Analysis of environmental contamination resulting from catastrophic incidents: part 1. Building and sustaining capacity in laboratory networks.

Catastrophic incidents, such as natural disasters, terrorist attacks, and industrial accidents, can occur suddenly and have high impact. However, they often occur at such a low frequency and in unpredictable locations that planning for the management of the consequences of a catastrophe can be difficult. For those catastrophes that result in the release of contaminants, the ability to analyze environmental samples is critical and contributes to the resilience of affected communities. Analyses of environmental samples are needed to make appropriate decisions about the course of action to restore the area affected by the contamination. Environmental samples range from soil, water, and air to vegetation, building materials, and debris. In addition, processes used to decontaminate any of these matrices may also generate wastewater and other materials that require analyses to determine the best course for proper disposal. This paper summarizes activities and programs the United States Environmental Protection Agency (USEPA) has implemented to ensure capability and capacity for the analysis of contaminated environmental samples following catastrophic incidents. USEPA's focus has been on building capability for a wide variety of contaminant classes and on ensuring national laboratory capacity for potential surges in the numbers of samples that could quickly exhaust the resources of local communities. USEPA's efforts have been designed to ensure a strong and resilient laboratory infrastructure in the United States to support communities as they respond to contamination incidents of any magnitude. The efforts include not only addressing technical issues related to the best-available methods for chemical, biological, and radiological contaminants, but also include addressing the challenges of coordination and administration of an efficient and effective response. Laboratory networks designed for responding to large scale contamination incidents can be sustained by applying their resources during incidents of lesser significance, for special projects, and for routine surveillance and monitoring as part of ongoing activities of the environmental laboratory community.

Analysis of environmental contamination resulting from catastrophic incidents: part 2. Building laboratory capability by selecting and developing analytical methodologies.

Catastrophic incidents can generate a large number of samples of analytically diverse types, including forensic, clinical, environmental, food, and others. Environmental samples include water, wastewater, soil, air, urban building and infrastructure materials, and surface residue. Such samples may arise not only from contamination from the incident but also from the multitude of activities surrounding the response to the incident, including decontamination. This document summarizes a range of activities to help build laboratory capability in preparation for sample analysis following a catastrophic incident, including selection and development of fit-for-purpose analytical methods for chemical, biological, and radiological contaminants. Fit-for-purpose methods are those which have been selected to meet project specific data quality objectives. For example, methods could be fit for screening contamination in the early phases of investigation of contamination incidents because they are rapid and easily implemented, but those same methods may not be fit for the purpose of remediating the environment to acceptable levels when a more sensitive method is required. While the exact data quality objectives defining fitness-for-purpose can vary with each incident, a governing principle of the method selection and development process for environmental remediation and recovery is based on achieving high throughput while maintaining high quality analytical results. This paper illustrates the result of applying this principle, in the form of a compendium of analytical methods for contaminants of interest. The compendium is based on experience with actual incidents, where appropriate and available. This paper also discusses efforts aimed at adaptation of existing methods to increase fitness-for-purpose and development of innovative methods when necessary. The contaminants of interest are primarily those potentially released through catastrophes resulting from malicious activity. However, the same techniques discussed could also have application to catastrophes resulting from other incidents, such as natural disasters or industrial accidents. Further, the high sample throughput enabled by the techniques discussed could be employed for conventional environmental studies and compliance monitoring, potentially decreasing costs and/or increasing the quantity of data available to decision-makers.

Asymmetry correction in the irradiated breast: outcomes of reduction mammaplasty and mastopexy after breast-conserving therapy.

BACKGROUND: There is relatively scant evidence concerning radiation effects on reduction mammaplasty and mastopexy, two procedures which are often used in the irradiated breast to restore symmetry following breast-conserving therapy (BCT). OBJECTIVE: The purpose of this study is to further examine outcomes of reduction mammaplasty and mastopexy in breast cancer patients previously treated with BCT and radiation. METHODS: A retrospective search at Baystate Medical Center (Springfield, MA) identified 12 patients who had received external beam radiation and either reduction mammaplasty or mastopexy. Overall radiation doses, including tumor bed boost, ranged from 5000 to 6600 cGy. The mean time between completion of radiation therapy and asymmetry correction was 63 months (range, 5 to 169 months). An overall average of 910 g of tissue was removed from the irradiated breast (range, 180 to 2925 g). The average length follow-up after asymmetry correction was 9 months (range, 1 to 44 months). RESULTS: In our patients, there were no major complications such as flap loss, tissue necrosis, heavy scarring, infection, or severe deformity. Minor complications in the irradiated breast occurred in 25% of patients and included prolonged edema (n = 1), delayed wound closure (n = 1), and minor scarring (n = 1). Histopathology was unremarkable except for one patient who was found to have recurrent ductal carcinoma in situ. CONCLUSIONS: In the cases reviewed, we did not observe any complications commonly associated with operating in an irradiated field. Good cosmesis and acceptable symmetry were achieved in all patients. Our data suggest that reduction mammaplasty and mastopexy after radiation therapy are relatively safe procedures with risks not significantly higher than either operation performed in patients without radiation.

Comparison of environmental radiation monitoring programs in China and the United States.

The monitoring of environmental radiation has been carried out across the United States by the U.S. Environmental Protection Agency's RadNet (formerly the Environmental Radiation Ambient Monitoring System, ERAMS) and the Global Network Program (GNP) of the Environmental Measurements Laboratory (EML), and in the People's Republic of China (PRC) by their National Radioactivity Contamination Monitoring System (NRCMS). It is expected that an awareness of the similarities and differences in the structure and operation of these programs will prove helpful to both countries and perhaps others as they continue to develop their monitoring capabilities.

An opportunity: improving client services during disaster relief.

Access to current, accurate, and relevant information is mandatory for effective disaster response. In-field observations, reviews of after-action reports, and basic research indicate that this most basic of requirements is not being met. Participating disaster recovery parties, in particular environmental health agencies, lack clarity about their exact roles and lack the most basic of technological solutions that could support any given role definition. There is a need, from both cost and training perspectives, for a single, integrated solution covering risk-based routine inspections, abnormalities, and major incidents.