemingway has negated. Yet even here we must notice that Lieutenant Henry turns his back upon our society after Caporetto. Following his personal objectives he abandons his friends, his responsibilities as an officer, the entire complex of organized social life represented by the army and the war. This farewell to arms is accomplished without request or permission. Lieutenant Henry, in fact, deserts, and his action is prophetic of his authors own future movement. You and me, says Nick to the Rinaldi of In Our Time, weve made a separate peace. And Hemingways separate peace was to embrace the woods of Michigan as well as Caporetto, the activities of normal times as well as war, and even at last the ordinary purposes of the individuals life within his society, as well as the collective purposes of society as a whole. Conclusion A Farewell to Arms is even more strictly the story of one man; here, even more than in The Sun Also Rises, the reader feels the cleft between the primary and secondary figures. Both books have the foreshortening of time which is more properly the privilege of the drama than of the traditional novel a technique toward which, since Hemingway demonstrated its immense value, American fiction has been striving with remarkable persistence. Back in the nineteenth century, when people like Henry James and Paul Bourget were taking such distinctions seriously, books like these would have been classified as novelas. I have some difficulty in feeling any wide gap between books in which Hemingway is reporting upon young men who are in character-tastes, occupations, age very much like himself, and books in which he drops the pretense of fiction in order to discuss the same materials in definite reference to himself. And why, to come directly to the main question, do we have to consider Death in the Afternoon and Green Hills of Africa such failures, anyway? One may not be particularly interested in bullfighting and still find that the considered statement, by an accomplished artist, regarding the effect on his own personality of the study of the worlds most stylized form of violence is a document of extraordinary interest, particularly if the artist is making a special effort to see himself clearly at the time. We can also agree with Edmund Wilson that as a book about animals Green Hills of Africa is dull, as we can agree with Max Eastman that as a manual of tauromachy Death in the Afternoon is silly, and still be passionately interested in Hemingways report on himself as a killer. I imagine the answer is that we were concerned by the apparent disappearance of a novelist who seemed to be losing his grip. Hemingway himself was aware of the danger and discoursed upon it for the benefit of the German traveler in the beginning of Green Hills of Africa. He also seemed to feel the danger of losing his memory for sharply characterized sensations, so essential to his kind of writing. In the books after 1930 he seems disproportionately intent on catching things before he forgets them. Works Cited Balbert, Peter. Courage at the Border-Line: Balder, Hemingway, and Lawrences the Captains Doll. Papers on Language Literature 42. 3 (2006) Bloom, Harold, ed. Ernest Hemingways a Farewell to Arms. Philadelphia: Chelsea House Publishers, 1987. Giles, Todd. Simon and Schusters Hemingway Audio Collection. The Hemingway Review 26. 1 (2006) Onderdonk, Todd. Bitched: Feminization, Identity, and the Hemingwayesque in the Sun Also Rises. Twentieth Century Literature 52. 1 (2006) Trodd, Zoe. Hemingways Camera Eye: The Problem of Language and an Interwar Politics of Form. The Hemingway Review 26. 2 (2007) Wagner-Martin, Linda, ed. Seven Decades of Criticism Seven Decades of Criticism. East Lansing, MI: Michigan State University Press, 1998. Whitlow, Roger. Cassandras Daughters: The Women in Hemingway. Westport, CT: Greenwood Press, 1984. Wilhelm, Randall S. Objects on the Table: Anxiety and Still Life in Hemingways A Farewell to Arms. The Hemingway Review 26. 1 (2006)

A Socio Ecological Model

A Socio Ecological Model A Socio- ecological model focuses on the influences on behaviour with focus on the environment and policy and reorientations of organizations such as the health system. The use of e ecological model presents a problem from other models, whereas other models can be specific, ecological model only give domains and does not give specific guidelines as to which domain to use for what specific behaviour. Where as psyco-social models propose a more generalised approach for example self efficacy and behavioural influences in dealing with issues ecological model has to be tailor made to a behaviour and a population. Hence other theories needs to be integrated into the model to aid in specify to deal with the problem at had Healthy Active Oregon 2003: Socio-Ecological ModelLooking Beyond the Individual http://www.balancedweightmanagement.com/TheSocio-EcologicalModel.htm The socio-ecological model recognises the interwoven interaction between the individual the environment in which he lives in. although the individual is responsible for maintaining a lifestyle that improves health and reduce risk, the social environment the individual lives in determines behaviour to a large extent, these can hence form a barrier which in a way can affect the community as a whole in achieving a behaviour change. Hence the social ecological approach suggests intrapersonal, interpersonal, community, organizational and public policy in dealing with a problem at hand. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs-2007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; October 2007. Social norms play a significant role in shaping beliefs and behaviors in healthy and unhealthy ways.10 For example, survey data from California indicate that adult smokers with strong attitudes about the health effects and restriction of secondhand smoke are more than twice as likely to have made a recent quit attempt and to have the intention to quit in the next six months.11 Adult smokers who demonstrated strong anti-tobacco industry beliefs were 65% more likely to have made a recent quit attempt and 85% more likely to have the intention to quit in the next six months.11 tobacco control program combines and coordinates community-based interventions that focus on 1) preventing initiation of tobacco use among youth and young adults, 2) promoting quitting among adults and youth, 3) eliminating exposure to secondhand smoke, and 4) identifying and eliminating tobacco-related disparities among population groups. Reducing tobacco use is particularly challenging Community Programs A community encompasses a diverse set of entities, including voluntary health agencies; civic, social, and recreational organizations; businesses and business associations; city and county governments; public health organizations; labor groups; health care systems and providers; health care professionals societies; schools and universities; faith communities; and organizations for racial and ethnic minority group State capacity and infrastructure, including clear leadership and dedicated resources, are essential to the development and implementation of a strong strategic plan that includes the identification and elimination of tobacco-related disparities Tobacco control programs need to foster the motivation to quit through policy changes and media campaigns and promote their quitline services. McLeroy, K. R., Bibeau, D., Steckler, A., Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Qarterly, 15(4), 351-377. McLeroy K R, Steckler Ab, Goodman RM and Burdine JN(1992) Health Education education research: theory and Practises-future direction. Health Education Research, 7:1-8. Piper S (2009) HEALTH PROMOTION FOR NURSES; theory and practice. Routledge Oxon pp28 Borland R, Chapman S, Owen N and Hill D (1990): Effects of Workplace Smoking Bans on Cigarette Consumption. American Journal of Public Health 80, 2 A survey by Borland et al examined the effect of smoking ban on the behaviour of workers in the workplace of Australias largest public service. Before the implementation of the ban publicity was done for a year, there were programs set up to help people quit smoking, control smoking addiction and pre-deadline restrictions were introduced at some worksites. 2,113 workers were surveyed for 2 weeks before the implementation of the ban and six month after the ban was introduced. The survey found out that of the 2113 participants, 492 participants who were smoking at the time of the initial survey had reduced to 471 giving a reduction of 21 smokers after the ban. 57 smokers at the initial survey had given up at follow up whereas 36 non-smokers at initial survey were reported to have started smoking. 58% of those who gave up are reported to have done so following the implementation of the smoking ban. The study also assessed the effect of the pre-implementation restrictions on the workers. Participants were grouped into those who were allowed to smoke at the work station(43%) and those who were not allowed to smoke at their work stations (57%) . the result showed a 4.5 cigarette pre day consumption difference between those who were not allowed to smoke on site and those who were allowed. After the ban it was also found that there was a 5.2 cigarettes reduction among those who had the pre-implementation restrictions and a 1.9 cigarettes reduction among those who were not restricted. Further the survey explored. The survey further explored the effect on the participants who did not have any restrictions prior to the ban. Participants were grouped into light, heavy and moderate smokers. It was found out that whiles there were no changes in consumption among the light smokers there was an average reduction of 5.8 and 7.9 cigarettes per day among moderate and heavy smokers respectively . However heavy smokers did not appear to smoke more coffee and lunch breaks though they tend to smoke more whiles working outside. There was an average compensated increase of 0.7 cigarettes outside the working environment. This study is based on the ecological model where a change in the environment causes a change in individuals behaviour. The socio-ecological model recognises the interwoven interaction between the individual and the environment in which he lives in (Healthy Active Oregon 2003). Although the individual is responsible for maintaining a lifestyle that improves health and reduce risk, the social environment the individual lives in determines behaviour to a large extent; these can hence form a barrier which in a way can affect the community as a whole in achieving a behaviour change (Healthy Active Oregon 2003). Hence the social ecological approach suggests intrapersonal, interpersonal, community, organizational and public policy in dealing with a problem at hand (McLeroy et al, 1988). Jane Wills (2007) VITAL NOTES FOR NURSES; Promoting Health. Blackwell Publishing Ltd Oxford pp 59 Legislative action is also intended to change behaviour through the state, this includes national policies and provision of supportive systems to aid people to be able to cope with the change and sustain healthy life styles. But this intervention may be met with such resistance and people may be forced to under take smoking undercover making it difficult to actually identify the individuals who are undertaking such acts Naidoo J and Wills J (2005) PUBLIC HEALTH AND HEALTH PROMOTION; developing practice. Second edition of practising Health Promotion: Dilemmas and Challenges. BAILLIERE TINDALL, LONDON WHO (1986) Ottawa Charter for Health Promotion www.who.int/hpr/archive/docs/ottawa.html (accessed on 12/02/10) Bauer J E, Hyland A, Li Q, Steger C Cummings M K (2005): A Longitudinal Assessment of the Impact of Smoke-Free Worksite Policies on Tobacco Use. American Journal of Public Health, 95(6): 1024-1029. Stokols D (1996) Translating Social Ecological Theory into Guidelines for Community Health Promotion; American Journal of Health Promotion, 10(4):282-98 Davies M Macdowall W (2006) Health Promotion Theory; UNDERSTANDING PUBLIC HEALTH. Open University Press, ENGLAND National Tobacco Strategy (1999): A SUMMARY DOCUMENT TO ACCOMPANY THE STRATEGY http://www.health.gov.au/internet/main/publishing.nsf/Content/09C1490BFFCC1872CA256F190004478B/$File/tobccstrat1.pdf. This is part of a national tobacco strategy framework, whose main objective is to improve the health of all citizens of Australia by eradicating or limiting the exposure of tobacco and all it forms. The key strategies that was set up for the frame work was to improve the control of tobacco through community action, promote cessation of the use of tobacco, limit promotion and regulate tobacco and finally, reduce environmental exposure to the smoke of tobacco. A community is said to be well-informed when it has adequate information on tobacco to be able to make an informed decision on tobacco use. In the community information such as how to get help and quit, the difference between the use of tobacco and addiction, the effect of tobacco smoke on the environment, the benefits of quitting at any age and sooner than latter and on a whole the effect of tobacco on the society. It is a well known fact that information alone does not lead to behaviour by individuals in the community. For a community to gain control over tobacco use it has to be involved in the planning and implementation of community based programes for controlling tobacco. Community leaders, parents, schools and youth organiztions can all be involved. All though the survey does not account how data was collected to assess community participation, can be assumed that since this was part of a national frame work and employees are part of a community it may be possible for the individuals to be involved in some kind of a community based activity. And the whole employees come together forms a community that can be involved in tobacco control activities and also form a network to support each other. Egger G, Spark R Donovan R (2005): HEALTH PROMOTION STRATEGIES AND METHODS. 2nd Edition McGraw-Hill Australia Pty Ltd. It was reported in the study that 36 people who were non-smokers previously at the initial survey had started smoking at follow up (Borland et al, 1990). This reinforces the notion that knowledge does not motivate an individual to change their behaviour. Individuals are bombarded with so much information in our current society, but people perceive the information based on their own psychological inclination. People can select what they want to hear and ignores others that is likely to make them change their habits. Also people have their own beliefs and ideologies about what causes disease conditiones. And almost every smoker can point out an old smoker who has not developed cancer or someone who died of lung cancer but never smoked.

Role of Silicosis in Silica-associated Lung Cancer

Role of Silicosis in Silica-associated Lung Cancer Background Crystalline silica is a mineral compound composed of silicon and oxygen atoms that are arranged in a repeating pattern. Common polymorphs of crystalline silica include quartz, cristobalite and tridymite, with quartz as the most common form. Human exposure to crystalline silica is most often from occupational tasks that involve disturbance, use or manufacture of quartz-containing materials, including stonecutting, mining, quarrying and ceramics.[i],[ii] In 1997, the International Agency for Research on Cancer (IARC) concluded there was sufficient evidence for carcinogenicity in humans with occupational exposure to respirable crystalline silica in the quartz or cristobalite form.[iii] The 1997 IARC Monograph noted the greater part of epidemiologic studies reported the presence of silicosis (referring to the chronic or also known as classic type), a fibrotic disease of the lung that is associated with high exposure to respirable crystalline silica dust, increases excess lung cancer risk among workers exposed to silica. However, it remains unclear whether lung cancer development among these workers is due to the presence of silicosis or due to exposure to significant silica levels with silicosis being a confounder rather than a prerequisite. A recent literature review of relevant epidemiological studies confirmed that there remains uncertainty about excess lung cancer risk exclusively among silicotic workers due to the shortcomings of the design of existing epidemiological studies, including the inaccurate measurement of silica exposure, inadequate characterization of the exposure-response relationship between crystalline silica and lung cancer, inadequate control for potential confounders such as known lung cancer risk factors and the presence of other carcinogenic agents in the workplace, and the absence of comparing the lung cancer risk between silicotics and non-silicotic (do not have silicosis) workers as controls. The proposed research study attempts to clari fy the role of silicosis in silica-associated lung cancer development by addressing some of the identified study design challenges. Significance Determining if silicosis is a prerequisite for lung cancer development has important public health implications for setting occupational standard for silica exposure, implementing workplace medical surveillance programs and determining causation in medico-legal cases. For example, if it is determined that lung cancer risk increases among workers exposed to silica only in the presence of silicosis, then efforts should be focused on reducing high silica exposure to a level that reduces the risk of developing silicosis. However, if it is determined that silicosis is not a prerequisite, then lung cancer development can occur at silica exposures lower than those likely to cause silicosis, which makes prevention of exposure to high silica levels not adequate for worker protection. Specific Aims To better understand the role of silicosis in the pathway leading to lung cancer from occupational exposure to silica, the specific aims of the study are: To examine the association between occupational exposure to crystalline silica and lung cancer risk in the presence and absence of silicosis and To measure the exposure-response relationship between crystalline silica and lung cancer risk with risk estimates adjusted by silicosis Procedures/Methods Study Design and Population A nested case-control study design will be utilized to analyze the association between occupational exposure to crystalline silica and lung cancer risk among silicotic and non-silicotic workers from an original cohort mortality study. The original study was conducted among workers from the Vermont granite industry.[iv] They were identified from a group insurance program enrollment between January 1st, 1947 and December 31st, 1998, Vermont Department of Health Division of Industrial Hygiene (DIH) records, pension records, data from a study of workers employed from 1979 to 1987 and data from a study of retired workers.iv The data from the multiple sources were linked to avoid duplications. As a result, the cohort consisted of 7052 Vermont granite industry workers. The mortality follow-up of the cohort identified 359 observed lung cancer deaths. iv Age at death, smoking history and silica dust exposure, medical history of obstructive lung disease and demographics will be compared betwee n the cases and controls. Workers that did not have sufficient smoking information, work histories and available chest radiographs were excluded. The exposure of interest will be the cumulative exposure to silica dust. The study population is unique in that the Vermont granite industry has a long history of silica exposure, medical surveillance and a general exclusion of occupational exposures associated with lung cancer. Case Ascertainment Lung cancer cases will be ascertained from the original Vermont granite industry cohort study. The vital status and cause of data was ascertained from the US National Death Index (NDI), US Social Security Administration vital status records and the Vermont State Records Office. The cause of death was coded to the 9th Revision of the International Classification of Diseases (ICD-9). Control Ascertainment Controls will also be ascertained from the original cohort study. The controls are defined as workers who did not die from lung cancer. Lung cancer cases will be matched to 2 controls by age. Silicosis Ascertainment The presence of silicosis among the cases and controls would be obtained from compensation and medical surveillance records. Silica Exposure Measurement Cumulative exposure to respirable crystalline silica was measured using a job exposure matrix that utilized industrial hygiene measurements. The cumulative exposures are categorized in quartiles. Sample Size Justification According to the sample size calculator (http://www.surveysystem.com/sscalc.htm), it is estimated that this study would need approximately 360 subjects are required in the study to obtain the confidence level of 95% with an interval of 5%, if we are selecting subjects from the 7052 Vermont granite industry workers cohort. We will strive to obtain 90 cases and 180 controls, based on the availability of sufficient smoking information, work histories and chest radiographs. Statistical Analysis Statistical analysis will be performed to calculate odds ratios to examine the association between lung cancer and total and each quartile of cumulative silica exposure in the presence and absence of silicosis. Odds ratios will be adjusted for smoking, obstructive lung disease and age as they are potential confounders. Odds ratios will be calculated with 95% confidence intervals. Study Strengths Strengths of the proposed study include: comparing the association of silica exposure and lung cancer in both silicotic and non-silicotic workers measuring the exposure-response relationship between silica and lung cancer risk, taking into account the presence and absence silicosis controlling for potential confounders of smoking and obstructive lung disease excluding potential confounders of other occupational exposures associated with lung cancer by studying the granite industry cohort conducting a nested case-control study is less expensive than a full cohort study since a comparably significant number of lung cancer cases have emerged Study Limitations Potential biases and study limitations are: Selection bias is a concern as silicotic workers are identified from compensation and medical surveillance records Silicotic workers may be diagnosed by different criteria, but resulting in non-differential misclassification Differential misclassification may result from categorizing the silica exposure in quartiles Silica exposure assessment may not be accurate if the job exposure matrix is methodologically sound Only studied one type of industry associated with silica exposure Non-diseased persons from whom the controls are selected may not be fully representative of the original cohort due to loss to follow-up or death References [i] International Labour Organization (ILO)/SafeWork Bookshelf (2006). ILO Encyclopaedia of Occupational Health and Safety: Volume 1, Part I. Body: Chapter 10 Silicosis. Available at http://www.ilo.org/safework_bookshelf/english?dnd=170000102nh=0. [ii] Occupational Safety and Health Administration (OSHA) (2002). OSHA Fact Sheet: Crystalline Silica Exposure Health Hazard Information [Electronic Version]. Available at http://www.osha.gov/OshDoc/data_General_Facts/crystalline-factsheet.pdf [iii] WHO/IARC (1997). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Silica, Some Silicates, Coal Dust and para-Aramid Fibrils [Electronic Version]. Volume 68; available at http://monographs.iarc.fr/ENG/Monographs/vol68/mono68.pdf. [iv] Vacek PM, Verma DK, Graham WG, Callas PW, Gibbs GW (2010). Mortality in Vermont granite workers and its association with silica exposure. Occup Environ Med, 68(5), 312-318.