Objective People living close to an environmental hazard site may suffer health harms from real or perceived contaminant exposures. In class-action litigation, medical monitoring is a potential remedy that has been allowed in some jurisdictions but not others. From 1952-1989 a U.S. Department of Energy (DOE) uranium metal plant near Fernald, Ohio, released ionizing radiation and uranium particulates into the surrounding community. Methods Settlement of litigation between nearby residents and the DOE resulted in an 18-year medical monitoring program (N=9775) which focused on general health promotion rather than effects of uranium. Results Participation was higher than projected; decreases in common risk factors (cholesterol and blood pressure) and deaths from cancer have been observed. Conclusions These data support the appropriateness of comprehensive medical monitoring as a remedy for people affected by defined sources of environmental contaminants.

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Objective The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. Materials and Methods We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for age-adjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72–0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72–0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02–2.10). Results No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. Conclusions Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

NSQIP) database (2005)(2006)(2007)(2008)(2009)(2010)(2011) were matched to preoperative NSQIP variables, and outcomes including mortality, stroke, and length of stay were analyzed. We further analyzed patients who were symptomatic and asymptomatic before CEA.Results: A total of 44,832 patients undergoing CEA were analyzed, of which 27,136 (60.5%) were asymptomatic and 17,696 (39.5%) were symptomatic. RAI demonstrated increasing risk of stroke and death based on risk stratification: low risk (0-10), 1.9%; high risk (>10), 5.2%. Increasing frailty RAI score correlated with increasing mortality, stroke, and length of stay (P < .01; Fig) . The majority of patients undergoing CEA scored low on the RAI (87.5% symptomatic/ 94.4% asymptomatic).Conclusions: Frailty is an independent predictor of increased mortality, stroke, and length of stay after CEA. An easily implemented RAI holds the potential to identify a limited subset of patients who are at higher risk for postoperative complications and may not benefit from CEA.