10-Year-Old Female with Acute Abdominal Pain with Pancreatic Mass.

A previously healthy 10-year-old female presented to a local emergency department following three days of nausea and vomiting diagnosed with a solid pseudopapillary tumor. Solid pseudopapillary neoplasms are a rare form of pancreatic cystic neoplasm that typically presents in young females in their 20-30s and are very rare in children. These neoplasms often present as an asymptomatic tumor found on incidental imaging. When symptomatic they most commonly present with abdominal pain and can also cause a palpable abdominal mass, weight loss, gastrointestinal obstruction, and nausea and vomiting. Timely diagnosis of this rare neoplasm is very important because complete resection of the tumor is the definitive treatment and leads to an excellent long-term survival.

Complexity of bioindicator selection for ecological, human, and cultural health: Chinook salmon and red knot as case studies.

There is considerable interest in developing bioindicators of ecological health that are also useful indicators for human health. Yet, human health assessment usually encompasses physical/chemical exposures and not cultural well-being. In this paper, we propose that bioindicators can be selected for all three purposes. We use Chinook or king salmon (Oncorhynchus tshawytscha) and red knot (Calidris canutus rufa, a sandpiper) as examples of indicators that can be used to assess human, ecological, and cultural health. Even so, selecting endpoints or metrics for each indicator species is complex and is explored in this paper. We suggest that there are several endpoint types to examine for a given species, including physical environment, environmental stressors, habitat, life history, demography, population counts, and cultural/societal aspects. Usually cultural endpoints are economic indicators (e.g., number of days fished, number of hunting licenses), rather than the importance of a fishing culture. Development of cultural/societal endpoints must include the perceptions of local communities, cultural groups, and tribal nations, as well as governmental and regulatory communities (although not usually so defined, the latter have cultures as well). Endpoint selection in this category is difficult because the underlying issues need to be identified and used to develop endpoints that tribes and stakeholders themselves see as reasonable surrogates of the qualities they value. We describe several endpoints for salmon and knots that can be used for ecological, human, and cultural/societal health.

Regulatory requirements and tools for environmental assessment of hazardous wastes: understanding tribal and stakeholder concerns using Department of Energy sites.

Many US governmental and Tribal Nation agencies, as well as state and local entities, deal with hazardous wastes within regulatory frameworks that require specific environmental assessments. In this paper we use Department of Energy (DOE) sites as examples to examine the relationship between regulatory requirements and environmental assessments for hazardous waste sites and give special attention to how assessment tools differ. We consider federal laws associated with environmental protection include the National Environmental Policy Act (NEPA), the Resource Conservation and Recovery Act (RCRA), the Comprehensive Environmental Response Compensation and Liability Act (CERCLA), as well as regulations promulgated by the Nuclear Regulatory Commission, Tribal Nations and state agencies. These regulatory regimes require different types of environmental assessments and remedial investigations, dose assessments and contaminant pathways. The DOE case studies illustrate the following points: 1) there is often understandable confusion about what regulatory requirements apply to the site resources, and what environmental assessments are required by each, 2) the messages sent on site safety issued by different regulatory agencies are sometimes contradictory or confusing (e.g. Oak Ridge Reservation), 3) the regulatory frameworks being used to examine the same question can be different, leading to different conclusions (e.g. Brookhaven National Laboratory), 4) computer models used in support of groundwater models or risk assessments are not necessarily successful in convincing Native Americans and others that there is no possibility of risk from contaminants (e.g. Amchitka Island), 5) when given the opportunity to choose between relying on a screening risk assessments or waiting for a full site-specific analysis of contaminants in biota, the screening risk assessment option is rarely selected (e.g. Amchitka, Hanford Site), and finally, 6) there needs to be agreement on whether there has been adequate characterization to support the risk assessment (e.g. Hanford). The assessments need to be transparent and to accommodate different opinions about the relationship between characterizations and risk assessments. This paper illustrates how many of the problems at DOE sites, and potentially at other sites in the U.S. and elsewhere, derive from a lack of either understanding of, or consensus about, the regulatory process, including the timing and types of required characterizations and data in support of site characterizations and risk assessments.

A biomonitoring plan for assessing potential radionuclide exposure using Amchitka Island in the Aleutian chain of Alaska as a case study.

With the ending of the Cold War, the US and other nations were faced with a legacy of nuclear wastes. For some sites where hazardous nuclear wastes will remain in place, methods must be developed to protect human health and the environment. Biomonitoring is one method of assessing the status and trends of potential radionuclide exposure from nuclear waste sites, and of providing the public with early warning of any potential harmful exposure. Amchitka Island (51 degrees N lat, 179 degrees E long) was the site of three underground nuclear tests from 1965 to 1971. Following a substantive study of radionuclide levels in biota from the marine environment around Amchitka and a reference site, we developed a suite of bioindicators (with suggested isotopes) that can serve as a model for other sites contaminated with radionuclides. Although the species selection was site-specific, the methods can provide a framework for other sites. We selected bioindicators using five criteria: (1) occurrence at all three test shots (and reference site), (2) receptor groups (subsistence foods, commercial species, and food chain nodes), (3) species groups (plants, invertebrates, fish, and birds), (4) trophic levels, and (5) an accumulator of one or several radionuclides. Our major objective was to identify bioindicators that could serve for both human health and the ecosystem, and were abundant enough to collect adjacent to the three test sites and at the reference site. Site-specific information on both biota availability and isotope levels was essential in the final selection of bioindicators. Actinides bioaccumulated in algae and invertebrates, while radiocesium accumulated in higher trophic level birds and fish. Thus, unlike biomonitoring schemes developed for heavy metals or other contaminants, top-level predators are not sufficient to evaluate potential radionuclide exposure at Amchitka. The process described in this paper resulted in the selection of Fucus, Alaria fistulosa, blue mussel (Mytilus trossulus), dolly varden (Salvelinus malma), black rockfish (Sebastes melanops), Pacific cod (Gadus macrocephalus), Pacific halibut (Hippoglossus stenolepis), and glaucous-winged gull (Larus glaucescens) as bioindicators. This combination of species included mainly subsistence foods, commercial fish, and nodes on different food chains.

Radionuclides in marine fishes and birds from Amchitka and Kiska Islands in the Aleutians: establishing a baseline.

Amchitka Island (51degrees N lat, 179 degrees E long) was the site of three underground nuclear tests from 1965-1971. There have been no substantive studies of radionuclides in marine fishes and birds in the area since the mid-1970's. In this study, levels of 60Co, 52Eu, 90Sr, 99Tc, 129I, 137Cs, and the actinides (241Am, 238Pu, 239,240Pu, 234U, 235U, 236U, and 238U) were studied in ten marine fish species (including Pacific Cod Gadus macrocephalus and Pacific Halibut Hippoglossus stenolepis) and five marine bird species (including Glaucous-winged Gulls Larus glaucescens, Tufted Puffins Fratercula cirrhata, and Common Eider Ducks Somateria mollissima) from Amchitka. The same species were collected at a reference site, Kiska Island (52 degrees N lat; 177 degrees E long), about 130 km west of Amchitka. Each sample was a composite of edible muscle from five or more individual fish or birds of similar size (+/-15%) from the same sampling station. The null hypotheses of no differences among species or between Amchitka and Kiska were tested. Most analytic results were below the minimum detectable activity (MDA), even when 1,000 g sizes and 72 h counting times were used. The only radionuclides detected above the MDA were 137Cs, 241Am, 239,240Pu, 234U, 235U, and 238U. There were significant differences in 137Cs as a function of species, but not location, for top predatory fishes. Of the fishes, eight of ten species had 137Cs values above the MDA for some samples; only one bird, Glaucous-winged Gull, had 137Cs values above the MDA. The highest concentrations of 137Cs were in Dolly Varden [Salvelinus malma, 0.780 (Bq kg(-1) wet weight)] and Pacific Cod (0.602 Bq kg(-1)). In aggregate for any actinides, 73 of 234 (31%) composites for fish were above the MDA, compared to only 3 of 98 (3%) for birds. 234U and 238U, radionuclides that are primarily natural in origin, were routinely detected in these biological samples, but there were no significant differences in mean concentrations between Amchitka and Kiska. The concentrations of all radionuclides examined at Amchitka are similar to those of other uncontaminated Northern Hemisphere sites, and are lower than those reported for fishes and birds from the Irish Sea in the vicinity of the Sellafield nuclear reprocessing facility, an area with known contamination.

Integrating long-term stewardship goals into the remediation process: natural resource damages and the Department of Energy.

The United States and other developed countries are faced with restoring and managing degraded ecosystems. Evaluations of the degradation of ecological resources can be used for determining ecological risk, making remediation or restoration decisions, aiding stakeholders with future land use decisions, and assessing natural resource damages. Department of Energy (DOE) lands provide a useful case study for examining degradation of ecological resources in light of past or present land uses and natural resource damage assessment (NRDA). We suggest that past site history should be incorporated into the cleanup and restoration phase to reduce the ultimate NRDA costs, and hasten resource recovery. The lands that DOE purchased over 50 years ago ranged from relatively undisturbed to heavily impacted farmland, and the impact that occurred from DOE occupation varies from regeneration of natural ecosystems (benefits) to increased exposure to several stressors (negative effects). During the time of the DOE releases, other changes occurred on the lands, including recovery from the disturbance effects of farming, grazing, and residential occupation, and the cessation of human disturbance. Thus, the injury to natural resources that occurred as a result of chemical and radiological releases occurred on top of recovery of already degraded systems. Both spatial (size and dispersion of patch types) and temporal (past/present/future land use and ecological condition) components are critical aspects of resource evaluation, restoration, and NRDA. For many DOE sites, integrating natural resource restoration with remediation to reduce or eliminate the need for NRDA could be a win-win situation for both responsible parties and natural resource trustees by eliminating costly NRDAs by both sides, and by restoring natural resources to a level that satisfies the trustees, while being cost-effective for the responsible parties. It requires integration of remediation, restoration, and end-state planning to a greater degree than is currently done at most DOE sites.

Scientific research, stakeholders, and policy: continuing dialogue during research on radionuclides on Amchitka Island, Alaska.

It is increasingly clear that a wide range of stakeholders should be included in the problem formulation phase of research aimed at solving environmental problems; indeed the inclusion of stakeholders at this stage has been formalized as an integral part of ecological risk assessment. In this paper, we advocate the additional inclusion of stakeholders in the refinement of research methods and protocols and in the execution of the research, rather than just at the final communication and reporting phase. We use a large study of potential radionuclide levels in marine biota around Amchitka Island as a case study. Amchitka Island, in the Aleutian Island Chain of Alaska, was the site of three underground nuclear tests (1965-1971). The overall objective of the biological component of the study was to collect a range of marine biota for radionuclide analysis that could provide data for assessing current food safety and provide a baseline for developing a plan to monitor human and ecosystem health in perpetuity. Stakeholders, including regulators (State of Alaska), resource trustees (US Fish and Wildlife Service, State of Alaska), representatives of the Aleut and Pribilof Island communities, the Department of Energy (DOE), and others, were essential for plan development. While these stakeholders were included in the initial problem formulation and approved science plan, we also included them in the refinement of protocols, selection of bioindicators, selection of a reference site, choice of methods of collection, and in the execution of the study itself. Meetings with stakeholders resulted in adding (or deleting) bioindicator species and tissues, prioritizing target species, refining sampling methods, and recruiting collection personnel. Some species were added because they were important subsistence foods for the Aleuts, and others were added because they were ecological equivalents to replace species deleted because of low population numbers. Two major refinements that changed the research thrust were (1) the inclusion of Aleut hunters and fishers on the biological expedition itself to ensure that subsistence foods and methods were represented, and (2) the addition of a fisheries biologist on a NOAA research trawler to allow sampling of commercial fishes. Although the original research design called for the collection of biota by Aleut subsistence fishermen, and by a commercial fishing boat, the research was modified with continued stakeholder input to actually include Aleuts and a fisheries biologist on the expeditions to ensure their representation. The inclusion of stakeholders during the development of protocols and the research itself improved the overall quality of the investigation, while making it more relevant to the interested and affected parties. Final responsibility for the design and execution of the research and radionuclide analysis rested with the researchers, but the process of stakeholder inclusion made the research more valuable as a source of credible information and for public policy decisions.

Radionuclides in marine macroalgae from Amchitka and Kiska Islands in the Aleutians: establishing a baseline for future biomonitoring.

Levels of radionuclides in seven species of marine brown algae and Ulva were determined to establish a baseline for the Northern Pacific Ocean/Bering Sea (Aleutian Islands). There were differences in levels among algal species and locations (Amchitka Island vs Kiska Island). No values were above the minimum detectable activity (MDA) level for (137)Cs, (129)I, (60)Co, (152)Eu, (90)Sr, and (99)Tc. There were interspecific differences in some radionuclides: Ulva lactuca (=Ulva fenestrata) had the highest levels of (241)Am, Alaria fistulosa had the highest levels of (239,240)Pu, and Fucus distichus (=Fucus gardneri) had the highest levels of (234)U, (235)U, and (238)U. However, levels of all radionuclides were generally low and near the MDA for all isotopes. Although Amchitka Island had higher levels of (239,240)Pu than Kiska, the differences were very small and not significant biologically. The data indicate that algae can be useful bioindicators of actinides because they accumulate them at very low environmental levels, allowing them to provide early warning of any potential seepage of radionuclides into the marine environment. Further, the data indicate that some species (the intertidal Fucus) are better accumulators than others, and these should be used as bioindicators in future monitoring schemes.

Developing a health and safety plan for hazardous field work in remote areas.

Developing health and safety plans (HASPs) is a common feature of occupational safety and health for many workplaces. Formal HASPs are a requirement for hazardous waste work, requiring the anticipation and identification of hazards and embodying the training, equipping, and evaluation of workers. Aside from OSHA, there are relatively few manuals or examples and virtually no papers that provide practical guidance in what a HASP should cover or how to create and implement one. Moreover, existing guidance refers to spatially circumscribed worksites. This article details development of a HASP to cover field researchers and ship personnel conducting scientific research in a remote area of the world (Amchitka Island in the western Aleutians), hundreds of kilometers from the nearest emergency room. It required characterizing the kinds of work to be performed and anticipating the hazards that could be encountered. It illustrates the meshing of a general HASP with a ship safety plan, a dive safety plan, and specialized topics, including stop-work authority, rock climbing, firearms, vehicle safety, and communication strategy. Remote area operations are a growing challenge facing the profession. An expedition of this sort requires extensive planning and experienced safety personnel and cannot rely on luck to ensure the safe return of participants.

Conceptual site models as a tool in evaluating ecological health: the case of the Department of Energy's Amchitka Island nuclear test site.

Managers of contaminated sites are faced with options ranging from monitoring natural attenuation to complete removal of contaminants to meet residential health standards. Conceptual site models (CSMs) are one tool used by the U.S. Department of Energy (DOE) and other environmental managers to understand, track, help with decisions, and communicate with the public about the risk from contamination. CSMs are simplified graphical representations of the sources, releases, transport and exposure pathways, and receptors, along with possible barriers to interdict pathways and reduce exposure. In this article, three CSMs are created using Amchitka Island, where the remaining contamination is from underground nuclear test shot cavities containing large quantities of numerous radionuclides in various physical and chemical forms: (1) a typical underground nuclear test shot CSM (modeled after other sites), (2) an expanded CSM with more complex receptors, and (3) a regional CSM that takes into account contaminant pathways from sources other than Amchitka. The objective was to expand the CSM used by DOE to be more responsive to different types of receptors. Amchitka Island differs from other DOE test shot sites because it is surrounded by a marine environment that is highly productive and has a high biodiversity, and the source of contamination is underground, not on the surface. The surrounding waters of the Bering Sea and North Pacific Ocean are heavily exploited by commercial fisheries and provide the United States and other countries with a significant proportion of its seafood. It is proposed that the CSMs on Amchitka Island should focus more on the pathways of exposure and critical receptors, rather than sources and blocks. Further, CSMs should be incorporated within a larger regional model because of the potentially rapid transport within ocean ecosystems. The large number of migratory or highly mobile species that pass by Amchitka provide the potential for a direct pathway to the local human population, known as Aleut, and commercial fisheries, which are remote from the island itself. The exposure matrix for receptors requires expansion for the Amchitka Island ecosystem because of the valuable marine and seafood resources in the region. CSMs with an expanded exposure/receptor matrix can be used effectively to clarify the conceptualization of the problem for scientists, regulators, and the general public.

Science, policy, and stakeholders: developing a consensus science plan for Amchitka Island, Aleutians, Alaska.

With the ending of the Cold War, the US Department of Energy is responsible for the remediation of radioactive waste and disposal of land no longer needed for nuclear material production or related national security missions. The task of characterizing the hazards and risks from radionuclides is necessary for assuring the protection of health of humans and the environment. This is a particularly daunting task for those sites that had underground testing of nuclear weapons, where the radioactive contamination is currently inaccessible. Herein we report on the development of a Science Plan to characterize the physical and biological marine environment around Amchitka Island in the Aleutian chain of Alaska, where three underground nuclear tests were conducted (1965-1971). Information on the ecology, geology, and current radionuclide levels in biota, water, and sediment is necessary for evaluating possible current contamination and to serve as a baseline for developing a plan to ensure human and ecosystem health in perpetuity. Other information required includes identifying the location of the salt water/fresh water interface where migration to the ocean might occur in the future and determining groundwater recharge balances, as well as assessing other physical/geological features of Amchitka near the test sites. The Science Plan is needed to address the confusing and conflicting information available to the public about radionuclide risks from underground nuclear blasts in the late 1960s and early 1970s, as well as the potential for volcanic or seismic activity to disrupt shot cavities or accelerate migration of radionuclides into the sea. Developing a Science Plan involved agreement among regulators and other stakeholders, assignment of the task to the Consortium for Risk Evaluation with Stakeholder Participation, and development of a consensus Science Plan that dealt with contentious scientific issues. Involvement of the regulators (State of Alaska), resource trustees (U S Fish and Wildlife Service), representatives of the Aleut and Pribilof Island communities, and other stakeholders was essential for plan development and approval, although this created tensions because of the different objectives of each group. The complicated process of developing a Science Plan involved iterations and interactions with multiple agencies and organizations, scientists in several disciplines, regulators, and the participation of Aleut people in their home communities, as well as the general public. The importance of including all parties in all phases of the development of the Science Plan was critical to its acceptance by a broad range of regulators, agencies, resource trustees, Aleutian/Pribilof communities, and other stakeholders.

Using integrated geospatial mapping and conceptual site models to guide risk-based environmental clean-up decisions.

Government and private sector organizations are increasingly turning to the use of maps and other visual models to provide a depiction of environmental hazards and the potential risks they represent to humans and ecosystems. Frequently, the graphic presentation is tailored to address a specific contaminant, its location and possible exposure pathways, and potential receptors. Its format is usually driven by the data available, choice of graphics technology, and the audience being served. A format that is effective for displaying one contaminant at one scale at one site, however, may be ineffective in accurately portraying the circumstances surrounding a different contaminant at the same site, or the same contaminant at a different site, because of limitations in available data or the graphics technology being used. This is the daunting challenge facing the U.S. Department of Energy (DOE), which is responsible for the nation's legacy wastes from nuclear weapons research, testing, and production at over 100 sites in the United States. In this article, we discuss the development and use of integrated geospatial mapping and conceptual site models to identify hazards and evaluate alternative long-term environmental clean-up strategies at DOE sites located across the United States. While the DOE probably has the greatest need for such information, the Department of Defense and other public and private responsible parties for many large and controversial National Priority List or Superfund sites would benefit from a similar approach.

The role of risk and future land use in cleanup decisions at the Department Of Energy.

As a result of the legacy of the Cold War, the Departments of Energy and Defense are involved in massive cleanup and remediation projects. While health risk to humans and ecological receptors is perceived to be the basis for remediation, this assumption is rarely examined. In this article, we examine the role of risk and future land-use designations in cleanup decisions, using the Department of Energy's self-assessment of 36 sites. We then discuss the risk-related tools that might be required to address the cleanup challenge. Much of the current cleanup program is driven by compliance with federal and state statutes and regulations, presumably to protect human health and the environment. Compliance, however, is not synonymous with cleanup. Although some of these laws and regulations take risk into account, the lack of site-specific data on exposures and risk scenarios, and the lack of attention to future land use or end states, has often resulted in disconnects between risk and cleanup goals, risk and final end states, and cleanup levels and end state or subsequent land use. Partly, these disconnects result from the need for a range of technical, economic, sociological, and public policy tools to address the issues. A better transfer of information among and within Department of Energy facilities, operations offices, and DOE headquarters is required. Further, linking cleanup decisions and goals with the final end state involves a number of risk tradeoffs, including (1) ecological versus human health, (2) worker versus public health, (3) among competing contaminated areas, (4) among temporal patterns of cleanup, (5) among different ecological receptors (plants vs. animals, one animal vs. another), and (6) among the sites across the DOE complex. For the nation, balancing among risks is essential within sites and among Department of Energy sites, as well as among other remediation sites (such as those of Department of Defense and Superfund sites).

Shifting priorities at the Department of Energy's bomb factories: protecting human and ecological health.

More than 50 years of research, development, manufacture, and testing of nuclear weapons at Department of Energy (DOE) sites has left a legacy of on-site contamination that often spreads to surrounding areas. Despite substantial cleanup budgets in the last decade, the DOE's top-to-bottom review team concluded that relatively little actual cleanup has been accomplished, although milestones have been met and work packages completed. Rather than solely use regulatory constraints to direct cleanup, many people have suggested that human and ecological health should guide long-term stewardship goals of DOE-managed sites. The main questions are how ecological and human health considerations should be applied in deciding the extent of cleanup that contaminated sites should receive and how near-term and longer run considerations of costs and benefits should be balanced as cleanup decisions are made. One effort to protect ecological integrity is the designation of the largest sites as National Environmental Research Parks (NERPs). Recently, the Competitive Enterprise Institute (CEI) suggested isolating and conserving DOE sites as a policy priority because of their rich ecological diversity. A more effective long-term stewardship approach for former nuclear weapons complex sites may emerge if the guiding principles are to (1) reduce risks to human and ecological health, (2) protect cultural traditions, and (3) lower short- and long-term cleanup and remediation costs. A "net benefits" perspective that takes both near- and longer-term costs and consequences into account can help illuminate the trade-offs between expensive cleanup in the near term and the need to assure long-term protection of human health, cultural values, and high levels of biodiversity and ecological integrity that currently exist at many DOE sites.