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Assessment of the phototoxicity of weathered Alaska North Slope crude oil to juvenile pink salmon.

Petroleum products are known to have greater toxicity to the translucent embryos and larvae of aquatic organisms in the presence of ultraviolet radiation (UV) compared to toxicity determined in tests performed under standard laboratory lighting with minimal UV. This study assessed the acute phototoxicity of the water accommodated fractions of weathered Alaska North Slope crude oil (ANS) to juvenile pink salmon, which are a heavily pigmented life stage. Fish in the highest ANS treatments exhibited melanosis, less mobility, reduced startle response, erratic swimming, and loss of equilibrium. Gills from fish exposed to ANS had elevated levels of hydroperoxides in oil-only, UV-only, and oil+UV treatments compared to control fish, which was indicative of increased lipid peroxidation in gill tissue. Under the test conditions of moderate salinity, low UV and high short-term oil exposure there were no indications of photoenhanced toxicity as assessed by elevation of mortality, behavioral impairment, or gill lipid peroxidation in oil+UV treatments. The results of this study suggest that pink salmon may be at less risk from photoenhanced toxicity compared to the translucent early-life stages of several other Alaska species.

Alaska↗

Polychlorinated naphthalenes and coplanar polychlorinated biphenyls in tissues of harbor seals (Phoca vitulina) from the northern Gulf of Alaska.

Blubber, liver and kidney samples of harbor seals (Phoca vitulina) from the northern Gulf of Alaska were collected during 2000-2001 for the analysis of polychlorinated naphthalenes (PCNs) and coplanar polychlorinated biphenyls (CoplPCBs). On the lipid weight (lw) base, the total concentrations of PCNs (Sigma PCNs) ranged from 0.3 to 27 ng/g lw, and the total concentrations of CoplPCBs (Sigma CoplPCBs) were 3.6-546 ng/g lw in all the tissue samples. Di-ortho PCBs and mono-ortho PCBs were dominant followed by non-ortho PCBs and PCNs. Sigma Mono-ortho PCBs and Sigma di-ortho PCBs in nursing seals were apparently lower than those in male adult seals, but Sigma PCNs and Sigma non-ortho PCBs in female adults were not significantly different from those in male adults. Differences in PCNs and CoplPCBs congener profiles in female and male adult seals are apparently related to their chemical structure and properties, animal's developmental stages and physiological conditions. A large quantity of mono-ortho and di-ortho PCBs might be transferred to newborns from the nursing seals during lactation, while non-ortho PCBs and PCNs were relatively accumulative in the mother seals. Sigma PCNs and Sigma CoplPCBs in the harbor seals correlated with ages, gender, body weight and blubber thickness, but the blubber Sigma PCNs and Sigma CoplPCBs in Kodiak Island and Southern Alaska Peninsula (KIAP) did not significantly differ from those in Prince William Sound (PWS). In addition to the new PCB data, this first report on PCN contamination in Alaskan harbor seal tissues is useful for the wildlife and ecosystem management and human health protection.

Adipose Tissue↗

Organochlorines in harbor seal (Phoca vitulina) tissues from the northern Gulf of Alaska.

Polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT) and its metabolites, heptachlor and hexachlorocyclohexanes (HCHs) were analyzed in the harbor seal (Phoca vitulina) tissues collected from the Gulf of Alaska during 2000-2001. summation SigmaPCBs (16-728 ng/gl w) and summation SigmaDDTs (14-368 ng/gl w) were the predominant pollutants followed by summation operatorHCHs (0.56-93 ng/gl w) and heptachlor (<or=0.068-6.0 ng/gl w). Concentrations of the above organochlorines (OCs) in the liver, kidney and blubber tissues correlated with ages, sex, body weight and blubber thickness of the harbor seals. The OC concentrations were similar between the samples collected from two different regions--Prince William Sound, and Kodiak Island and Southern Alaska Peninsula. Mean levels of OCs in nursing female adults were much lower than those in male adults, which indicate that lactation transfer OCs from mother seals to newborns.

Adipose Tissue↗

Concentrations of persistent organochlorine contaminants in bowhead whale tissues and other biota from northern Alaska: implications for human exposure from a subsistence diet.

Bowhead whale (Balaena mysticetus; n = 5) blubber, liver, muscle, kidney, heart, diaphragm, tongue, and uncooked maktak (bowhead whale epidermis and blubber) were collected during subsistence hunts at Barrow, AK, USA (1997-1999) to measure concentrations of persistent organochlorine contaminants (OCs). The exposure of humans to OCs via bowhead whales and other biota [fish, ringed (Phoca hispida) and bearded seals (Erignathus barbatus), and beluga whale (Delphinapterus leucas)] as part of a subsistence diet was evaluated. Concentrations of OCs in bowhead whale tissues were correlated with lipid content (P < 0.001) and were less than levels in other marine mammals reported herein, reflecting the lower trophic status of this cetacean. The relative proportions of hexachlorobenzene (HCB) and sum (Sigma) concentrations of chlordane components (SigmaCHL), DDT-related compounds (SigmaDDT), and polychlorinated biphenyls (SigmaPCB) were not statistically different among the tissues analyzed (P < 0.05). However, relatively higher proportions of hexachlorocyclohexane isomers (SigmaHCH), particularly beta-HCH, were observed in bowhead whale heart and diaphragm (P < 0.03). Based on Canadian and World Health Organization daily intake guidelines, "safe" human consumption rates of bowhead whale tissue and other marine biota were calculated. The most restrictive limits (mean value) for daily consumption for bowhead and beluga whale were 302 and 78 g for maktak and maktaaq (beluga whale epidermis and blubber), respectively. The tolerable daily intake limits of dioxin-like compounds from the consumption of bowhead whale blubber and liver were calculated to be 199 g (approximately 600 g for maktak) and 2222 g, respectively. A detailed profile of traditional/country foods consumed by subsistence communities of northern Alaska is required to address chronic exposure in more detail. Overall, bowhead whale tissues and other biota from northern Alaska are safe to consume at, or below, the levels calculated.

Alaska↗

Discovery and characterization of multifunctional bioactive peptides from Alaska Pollock (Gadus chalcogrammus) milt: hybrid in silico, in vitro, and proteomic approaches.

The growing demand for multifunctional bioactive peptides has sparked interest in underutilized marine by-products as sustainable bioresources. This study explored Alaska Pollock (Gadus chalcogrammus) milt protein as a novel source of peptides with anti-inflammatory, anti-hypertensive, and anti-diabetic effects. Protein composition was analyzed via LC-MS, followed by in silico digestion and bioactivity prediction. Molecular docking identified peptides targeting DPP-IV, &#x3b1;-glucosidase, ACE, GLP-1 receptor, COX-2, MuRF1, and the 20S proteasome. Among the candidates, a promising peptide (CLPPH) was synthesized and validated in vitro, demonstrating inhibitory effects on nitric oxide production, DPP-IV, ACE, and &#x3b1;-glucosidase. These results highlight CLPPH's potential as a multifunctional bioactive peptide and support the valorization of Alaska Pollock milt as a sustainable source for functional foods and nutraceutical applications.

Animals↗

Exploring differences in caseloads of rural and urban healthcare providers in Alaska and New Mexico.

OBJECTIVES: Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers. METHOD: An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural). RESULTS: Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size. CONCLUSIONS: The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.

Adolescent↗

Spatial patterns of cadmium and lead deposition on and adjacent to National Park Service lands in the vicinity of Red Dog Mine, Alaska.

Heavy metal escapement associated with ore trucks is known to occur along the DeLong Mountain Regional Transportation System (DMTS) haul road corridor in Cape Krusenstern National Monument, northwest Alaska. Heavy metal concentrations in Hylocomium splendens moss (n = 226) were used in geostatistical models to predict the extent and pattern of atmospheric deposition of Cd and Pb on Monument lands. A stratified grid-based sample design was used with more intensive sampling near mine-related activity areas. Spatial predictions were used to produce maps of concentration patterns, and to estimate the total area in 10 moss concentration categories. Heavy metal levels in moss were highest immediately adjacent to the DMTS haul road (Cd > 24 mg/kg dw; Pb > 900 mg/kg dw). Spatial regression analyses indicated that heavy metal deposition decreased with the log of distance from the DMTS haul road and the DMTS port site. Analysis of subsurface soil suggested that observed patterns of heavy metal deposition reflected in moss were not attributable to subsurface lithology at the sample points. Further, moss Pb concentrations throughout the northern half of the study area were high relative to concentrations previously reported from other Arctic Alaska sites. Collectively, these findings indicate the presence of mine-related heavy metal deposition throughout the northern portion of Cape Krusenstern National Monument. Geospatial analyses suggest that the Pb depositional area extends 25 km north of the haul road to the Kisimilot/Iyikrok hills, and possibly beyond. More study is needed to determine whether higher moss heavy metal concentrations in the northernmost portion of the study area reflect deposition from mining-related activities, weathering from mineralized Pb/Zn outcrops in the broader region, or a combination of the two. South of the DMTS haul road, airborne deposition appears to be constrained by the Tahinichok Mountains. Heavy metal levels continue to diminish south of the mountains, reaching a minimum in the southernmost portion of the study area near the Igichuk Hills (45 km from the haul road). The influence of the mine site was not studied.

Alaska↗

Rheumatoid arthritis in American Indians and Alaska Natives: a review of the literature.

BACKGROUND AND OBJECTIVES: An increased prevalence of rheumatoid arthritis (RA) has been reported in several American Indian and Alaska Native (AI/AN) populations. This article reviews the prevalence of RA in these populations, including clinical and serologic features. METHODS: References were taken from Medline through November 2003, in addition to the Arctic Health Literature Database and the American Indian and Alaska Native Health Bibliography. RESULTS: Published articles reveal an increased prevalence of RA in the Tlingit, Yakima, Pima, and Chippewa Indians. Clinically the disease in these groups is often severe, with early age of onset, high frequency of radiographic erosions, rheumatoid nodules, and positive rheumatoid factor. Studies of HLA alleles in cases and controls have found a high frequency of HLA DRB1*1402. CONCLUSIONS: The increased prevalence of RA and more severe disease in specific AI/AN populations suggest an important genetic influence on the development of RA in AI/AN populations. A high frequency of specific high-risk HLA alleles in these populations may account for some of the increased risk, but other genetic factors are likely to contribute. Environmental factors have not been studied in detail, but may also play an important role. RELEVANCE: Understanding the patterns and burden of disease in AI/AN populations may contribute to understanding the etiology of RA and to the development of preventive strategies.

Alaska↗

Assessment of anxiety sensitivity in young American Indians and Alaska Natives.

In the present study, the Anxiety Sensitivity Index [ASI; Behav. Res. Ther. 24 (1986) 1] was administered to 282 American Indian and Alaska Native college students in a preliminary effort to: (a) evaluate the factor structure and internal consistency of the ASI in a sample of Native Americans; (b) examine whether this group would report greater levels of anxiety sensitivity and gender and age-matched college students from the majority (Caucasian) culture lesser such levels; and (c) explore whether gender differences in anxiety sensitivity dimensions varied by cultural group (Native American vs. Caucasian). Consistent with existing research, results of this investigation indicated that, among Native peoples, the ASI and its subscales had high levels of internal consistency, and a factor structure consisting of three lower-order factors (i.e. Physical, Psychological, and Social Concerns) that all loaded on a single higher-order (global Anxiety Sensitivity) factor. We also found that these Native American college students reported significantly greater overall ASI scores as well as greater levels of Psychological and Social Concerns relative to counterparts from the majority (Caucasian) culture. There were no significant differences detected for ASI physical threat concerns. In regard to gender, we found significant differences between males and females in terms of total and Physical Threat ASI scores, with females reporting greater levels, and males lesser levels, of overall anxiety sensitivity and greater fear of physical sensations; no significant differences emerged between genders for the ASI Psychological and Social Concerns dimensions. These gender differences did not vary by cultural group, indicating they were evident among Caucasian and Native Americans alike. We discuss the results of this investigation in relation to the assessment of anxiety sensitivity in American Indians and Alaska Natives, and offer directions for future research with the ASI in Native peoples.

Adolescent↗

Potential for photoenhanced toxicity of spilled oil in Prince William Sound and Gulf of Alaska waters.

Photoenhanced toxicity is the increase in the toxicity of a chemical in the presence of ultraviolet light (UV) compared to a standard laboratory test conducted with fluorescent lighting (minimal UV). Oil products, weathered oil, and specific polycyclic aromatic compounds present in oil are 2 to greater than 1000 times more toxic in the presence of UV. The photoenhanced toxicity of oil to fish and aquatic invertebrates appears to occur through a process of photosensitization, rather than photomodification of the aqueous phase oil. In photosensitization, the bioaccumulated chemical transfers light energy to other molecules causing toxicity through tissue damage rather than a narcosis mechanism. The available evidence indicates that phototoxic components of oil are specific 3-5 ring polycyclic aromatic hydrocarbons (PAHs) and heterocycles. Determinants of photoenhanced toxicity include the extent of oil bioaccumulation in aquatic organisms and the spectra and intensity of UV exposure. No studies have specifically investigated the photoenhanced toxicity of spilled oil in Alaska waters. Although there are substantial uncertainties, the results of this evaluation indicate there is potential for photoenhanced toxicity of spilled oil in Prince William Sound and the Gulf of Alaska. The potential hazard of photoenhanced toxicity may be greatest for embryo and larval stages of aquatic organisms that are relatively translucent to UV and inhabit the photic zone of the water column and intertidal areas. Photoenhanced toxicity should be considered in oil spill response because the spatial and temporal extent of injury to aquatic organisms may be underestimated if based on standard laboratory bioassays and existing toxicity databases. Additionally, the choice of counter measures and oil removal operations may influence the degree of photoenhanced toxicity.

Accidents↗

Distribution, speciation, and transport of mercury in stream-sediment, stream-water, and fish collected near abandoned mercury mines in southwestern Alaska, USA.

Concentrations of total Hg, Hg (II), and methylmercury were measured in stream-sediment, stream-water, and fish collected downstream from abandoned mercury mines in southwestern Alaska to evaluate environmental effects to surrounding ecosystems. These mines are found in a broad belt covering several tens of thousands of square kilometers, primarily in the Kuskokwim River basin. Mercury ore is dominantly cinnabar (HgS), but elemental mercury (Hg degrees) is present in ore at one mine and near retorts and in streams at several mine sites. Approximately 1400 t of mercury have been produced from the region, which is approximately 99% of all mercury produced from Alaska. These mines are not presently operating because of low prices and low demand for mercury. Stream-sediment samples collected downstream from the mines contain as much as 5500 microg/g Hg. Such high Hg concentrations are related to the abundance of cinnabar, which is highly resistant to physical and chemical weathering, and is visible in streams below mine sites. Although total Hg concentrations in the stream-sediment samples collected near mines are high, Hg speciation data indicate that concentrations of Hg (II) are generally less than 5%, and methylmercury concentrations are less than 1% of the total Hg. Stream waters below the mines are neutral to slightly alkaline (pH 6.8-8.4), which is a result of the insolubility of cinnabar and the lack of acid-generating minerals such as pyrite in the deposits. Unfiltered stream-water samples collected below the mines generally contain 500-2500 ng/l Hg; whereas, corresponding stream-water samples filtered through a 0.45-microm membrane contain less than 50 ng/l Hg. These stream-water results indicate that most of the Hg transported downstream from the mines is as finely-suspended material rather than dissolved Hg. Mercury speciation data show that concentrations of Hg (II) and methylmercury in stream-water samples are typically less than 22 ng/l, and generally less than 5% of the total Hg. Muscle samples of fish collected downstream from mines contain as much as 620 ng/g Hg (wet wt.), of which 90-100% is methylmercury. Although these Hg concentrations are several times higher than that in fish collected from regional baseline sites, the concentration of Hg in fish is below the 1000 ng/g action level for edible fish established by the US Food and Drug Administration (FDA). Salmon contain less than 100 ng/g Hg, which are among the lowest Hg contents observed for fish in the study, and well below the FDA action level.

Alaska↗

Contaminant exposure and effects in pinnipeds: implications for Steller sea lion declines in Alaska.

After nearly 3 decades of decline, the western stock of Steller sea lions (SSL; Eumetopias jubatus) was listed as an endangered species in 1997. While the cause of the decline in the 1970s and 1980s has been attributed to nutritional stress, recent declines are unexplained and may result from other factors including the presence of environmental contaminants. SSL tissues show accumulation of butyltins, mercury, PCBs, DDTs, chlordanes and hexachlorobenzene. SSL habitats and prey are contaminated with additional chemicals including mirex, endrin, dieldrin, hexachlorocyclohexanes, tetrachlorodibenzo-p-dioxin (TCDD) and related compounds, cadmium and lead. In addition, many SSL haulouts and rookeries are located near other hazards including radioactivity, solvents, ordnance and chemical weapon dumps. PCB and DDT concentrations measured in a few SSL during the 1980s were the highest recorded for any Alaskan pinniped. Some contaminant exposures in SSL appear to be elevated in the Gulf of Alaska and Bering Sea compared to southeast Alaska, but there are insufficient data to evaluate geospatial relationships with any certainty. Based on very limited blubber data, current levels of PCBs may not pose a risk to SSL based on comparison to immunotoxicity tissue benchmarks, but SSL may have been at risk from pre-1990 PCB exposures. While exposure to PCBs and DDTs may be declining, SSL are likely exposed to a multitude of other contaminants that have not been monitored. The impacts of these exposures on SSL remain unknown because causal effects have not been established. Field studies with SSL have been limited in scope and have not yet linked contaminant exposures to adverse animal health or population effects. Several biomarkers may prove useful for monitoring exposure and additional research is needed to evaluate their utility in SSL. We conclude that there are insufficient data to reject the hypothesis that contaminants play a role in the continued decline of SSL, and suggest that a coordinated monitoring program be developed which can be related to key biological, ecological and laboratory toxicity data.

Adipose Tissue↗

Southeast Alaska to Seattle emergency medical air transports: demographics, stabilization, and outcomes.

Most rural EMS aeromedical transport studies have been based on distances of less than 100 miles. No current published studies exist evaluating long-distance transports. A retrospective chart review was conducted of all patients transported from southeast Alaska to Seattle, Washington, by an intensive care air ambulance over a five-year period (1982-1986). During the study period, 442 patients were transported an average one-way distance of 703 +/- 58.9 miles. Of these, 134 had a diagnosis of major or multiple trauma and were the focus of the study. Patient demographics and medical stabilization by Alaskan physicians, the flight team, and the receiving hospital were analyzed. Injury severity and outcomes also were evaluated. Of the study group, 31% required air transport within Alaska before being seen by a physician. The flight team provided major stabilization for 11% of the trauma victims, minor stabilization for 42%, and no further stabilization for 47%. Patient flights were categorized using previously published criteria as "essential" to survival in 27% of the cases, "helpful" in 55%, and "noncontributory" in 18%. This study presents a profile of patients injured in remote areas who require stabilization by rural, often nonsurgical physicians and face long-distance transfers before reaching definitive care. Health-care systems in sparsely populated areas may use this study as a reference for comparing trauma outcomes and quality of care in long-distance air transport.

Adolescent↗

An assessment of the reported leakage of anthropogenic radionuclides from the underground nuclear test sites at Amchitka Island, Alaska, USA to the surface environment.

Three underground nuclear tests representing approximately 15-16% of the total effective energy released during the United States underground nuclear testing program from 1951 to 1992 were conducted at Amchitka Island, Alaska. In 1996, Greenpeace reported that leakage of radionuclides, 241Am and 239+240Pu, from these underground tests to the terrestrial and freshwater environments had been detected. In response to this report, a federal, state, tribal and non-governmental team conducted a terrestrial and freshwater radiological sampling program in 1997. Additional radiological sampling was conducted in 1998. An assessment of the reported leakage to the freshwater environment was evaluated by assessing 3H values in surface waters and 240Pu/239Pu ratios in various sample media. Tritium values ranged from 0.41 Bq/l +/- 0.11 two sigma to 0.74 Bq/1 +/- 0.126 two sigma at the surface water sites sampled, including the reported leakage sites. Only at the Long Shot test site, where leakage of radioactive gases to the near-surface occurred in 1965. were higher 3H levels of 5.8 Bq/1 +/- 0.19 two sigma still observed in 1997, in mud pit #3. The mean 240Pu/239Pu for all of the Amchitka samples was 0.1991 +/- 0.0149 one standard deviation, with values ranging from 0.1824 +/- 1.43% one sigma to 0.2431 +/- 6.56% one sigma. The measured 3H levels and 240Pu/239Pu ratios in freshwater moss and sediments at Amchitka provide no evidence of leakage occurring at the sites reported by Buske and Miller (1998 Nuclear-Weapons-Free America and Alaska Community Action on Toxics, Anchorage, Ak, p.38) and Miller and Buske (1996 Nuclear Flashback: The Return to Anchitka, p.35). It was noted that the marine sample; 240Pu/239Pu ratios are statistically different than the global fallout ratios presented by Krey et al. (1976) and Kelley, Bond, and Beasley (1999). The additional non-fallout component 240Pu/239Pu ratio, assuming a single unique source, necessary to modify the global fallout 240Pu/239Pu ratio to that measured in the marine samples is on the order of 0.65 (Hameedi, Efurd, Harmon, Valette-Silver, & Robertson, 1999; Kelley et al., 1999). While this potentially suggests another plutonium source, such as high burn-up nuclear reactor fuel, rather than underground nuclear tests, the uncertainties in analyses and environmental processes need to be fully assessed before any conclusion can be reached. Further work is needed to evaluate these findings and to support any radiological assessment of the marine environment surrounding Amchitka. Based on geohydrological testing and modeling, leakage from the Amchitka Underground Nuclear Tests is projected to occur to the marine environment (Claassen, 1978; Fenske, 1972; Wheatcraft, 1995).

Alaska↗

Experience of violence among teenage mothers in Alaska.

PURPOSE: To quantify the experience of violence before, during, and after pregnancy among teenage mothers compared to older mothers and to identify the proportion of births to teenagers that result from statutory rape. METHODS: We analyzed data collected during 1991-1994 from the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based, stratified sample survey of 200 of the approximately 900 Alaska resident women each month who have delivered a live infant. RESULTS: Compared to new mothers at least 20 years of age, mothers < 18 and 18-19 years of age were approximately twice as likely to report having experienced violence during pregnancy (10% vs. 4%) and were two to three times as likely to have experienced violence after pregnancy (10% and 6%, respectively, vs. 3%). When controlling for potentially confounding factors, however, age was associated with the experience of violence only for mothers < 18 years after pregnancy. The percentage of women who reported experiencing violence each week increased following pregnancy for mothers of all ages. At least 38.9% and up to 66.2% of all births to unmarried teenagers younger than 16 years of age resulted from second-degree statutory rape. CONCLUSIONS: Teenage mothers are more likely to experience violence during and after their pregnancy than older women and for women of all ages the risk increases after pregnancy. Nearly half of the births to the youngest teenagers result from second-degree statutory rape.

Adolescent↗

Survey of fox trappers in northern Alaska for rabies antibody.

The purpose of this research was to determine whether trappers in northern Alaska acquired immunity to rabies virus from non-bite exposures while trapping and skinning arctic foxes (Alopex lagopus). In coastal Alaska recurring epizootics presumably provide trappers ample opportunity for contact with rabid animals. Serum neutralization analyses of blood samples collected from 26 individuals were conducted. All but three had negative rabies neutralizing antibody levels (< 0.05 I.U./ml). Two of these had previously received rabies vaccine but one individual who had trapped for about 47 years with an estimated harvest of over 3000 foxes and who had never received pre- or post-exposure rabies vaccination had a rabies serum neutralizing antibody concentration of 2.30 I.U./ml. This represents the first report of an unvaccinated person acquiring rabies virus antibody with a titre above the 0.5 I.U./ml level considered acceptable by the World Health Organization.

Adult↗

The emergency medical services system response to a commercial airliner incident at the very remote location of Shemya, Alaska.

INTRODUCTION: A multiple patient incident involving a commercial airliner is a challenge for any community EMS system. When the community is on a remote island in the North Pacific Ocean, where there is no hospital and only a small clinic staffed by just one physician and several nurses and technicians, the challenge is much greater. The incident described herein necessitated providing emergency care at the airport, and at the same time, activating a response capability from hundreds of miles away to transport the patients to definitive care. The situation was compounded further by the fact that most of those injured spoke little or no English. This paper reviews the events that occurred and the lessons learned. OBJECTIVE: To identify the events that occurred when a commercial airliner, with more than 250 passengers and crew aboard, experienced an in-flight "upset" that resulted in many being injured. What was learned may help other areas be better prepared for such events. STUDY POPULATION: A commercial airliner incident that occurred in April, 1993 resulted in the need for emergency medical care at the remote island location of Shemya, Alaska initially, and fixed-wing transport of the injured to definitive care in Anchorage, Alaska, USA, which is about 1,300 miles (2,130 km) from Shemya. METHODS: A case review methodology was used that included interviews with key persons involved in the response to this incident to learn first-hand what occurred; by review of the National Transportation Safety Board (NTSB), reports, and by having agencies involved in the event review draft report materials to ensure accuracy. RESULTS: This study showed how a remote site with a small cadre of medically trained personnel could organize and effectively provide initial emergency care for > 200 persons, and have them transported more than a thousand miles to definitive care. CONCLUSIONS: Valuable lessons were learned from this incident that may help other areas be better prepared, particularly in remote areas, for large multiple patient events.

Accidents, Aviation↗

Overweight and obesity among Alaskan Eskimos of the Bering Straits Region: the Alaska Siberia project.

OBJECTIVE: To document the height, weight, BMI and prevalence of obesity for Eskimo residents of four villages of the Bering Straits Region of Alaska. DESIGN AND SUBJECTS: 454 Non-pregnant residents over 24 y of age, with at least one Eskimo grandparent participated in one cross sectional survey within each village. MEASUREMENTS: Height, weight, calculation of BMI (kg/m2), proportion of 'overweight' (BMI 25-29.9), and proportion of 'obese' (BMI>/=30). RESULTS: For women and men, respectively, mean heights were 153.4 and 165.2 cm; weights were 64.2 and 71.6 kg; and BMI were 27.2 and 26.2 kg/m2 after age standardization. For women, 27.9% were overweight, and 32.8% were obese compared with 36.2% and 15.6%, respectively, for men. Alaskan Eskimo participants of the Alaska Siberia Project had a significantly lower proportion of total overweight (BMI>/=25, 54.9% for women, and 32.0% for men) compared with the three sites of the Strong Heart Study, which ranged from 65.9 to 80.2% for women and 53.6 to 66.7% for men. Compared with American men of all races, the proportion of overweight and obese participants was similar for Eskimo men. The proportion of obese was significantly higher for Eskimo women compared with American women of all races, but the proportion of overweight was similar. CONCLUSION: Although the prevalence of obesity among the Alaskan Eskimos is lower than for American Indians, the high proportion of overweight observed in this study is of concern for Alaskan Eskimo adults, especially for women.

Adult↗