Case-fatality study of workers and residents with radiographic asbestos disease in Libby, Montana.

BACKGROUND: Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%), with smaller quantities of richterite (11%) and tremolite (6%), which are together referred to as Libby amphibole (LA). METHODS: A total of 1883 individuals who were occupationally and/or environmentally exposed to LA and were diagnosed with asbestos-related pleuropulmonary disease (ARPPD) following participation in communitywide screening programs supported by the Agency for Toxic Substances and Disease Registry (ATSDR) and followed up at the Center for Asbestos Related Disease (CARD) between 2000 and 2010. There were 203 deaths of patients with sufficient records and radiographs. Best clinical and radiologic evidence was used to determine the cause of death, which was compared with death certificates. RESULTS: Asbestos-related mortality was 55% (n = 112) in this series of 203 patients. Of the 203 deaths, 34 (17%) were from asbestos-related malignancy, 75 (37%) were from parenchymal asbestosis, often with pleural fibrosis, and 3 (1.5%) were from respiratory failure secondary to pleural thickening. CONCLUSIONS: Asbestos is the leading cause of mortality following both occupational and nonoccupational exposure to LA in those with asbestos-related disease.

Workers with Libby amphibole exposure: retrospective identification and progression of radiographic changes.

PURPOSE: To assess how early pleural and/or parenchymal abnormalities consistent with asbestos exposure could be ascertained and to identify factors associated with progression. MATERIALS AND METHODS: Informed consent was obtained under an institutional review board-approved protocol. Multiple sequential chest radiographs obtained between 1955 and 2004 in 84 workers exposed to amphiboles associated with vermiculite in the town of Libby, Montana, were studied. A panel of three NIOSH B readers reviewed each worker's longitudinal chest radiograph series in reverse chronologic order and achieved a consensus reading for each radiograph. Measures of exposure were compared between workers with and those without progression of parenchymal and pleural abnormalities. RESULTS: Because of the way the study was designed, all subjects had pleural (n = 84) and/or parenchymal (n = 26) abnormalities on the most recent chest radiograph. Compared with other investigations that used different methods, this investigation revealed shorter latency periods (defined as the interval between date of hire and date of earliest radiographic detection) for circumscribed pleural plaque (median latency, 8.6 years) and pleural calcification (median latency, 17.5 years). Pleural abnormalities progressed in 64 workers, while parenchymal abnormalities progressed in 14. No significant differences were found with regard to measures of exposure between workers with and those without progression. CONCLUSION: The latency period for the development of pleural plaques may be shorter than previously reported. Early plaques are subtle and may not be detectable except at retrospective review.

Long-term motor programming improvements occur via concatenation of movement sequences during random but not during blocked practice.

According to S. T. Klapp (1995, 1996), extensive practice serves to induce the concatenation of multiple-element responses. One benefit of the chunking process, argued Klapp, is more efficient execution of motor programming. The authors conducted the present study with 30 participants to investigate that proposition. The chunking process was found to be very transient following some practice regimes. Specifically, compared with exposure to random practice, extensive blocked practice resulted in only temporary movement sequence consolidation. The present results provide support for the claim that random practice not only leads to improvements in the completion of intratrial movement planning processes but also affects the structure of the memory developed during practice. Both components are important contributors to long-term improvements in movement preparation associated with a high contextual-interference practice condition.

Programming and reprogramming sequence timing following high and low contextual interference practice.

Individuals practiced two unique discrete sequence production tasks that differed in their relative time profile in either a blocked or random practice schedule. Each participant was subsequently administered a "precuing" protocol to examine the cost of initially compiling or modifying the plan for an upcoming movement's relative timing. The findings indicated that, in general, random practice facilitated the programming of the required movement timing, and this was accomplished while exhibiting greater accuracy in movement production. Participants exposed to random practice exhibited the greatest motor programming benefit, when a modification to an already prepared movement timing profile was required. When movement timing was only partially constructed prior to the imperative signal, the individuals who were trained in blocked and random practice formats accrued a similar cost to complete the programming process. These data provide additional support for the recent claim of Immink & Wright (2001) that at least some of the benefit from experience in a random as opposed to blocked training context can be localized to superior development and implementation of the motor programming process before executing the movement.

Learning to detect error in movement timing using physical and observational practice.

Three experiments assessed the possibility that a physical practice participant's ability to render appropriate movement timing estimates may be hindered compared to those who merely observed. Results from these experiments revealed that observers and physical practice participants executed and estimated the overall durations of movement sequences similarly and more accurately than those who were not privy to any previous practice. This was true for a case in which (a) the execution demands for the physical practice participant were relatively high when multiple movement sequences were practiced with a consistent relative time structure but different overall durations (Experiment 1) and (b) the execution demands were relatively modest when only a single sequential motor task was learned (Experiment 2). Moreover, this general set of findings remained true for individuals who had previous experience with physical or observational practice, even when timing estimations were made during tests with no execution demands (Experiment 3). Thus, executing a movement sequence does not appear to interfere with the development of a learner's subjective evaluation of overall timing performance. Specifically, these data provided evidence that recognizing error in movement timing can be accomplished via observation, and, more generally, they add to the growing evidence supporting the claim that observational practice is a legitimate method facilitating the acquisition of sequential movement behaviors.