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.

Importance of Technology

My transcripts †¢ Transcript 1= luv u 4 ever 🙂 †¢ Transcript 2= u r 2 sweet 2 b 4got10 can u cum c me face2face †¢ Transcript 3= I h8 u!!! †¢ Transcript 4= Jake ur bag is pukka †¢ Transcript 5=iv been chatin with my penpal all day †¢ Transcript 6= how ya doin! †¢ Transcript 7=Jake-â€Å"r ur headphones good† Demal-â€Å"yh their awesome FYI they where only $5. 99 Ali Nasir10BMR. Wotson Introduction †¢ One of the forms of multimodal talk is texting †¢ Texting has captivated a whole generation of young people †¢ Texting has become universal, it is practiced all over the world †¢ Texting is done from mobile to mobile, by sending the text to the mobile number. It can also be sent to many at the same time †¢ Texting is thought to be mostly used by the young people and teenagers †¢ The older generations feel that texting has taken the ability of writing and correct spelling to zero, they deplore what texting has done to the English language †¢ Texting is also done as a means of advertising †¢ Large companies text to anyone they can †¢ Doctor surgeries and even schools like the one I study at also use texting to inform patients and parents relative information. †¢ The language of texting has advanced so much since it had started †¢ There are so many ways to text to each otherParagraph 1 †¢ People have found innovative ways of texting with using rebus abbreviation, this is where a name or a word is represented by a picture or pictures suggesting its syllables †¢ They are like puzzles †¢ Punctuation marks and brackets are used to show emotions. We can see this in transcript 1. 🙂 seen upright they mean nothing but look at them sideways and it is a smiling face †¢ Other symbols and numbers are used like &, @, 4, 8. Paragraph 2 †¢ The use of abbreviated and shortened forms of words saves time in texting and also shortens texts to keep mobile bills at a minimum, as seen in transcript 2. People are so fast at texting in abbreviations that the mind boggles at the speed of their thumbs †¢ There is efficiency in the way letters are used, and texters shorten words to a minimum. Paragraph 3 †¢ Inotation is defined as the tone or pitch of the voice in speaking or the way a person is speaking like conveying anger, liveliness, being shy. †¢ Inotation cannot really be well conveyed in texting. †¢ The messages loose the true meaning of the sender like shown in transcript 3. †¢ Sometimes miscommunication happens and feelings are hurt. †¢ It is hard to explain what you are really feeling through texting. When we communicate body language and tone of voice play an important role. †¢ When we try intonating in a text the other person may read something different in the explanation marks you have sent. †¢ Sometimes Imitation in the text can read a double meaning. Paragraph 4 †¢ The use of non standard words in the texting world has become so popular that almost everyone who texts knows the meanings of the abbreviated words. †¢ Also dialect of different places is making its way into texting. †¢ Like we see words such as lush or mint being used in other regions of England. For example in Manchester â€Å"mint† means really good and â€Å"mardy† means moody, in whales â€Å"lush† means very nice and in London â€Å"pukka† means very good. †¢ We see their uses in transcript 4. †¢ The use of slang in texting has also found a place in texting. †¢ To a person who dose not text, the language use must seem foreign. Paragraph 5 †¢ In non standard words a new form of communication has emerged. †¢ For example a text pal is a person that you never talk to or see, but you ju7st text to like a pen pal. Another example is saying things like â€Å"text of the devil† a version of speak of the devil. The way we w ould use these new words can be seen in transcript 5. †¢ A whole new dictionary would have to written just to accommodate all the new words that have sprung up in this new texting age. Paragraph 6 †¢ The use of incomplete sentences or the use of phrases instead of using the proper grammatical sentences is common in texting, †¢ When you use incomplete sentences you fail to express the total meaning. †¢ Shortening of sentence or use of phrases is fine while texting because of maybe, the lack of time or space texting like in transcript 6. †¢ Phrases also are a part of this new language and most teenagers will know hundreds of them. It is like a second language for them. †¢ These are a few popular phrases in texting; BFF (best friends forever), FYI (for your information), IDC (I don’t care), JC (just chilling), GAL (get a life). †¢ We can see how to use a phrase in transcript 7. Paragraph 7 †¢ I think one of the similarities between texting and speech is that we text the way we speak. †¢ We text the words the way they sound, not like the way they are spelt in the dictionary. †¢ We text phonetically. †¢ Spelling goes out of the window. †¢ The content of the text that is written is a different matter. We see that many words are taken out of the sentences to make them shorter and if we read these shortened text messages out loud we would sound like cavemen in cartoons or like Tarzan saying,† me Tarzan, you Jane. †¢ Even I say to my mum SOZ (sorry), LOL (laugh out loud) and CBA (can’t be asked). †¢ My mum is always shouting at me to speak proper English Paragraph 8 †¢ When it comes to actual writing students are using text language instead of proper English in their studies †¢ This is creating problems in our schools, colleges and the workplace †¢ Texting is a distraction and stops you from paying attention to what is happening around you. Students are found textin g in classes instead of paying attention of what is happening in the classroom. †¢ Texting has its negatives but it also has its positives. †¢ It keeps people connected to each other. †¢ Testers are always updating each other of what is going on there and then. †¢ Sometimes it is better to quietly text than to talk in a public place and disturb others. †¢ For every new technology there will always be positives and negatives. †¢ I think there is always a middle way in which we can use texting and not go to the extreme.

Writing an Impressive Nursing Entrance Essay Samples Features

Writing an Impressive Nursing Entrance Essay Samples Features Templates like Descriptive Essay about Office can be helpful for an individual who's planning to pay a visit to an office. It follows the typical introductionbodyconclusion format of the majority of literature. Descriptive Narrative Essay Example may be used mainly to recreate a function. Instance of a brief descriptive paragraph. The Honest to Goodness Truth on Writing an Impressive Nursing Entrance Essay Samples You are able to receive all of such ideas from these types of samples. Another excellent place to look for useful sample papers is on a number of the career sites. This sample demonstrates how just the job is completed. The samples can be retrieved via the download hyperlink button beneath each sample. The bulk of the essay employs standard English and English grammar. While writing from the heart is definitely simpler to do, you can't forget to continue to keep your grammar proper. You could also l ack enough knowledge on the subject, or you aren't good in the usage of English language for writing essays. You have to remember an essay example ought to have a significant tone to it, or in different words, it shouldn't be humorous. Possessing a very clear and structured plan is the foundation for any great bit of writing, and a college essay is not any different. Many trustworthy writing services are eager to provide essay help. There are a lot of reputable career websites that you're guaranteed to get a few really wonderful sample essays. Take a peek at our completely free college essay tips! Using Writing an Impressive Nursing Entrance Essay Samples The college application essay is a crucial part of the admissions process. Writing skills aren't god-given talents. Applying in a particular college can be rough for a student however. Writing forms an essential part of our learning and continued development. 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Allow it to sit for a couple days untouched. New Questions Abo ut Writing an Impressive Nursing Entrance Essay Samples Any achievement that's in the nursing field ought to be highlighted with care so it does not come off with brass. Last, the detail of true speech makes the scene pop. The coat hanger comes out of a dumpster. Consult your parents to spell out the rear row to you. How to Choose Writing an Impressive Nursing Entrance Essay Samples All they require is a sort gesture and reassurance, and they'll be useful. The listed are traits that each and every nurse has to be in a place to take decent care of patients. Education has become the most significant factor in the life span of any person. Nurses play a crucial part in the health care examination of patients. The Dirty Facts About Writing an Impressive Nursing Entrance Essay Samples While writing an essay for an english class may appear overwhelming it does not need to be. 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Love for Friends and Love for Lovers Compared in...

In his A Midsummer Night’s Dream, Shakespeare contrasts the love existing in the relationships of friends and of lovers. Love here does not refer to romantic emotion exclusively; â€Å"love† means connection and empathy with another being. The female relationships in the poem, between Hermia and Helena, and Titania and her fairies, exist with a love based on connections between the females. However, the lovers’ relationships arise from a love produced by desire for another’s differences. The females produce a strong bond with each other that exists to provide the other person with a better version of themselves and protection from destruction. Love can only exist in this relationship because it exists away from outside forces, such as sight.†¦show more content†¦So we grew together/ Like to a double cherry tree, seeming parted/ But yet an union in partition/ Two lovely berries molded on one stem/ So with two seeming bodies but one heart.†(97 ) The love between these women molds them into â€Å"one heart.† Unlike male-female love, this female-female love develops a connection between the two that originates from association rather than longing. Besides a connection between the women, the relationship develops independent of outside forces. In the woods, the help of the fairies resolved the lover’s dispute. However, the female’s argument was never involved in the magic, which symbolizes these â€Å"outside forces†. The lover’s relationship was only able to exist in the woods with the help of magic, but the females’ friendship exists both in a dream and in consciousness. The female friendship is based solely on connection with another being, and exists independent of the senses and society. In the poem Shakespeare portrays both interactions of love through rhyming, between both the lovers and the female friendships. In conversation between Hermia and Lysander, one can see that this rhythmic patter still exists: â€Å"Hermia: Be it so Lysander. Find you out a bed/ For I upon this bank will rest my head. / Lysander: One turf will sere as a pillow for us both/ One heart, one bed, two bosoms, and one troth. / Hermia: Nay, good Lysander.Show MoreRelatedWilliam Shakespeare s A Midsummer Night s Dream830 Words   |  4 PagesWilliam Shakespeare’s A Midsummer Night’s Dream weaves stories of social ranks in the commedia dell’arte and some of its easily recognized stock characters. Shakespeare uses commedia dell’arte characters in A Midsummer Night’s Dream to capture our imagination and amuse us. 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