The Institute and Faculty of Actuaries UK Asbestos Working Party update 2020 sets out the methodology and assumptions used to estimate the potential cost of asbestos-related claims to the UK Employers’ Liability Insurance Market. The Working Party has estimated the UK EL Insurance Market cost for the following asbestos-related disease types: mesothelioma, lung cancer, asbestosis and pleural thickening, and pleural plaques. For each disease type the Working Party has constructed a range of scenarios to highlight the uncertainty of these estimates. The Working Party reminds practitioners that use the Working Party scenarios that they should always consider the experience and trends that have occurred since the scenarios were published, adjusting the scenarios to take into account new information.

Numerous occurrences of asbestos minerals, notably chrysotile and tremolite, are to be found on fracture surfaces in thrust fault deformation zones of Cretaceous dunite-harzburgite and pyroxenite in the Çankırı and Ankara regions, central Anatolia, Turkey. Consequently, potential exists for the development of regional malignant mesothelioma. The means of serpentinization, such as reaction of seawater during accretion of the upper ophiolitic mantle crust in a subduction zone and/or following uplift of ophiolitic units and the influence of hydrothermal/meteoric fluids along fractures, were investigated. Cretaceous dunite-harzburgite and localized pyroxenite rocks are mainly composed of serpentinized olivine and pyroxene associated with opaque minerals and Fe-(oxyhydr)oxide phases. Smectite, chlorite, illite, kaolinite, hydromagnesite, goethite, quartz, and opal-CT are also present. Chrysotile and localized tremolite occur either as a mesh, a suboriented to oriented long-fiber bundle, or as fiber-filling millimetric micro-vein textures on relicts of olivine and pyroxene (enstatite, augite). The chrysotile and tremolite have non-pseudomorphic textures developed under high pressure and temperature. The textures suggest authigenic formation of chrysotile and tremolite via a dissolution and precipitation mechanism. Additionally, spherical structures of opal-CT and locally platy hydromagnesite crystals either enclose or are developed within chrysotile/tremolite fiber bundles. The leaching of MgO, Fe2O3, Al2O3, Ni, Cr, and Nb, an increase in the LREE/HREE ratio, and negative Eu anomalies in the dunite-harzburgite and pyroxenite, and asbestos samples suggest that the chrysotile and tremolite were derived from the serpentinization of olivine and pyroxene. The chrysotile and tremolite were developed along fractures by hydrothermal fluid alteration during accretion and/or following the uplift of ophiolitic units of the region under high pressure and temperature conditions. This interpretation is also supported by isotope data and the calculated formation temperature of 170–555°C for chrysotile and tremolite. The average structural formulae for chrysotile and tremolite are (NanK0.03)(Mg5.54Fe0.09Al0.05Ca0.01Mn0.001) (Si3.96Al0.03)O10(OH)8 and (Na0.17K0.07)(Ca1.59Mg0.19Mn0.002)(Mg4.72Fe0.28)(Si7.86Al0.1Fe0.06)O22(OH)2, respectively.

An epidemiological and environmental study of the area around Biancavilla (CT, Italy) was prompted by a significant incidence of malignant pleural mesothelioma, which was not related to a specific occupational activity. An environmental dispersion of fibres was found and attributed to local quarry activities, whose extracted volcanic products also contained fibrous amphiboles and had been used extensively in the local building industry, especially in the period 1960–1970.

Abundant yellowish and grey-whitish asbestiform amphiboles with strongly asymmetric morphology were identified in this study, intimately associated with albitic feldspar, hematite and very minor orthopyroxene. These minerals fill the pores of the altered volcanic host rock (metasomatized benmoreitic lavas and pyroclastic rocks). The Rietveld method allowed a quantitative mineralogical analysis of the mineral mixture (24% amphiboles-asbestos, 73% feldspar and 3% hematite).

The crystal size and morphology of the grey-whitish amphibole fibres do not allow quantitative microprobe analyses; semi-quantitative EDS-SEM analyses of a prismatic mineral known to be fluoroedenite and the unknown fibrous crystals studied here suggest that they are the same mineral, although the fibres are generally depleted in Ca and Mg. The F content is the same in both occurrences. Unitcell parameters of the fibres are: a = 9.815(1), b = 17.992(3), c = 5.2733(6) Å , β = 104.547(9)º, V = 901.4(3)Å3, and the refractive indices are in the range 1.60 –1.63. Optical, chemical and Rietveld analyses of the fibres confirm their similarity with the yellow prismatic fluoro-edenite previously analysed.

Biancavilla is the first occurrence of amphibole fibres in a volcanic context (the Etnean volcanic complex). These fibres have a very anomalous composition (high ANa, IVAl and O3F contents) in comparison to other known oncogenic minerals.

Because of widespread tremolite and chrysotile minerals in Palaeozoic-Mesozoic metamorphic and Triassic ophiolitic units, respectively, in the Eskişehir region, Turkey, there is significant potential for development of cases of mesothelioma. Such occurrences in the Eskişehir region show a positive correlation with the concentration and dimension of tremolite crystals compared with those of chrysotile crystals. A detailed assessment of the mineralogy, geochemistry and genesis of these materials has not been carried out to date; the present study was undertaken to fill that gap. The sharp diagnostic basal reflections at 8.14 Å, 3.09 Å and at 7.30 Å, 3.63 Å, well defined fibrous crystallinity, and ideal differential thermal analysis-thermal gravimetric and Raman curves suggest the development of well crystallized fibrous/acicular tremolite and chrysotile with the average structural formulae of: (Na0.07K0.03)(Ca1.68Mg0.18Mn0.01)(Fe0.42Mg4.55Ti0.01)(Si7.60Al0.24Fe0.16)O22(OH)2, and (Mg5.55Fe0.41 Mn0.006)(Si3.79Al0.13)O10(OH)8, respectively.

Enrichment of light rare earth elements relative to medium rare earth elements and heavy rare earth elements in tremolite compared to that of chrysotile which exhibits no anomaly and negative anomalies for Ba, Sr, Ce, Nb, Yand Zr in the tremolite samples and chrysotile, are responses to the fractionation of feldspar, glaucophane, pyroxene and olivine under the high temperatures of hydrothermal-alteration processes during serpentinization and the high-pressure conditions of metamorphism. Based on H and O isotope data, the tremolite and chrysotile are thought to have developed from tectonically controlled magmatic and meteoric hydrothermal systems and the formation temperatures of the tremolite are higher than those of chrysotile.

Objective: This article describes how a Multidisciplinary Pain Management Group was set up in a palliative care unit, and outlines the ways that the group works with different patients. We place these comments in the context of the wider representations of pain.

Methods: Our observations of patients seen by the multidisciplinary team.

Results: We tentatively propose that where the patient's pain has certain characteristics it may require a different approach. Patients who are older, with a lengthy treatment history, may require a different input than younger patients, who may have a number of factors that further complicate their experience of pain. We use our extensive experience with mesothelioma patients to draw a further important distinction between this patient group and other patients.

Significance of research: Our observations suggest the need to allow sufficient time for intensive psychological work to be done with mesothelioma patients in order for pharmacological interventions to be effective.