Analyses of mortality of workers at the Hanford Site were updated to include an additional three years of data (1979-81). Deaths occurring in the state of Washington in the years 1982-85 were also evaluated. Hanford workers continued to exhibit a strong healthy worker effect with death rates substantially below those of the general U.S. population. Comparisons by level of radiation exposure within the Hanford worker population provided no evidence of a positive correlation of radiation exposure and mortality from all cancers combined or of mortality from leukemia. Estimates of cancer risk due to radiation were negative, but confidence intervals were wide, indicating that the data were consistent with no risk and with risks several times larger than estimates provided by major groups concerned with risk assessment. Of 18 categories of cancer analyzed, a correlation of borderline statistical significance was identified for female genital cancers (p = 0.05), but was interpreted as probably spurious. The previously identified correlation for multiple myeloma persisted (p = 0.002).

Workers employed in 15 utilities that generate nuclear power in the United States have been followed for up to 18 years between 1979 and 1997. Their cumulative dose from whole body ionizing radiation has been determined from the dose records maintained by the facilities themselves and the REIRS and REMS systems maintained by the Nuclear Regulatory Commission and the Department of Energy, respectively. Mortality in the cohort from a number of causes has been analyzed with respect to individual radiation doses. The cohort displays a very substantial healthy worker effect, i.e. considerably lower cancer and noncancer mortality than the general population. Based on 26 and 368 deaths, respectively, positive though statistically nonsignificant associations were seen for mortality from leukemia (excluding chronic lymphocytic leukemia) and all solid cancers combined, with excess relative risks per sievert of 5.67 [95% confidence interval (CI) -2.56, 30.4] and 0.506 (95% CI -2.01, 4.64), respectively. These estimates are very similar to those from the atomic bomb survivors study, though the wide confidence intervals are also consistent with lower or higher risk estimates. A strong positive and statistically significant association between radiation dose and deaths from arteriosclerotic heart disease including coronary heart disease was also observed in the cohort, with an ERR of 8.78 (95% CI 2.10, 20.0). While associations with heart disease have been reported in some other occupational studies, the magnitude of the present association is not consistent with them and therefore needs cautious interpretation and merits further attention. At present, the relatively small number of deaths and the young age of the cohort (mean age at end of follow-up is 45 years) limit the power of the study, but further follow-up and the inclusion of the present data in an ongoing IARC combined analysis of nuclear workers from 15 countries will have greater power for testing the main hypotheses of interest.

Noncontingent reinforcement (NCR) was used as an intervention with 2 elderly dementia patients who engaged in disruptive vocalization. Several assessment procedures, including functional analysis, were conducted to identify reinforcing stimuli for use in the NCR intervention. Functional analyses and the NCR intervention were implemented in each participant's natural environment. NCR was effective in reducing disruptive vocalizations.

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Updated analyses of mortality of workers at the Hanford site provide little evidence of a positive correlation of cumulative occupational radiation dose and mortality from leukemia and from all cancer except leukemia. Estimates of the excess relative risk per 10 mSv were negative for both disease categories, but these estimates are consistent both with no risk and with estimates obtained through extrapolation from high-dose data. For all cancer except leukemia, the upper limit for a two-sided 90% confidence interval was about 1.5 times the prediction of the BEIR V model, but several times the estimate recommended by the ICRP 60 committee. For leukemia, the comparable upper limit was very close to that predicted by either BEIR V or ICRP 60. The all-cancer risk estimate, from a recent report on updated analyses of data for Oak Ridge National Laboratory workers, was strongly rejected based on the Hanford data. Of 24 specific cancer categories evaluated, only cancer of the pancreas and Hodgkin's disease showed positive correlations with radiation dose that approached statistical significance with one-tailed p values of 0.07 and 0.04, respectively; these correlations are interpreted as probably spurious. For multiple myeloma, for which a correlation was reported previously, the p value was 0.10. However, a significant correlation (p < .05) was obtained when analyses were expanded to include deaths with multiple myeloma listed on the death certificate but not considered to be the underlying cause, when analyses were expanded to include deaths occurring in Washington State during the time period 1987-1989, or when a 2-y latency period (instead of 10-y) was assumed.