IN CASE OF EMERGENCY: LOCAL MEDICAL SERVICES AND EMERGENCY AIR TRANSPORTATION IN SOUTHEAST ALASKA

Alaska, often referred to as “The Last Frontier”, is a vast, geographically diverse and sparsely settled landscape. Although many popular reality shows tend to exaggerate and dramatize life in Alaska, they do point to an important fact: when an emergency occurs, or someone experiences serious health complications, immediate access to sufficient medical services may not be available. Much of the state’s population faces barriers to accessing needed medical care due to large distances between communities and limited road networks due to coastal locations or challenging terrain. Using Penchansky and Thomas’s five components of Access Theory (1981), this thesis explores factors that influence access to local medical services and emergency air transportation in Southeast Alaska. Interviews with local health care providers and medevac personnel, field observations, and other qualitative data sources were used to answer the following questions: 1) How does access to health care services vary between rural communities and the regional center in Southeast Alaska? and 2) What role does emergency air transport play in facilitating access to health care services in the Southeastern region? The study found that within the service hierarchy of the Southeast Alaska medical system, the availability of services, particularly certain specialists, was the biggest factor in access to health care. Also, despite the high cost, medevac services provide an increasingly vital role in the health care system

Prevalence of MRSA and Antimicrobial Resistance of Staphylococcus aureus in Maryland Ground Meat Products

Gemstone Team Antibiotic ResistanceThe aim of this study was to evaluate the risk of exposure to antimicrobial-resistant Staphylococcus aureus from food-grade raw ground meat products in Maryland. Samples of ground beef (n = 198), pork (n = 300), and turkey (n = 196), were collected by random sampling from March-August, 2008. All isolates were tested for resistance to methicillin and confirmed S. aureus isolates (n = 200) were tested for susceptibility to 21 additional antimicrobials. Overall, turkey- and pork-derived isolates were more likely to be resistant to commonly used antimicrobials. One isolate from pork was confirmed to be the USA100 strain of MRSA and was resistant to 10 antibiotics. In addition, antibiotic-resistant non-S. aureus isolates were characterized and may represent a source for the transfer of resistance genes to S. aureus. Our findings suggest that meat production practices may impact the prevalence and antimicrobial resistance of S. aureus in ground meat

The Dietary Polysaccharide Maltodextrin Promotes <i>Salmonella</i> Survival and Mucosal Colonization in Mice

<div><p>In the latter half of the 20^th century, societal and technological changes led to a shift in the composition of the American diet to include a greater proportion of processed, pre-packaged foods high in fat and carbohydrates, and low in dietary fiber (a “Western diet”). Over the same time period, there have been parallel increases in <i>Salmonella</i> gastroenteritis cases and a broad range of chronic inflammatory diseases associated with intestinal dysbiosis. Several polysaccharide food additives are linked to bacterially-driven intestinal inflammation and may contribute to the pathogenic effects of a Western diet. Therefore, we examined the effect of a ubiquitous polysaccharide food additive, maltodextrin (MDX), on clearance of the enteric pathogen <i>Salmonella</i> using both <i>in vitro</i> and <i>in vivo</i> infection models. When examined <i>in vitro</i>, murine bone marrow-derived macrophages exposed to MDX had altered vesicular trafficking, suppressed NAPDH oxidase expression, and reduced recruitment of NADPH oxidase to <i>Salmonella</i>-containing vesicles, which resulted in persistence of <i>Salmonella</i> in enlarged Rab7⁺ late endosomal vesicles. <i>In vivo</i>, mice consuming MDX-supplemented water had a breakdown of the anti-microbial mucous layer separating gut bacteria from the intestinal epithelium surface. Additionally, oral infection of these mice with <i>Salmonella</i> resulted in increased cecal bacterial loads and enrichment of lamina propria cells harboring large Rab7⁺ vesicles. These findings indicate that consumption of processed foods containing the polysaccharide MDX contributes to suppression of intestinal anti-microbial defense mechanisms and may be an environmental priming factor for the development of chronic inflammatory disease.</p></div

MDX does not block SCV maturation.

<p>(<b>A</b>) Confocal micrographs of BMDM 90 minutes post-infection stained for Lamp2 (green) and <i>Salmonella</i> (red). Nuclei stained with DAPI (blue). Scale bars: 10 µm. (<b>B</b>) Quantitation of the number of <i>Salmonella</i> co-localizing with Lamp2⁺ vesicles per BMDM 90 minutes post-infection from confocal micrographs. Data represented as mean±SEM, ns = not statistically significant.</p

MDX does not affect <i>Salmonella</i> entry or trafficking to early endosomes.

<p>(<b>A</b>) Quantitation of the number of <i>Salmonella</i> per BMDM 30 minutes post-infection in confocal micrographs. Data represented as mean±SEM (<b>B</b>) Recovery of viable intracellular <i>Salmonella</i> from BMDM 30 minutes post-infection. Data represented as mean±SD (<b>C</b>) Confocal micrographs of BMDM 15 minutes post-infection stained for <i>Salmonella</i> (red) and Rab5 (green). Nuclei stained with DAPI (blue). Scale bars: 10 µm. (<b>D</b>) Quantitation of the number of co-localized <i>Salmonella</i> with Rab5⁺ vesicles per BMDM 15 minutes post-infection in confocal micrographs. Data represented as mean±SEM, ns = not statistically significant.</p

Dietary MDX consumption increases mucosal <i>Salmonella</i> colonization.

<p>(<b>A</b>) Quantitation of <i>Salmonella</i> recovered from cecum, MLN, spleen, and liver homogenates 48 hours post-infection of mice exposed to water (control) or 5% MDX-supplemented water for 2 weeks. Data represented as values from individual mice (dots; control n = 6; MDX n = 7) and mean±SEM. **p<0.01 (<b>B</b>) Confocal micrographs visualizing <i>Salmonella</i> colonization (green) in cecal tissue of control or MDX-supplemented mice. Nuclei stained with DAPI (blue). Scale bars: 100 µm. (<b>C</b>) Mean pathology scores of hematoxylin and eosin stained cecal tissue from infected mice. Pathology scores integrate analyses of epithelial integrity (Epithelial Injury), goblet cell hyperplasia (Goblet Cells), polymorphonuclear cell infiltration (PMN), and submucosal edema (Edema). (<b>D</b>) Confocal micrographs visualizing Rab7⁺ vesicles (green) in cecal tissue of control or MDX-supplemented mice. Nuclei stained with DAPI (blue). Scale bars: 100 µm. (<b>E</b>) Quantitation of the number of cecal lamina propria cells with Rab7⁺ vesicles. Six fields per group assessed, data represented as mean±SEM. *p<0.05.</p

MDX exposure impairs <i>Salmonella</i> clearance in multiple cell types.

<p>(<b>A</b>) Recovery of intracellular <i>Salmonella</i> in gentamycin protection assays from the indicated cell types cultured in glucose or MDX supplemented media. (<b>B</b>) Confocal micrographs of infected BMDM stained for <i>Salmonella</i> (green). Nuclei stained with DAPI (blue). Scale bars: 10 µm. (<b>C</b>) Recovery of intracellular <i>Salmonella</i> in gentamycin protection assays from BMDM cultured in media reconstituted with a mixtures of MDX and glucose (i.e. 25% MDX/75% glucose for a total of 4.5 g/L). Data represented as mean±SD. *p<0.05, **p<0.01, ***p<0.001.</p