Background gamma radiation and soil activity measurements in the northern Marshall Islands

"I've Never Been to a Doctor": Health Care Access for the Marshallese in Washington State

The Ri Majel (Marshallese) migrants of Washington State have endured health inequities and unique laws dictating their access to health care once they arrive to the United States. These health inequities can be seen to be a result of historical trauma and militarization of their islands. The research question was an inquiry regarding access to health care for the Ri Majel in Washington State. We first provide detailed historical data in the background to contextualize our research inquiry. We interviewed 12 people and using manifest content analysis found 2 main themes regarding the health of the Ri Majel: (1) health care access and inequity and (2) historical trauma and embodiment. Health care access was impeded by (1) ongoing effects of radiation, (2) repeated denial of services, (3) lack of health care and insurance, (4) lack of language interpretation during health care visits, and (5) poverty. Historical trauma and embodiment were evidenced by these findings: (1) illness and early mortality; (2) provider lack of knowledge and understanding of the Ri Majel; (3) structural discrimination; (4) feelings of sadness and despair; (5) shyness and humility; and (6) a sense of "cannot/will not" and fatalism. Our findings demonstrate the need to examine structural factors when assessing health inequities and a need to understand and mitigate the effects of historical trauma enacted by structural racism, violence, and colonialism. Strategies to mitigate the embodiment of historical trauma require further investigation.

Advances in the management of radioactive wastes and radionuclide contamination in environmental compartments: a review

Several anthropogenic activities produce radioactive materials into the environment. According to reports, exposure to high concentrations of radioactive elements such as potassium (⁴⁰K), uranium (²³⁸U and ²³⁵U), and thorium (²³²Th) poses serious health concerns. The scarcity of reviews addressing the occurrence/sources, distribution, and remedial solutions of radioactive contamination in the ecosystems has fueled data collection for this bibliometric survey. In rivers and potable water, reports show that several parts of Europe and Asia have recorded radionuclide concentrations much higher than the permissible level of 1 Bq/L. According to various investigations, activity concentrations of gamma-emitting radioactive elements discovered in soils are higher than the global average crustal values, especially around mining activities. Adsorption technique is the most prevalent remedial method for decontaminating radiochemically polluted sites. However, there is a need to investigate integrated approaches/combination techniques. Although complete radionuclide decontamination utilizing the various technologies is feasible, future research should focus on cost-effectiveness, waste minimization, sustainability, and rapid radionuclide decontamination. Radioactive materials can be harnessed as fuel for nuclear power generation to meet worldwide energy demand. However, proper infrastructure must be put in place to prevent catastrophic disasters.

Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region

It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia.

Trophic and spatial patterns of contaminants in fishes from the Republic of the Marshall Islands in the equatorial Pacific

The Republic of the Marshall Islands (RMI) has been affected by marine pollution from militarization and urbanization. To address concerns raised by the Marshall Islands Marine Resources Authority, this study examined concentrations of dissolved contaminants in reef and pelagic fishes in the RMI and assessed potential associated risks. Metals, organochlorine pesticides, polychlorinated biphenyls (PCBs), and polycyclic aromatic hydrocarbons (PAHs) were examined in reef and pelagic fishes from six atolls: Kwajalein, Majuro, Jaluit, Utirik, Rongelap, and Wotje. Clear trophic patterns emerged for metals. Total arsenic was highest in higher trophic level reef fishes, particularly in the camouflage grouper (Epinephelus polyphekadion) (>100 μg g^-1 total As), but inorganic arsenic was negligible in higher trophic levels and showed an inverse trend with the highest percentages present in parrotfishes and herbivores. Copper and mercury were elevated in higher trophic level reef and pelagic fishes, respectively, and the maximum mercury concentrations (6.45 μg g^-1 in Gymnosarda unicolor) were among the highest reported in the Pacific. Conversely, cadmium and lead were highest in lower trophic levels, like surgeonfishes and parrotfishes. PCBs were more clearly linked to locations and were highest at two atolls with military history (Kwajalein and Jaluit) (>U.S. EPA Screening Value of 2.5 ppb). PAHs were ubiquitous across taxa (detected in 97% of samples), but the highest concentrations were in lower trophic levels. Organochlorine pesticides were detected at very low concentrations that do not likely pose a risk. We compare concentrations to established thresholds for human health and find that - for specific locations and species - contaminant concentrations may pose a risk to fish and other marine taxa, as well as human consumers. This study provides baseline information that aids the development of marine conservation and public health recommendations and addresses a data gap that persists for marine pollution throughout the Pacific Islands.

Micronesian maritime piloting charts as bioimaging proxies for the rescue of cells on the apoptotic trajectory

This interdisciplinary study falls within the realm of ethnoscience thanks to its resorting to the scientific methods behind the Micronesian canoe voyaging in search of bioimaging tools for the early prediction of cell fate in response to a therapy. Two distinct indigenous methods for navigation across the ocean were assessed as bridges for correlating (i) the interaction of oceanic swells near atolls with the way microcurrents in the cell culture dish may shape the morphology of cells, and (ii) the spatial arrangement of cultured cells with the canoe voyaging from one island to the next. Both methods effectively predicted the cell fate at early time points in the treatment with superparamagnetic nanoparticles, when the adverse effects were still reversible and not apparent yet at the levels of cell morphology, proliferation rate or confluence. The mattang chart, the most fundamental and theoretical of navigational devices used in the Marshallese seafaring tradition, was used to measure subtle morphological changes occurring in cells due to the treatment. The cells subjected to the treatment were consistently withdrawing their bodies from the areas of intense swell interaction activity on the superimposed mattangs. Given that the cytoskeletal microfilaments defining the features of control cells were largely filling up these areas, this metric proved useful for deducing the course of the treatment at its early stages. The same deduction was proven feasible with the use of a Carolinian navigational technique based on the concept of the etak, in which case the distances traversable between cells in a population subjected to the treatment were divisible to a significantly higher number of etaks than the same distances in the population of control cells. Therefore, treating cells and their nuclei as analogous to Pacific atolls navigable to and fro with the use of imaginary microscopic canoes and the navigational principles native to the Marshall and the Caroline Islands proves as a clever, but also very effective cell fate prediction approach, which various branches of biomedical science could take advantage of. These practical benefits notwithstanding, this conceptual study was performed primarily with a goal to spark the interest in studying these and other ancient ethnoscientific inventions as potential addenda to the broad repertoire of techniques used in biomedical and other sciences to combat some of their greatest challenges.

Cytogenetic and epigenetic aberrations in peripheral lymphocytes of northwest Arkansas Marshallese

PURPOSE

Nuclear weapons testing in the northern Marshall Islands between 1946 and 1958 resulted in ionizing radiation (IR) exposure of the thousands of Marshallese. Furthermore, numerous islands were contaminated by radioactive fallout. Significant increases in cancer and metabolic syndrome incidences have been reported among Marshallese, and potential for further increases looms due to the latency of radiation-induced health effects. The purpose of this study was to investigate the genetic and epigenetic effects of exposure to IR that could be associated with radiation-induced disease among the Northwest Arkansas (NWA) Marshallese.

MATERIALS AND METHODS

We performed analysis of chromosomal aberrations and DNA methylation based on residential and exposure history of NWA Marshallese.

RESULTS

Analysis of chromosomal aberrations demonstrated higher incidence of genetic rearrangements in women with self-reported history of radiation exposure (95% CI: 0.10, 1.22; p=.022). Further clustering of study participants based on their residential history demonstrated that participants who spent substantial amounts of time (≥6 months) in the northern atolls (thus, in the proximity of nuclear tests) before 1980 had more chromosomal aberrations than their peers who lived only in the southern atolls (95% CI: 0.08, -0.95; p=.021), and that this difference was driven by women. A relationship between the time spent in the northern atolls and increase in chromosomal aberrations was observed: 0.31 increase in chromosomal aberrations for every 10 years spent at northern atolls (95% CI: 0.06, 0.57; p=.020). Finally, significant inverse correlations between the chromosomal aberrations and the extent of DNA methylation of four LINE-1 elements L1PA2, L1PA16, L1PREC1, and L1P4B were identified.

CONCLUSIONS

The results of this study provide first evidence of the presence of stable genetic and epigenetic rearrangements in peripheral lymphocytes of NWA Marshallese and warrant further studies to analyze the role of radiation exposure in health disparities experienced by this Pacific Island nation.

Assessment of residual radionuclide levels at the Bokak and Bikar Atolls in the northern Marshall Islands

The Bikar and Bokak Atolls, located in the northern Marshall Islands, are extremely isolated and consist of pristine marine and terrestrial ecosystems. Both atolls may have experienced significant radioactive deposition following the nuclear weapon testing conducted at Bikini and Enewetak proving grounds. Here we report activity concentrations of artificial radionuclides (²³⁹Pu, ²⁴⁰Pu, ²⁴¹Pu, ²⁴¹Am, ¹³⁷Cs and ⁹⁰Sr) in marine and terrestrial samples collected from Bikar and Bokak Atolls. Artificial radionuclides in soil from the Majuro Atoll are also reported and form a radiological baseline against which the levels at the other atolls can be compared. We observed low levels of artificial radionuclides in soil from Majuro and Bokak, but significantly higher levels in soil from Bikar. The residual radioactivity in the Bikar environment is comparable to the levels previously reported for other nearby atolls, including Taka and Utrik, but lower than for Rongerik, Rongelap, Bikini and Enewetak. An analysis of ²⁴⁰Pu/²³⁹Pu isotope ratios and estimations of the dates of contamination from ²⁴¹Am/²⁴¹Pu activity ratios both indicated that the Bikar Atoll was contaminated mainly by radioactive fallout from the Castle Bravo test in 1954. We compare the results of our measurements at Bikar and Bokak to data from other atolls in the Marshall Islands and to regions of the world affected by both global and regional fallout from atmospheric nuclear weapons testing and nuclear accidents.

Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State

In 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. We sequenced 166 mumps virus genomes collected in Washington and other US states, and traced mumps introductions and transmission within Washington. We uncover that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple co-circulating transmission chains. Although age and vaccination status may have impacted transmission, our data set could not quantify their precise effects. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission and pinpoint contact networks as critical for mumps transmission. These results imply that contact structures and historic disparities may leave populations at increased risk for respiratory virus disease even when a vaccine is effective and widely used.

Cutaneous Radiation Injuries: Models, Assessment and Treatments

Many cases of human exposures to high-dose radiation have been documented, including individuals exposed during the detonation of atomic bombs in Hiroshima and Nagasaki, nuclear power plant disasters (e.g., Chernobyl), as well as industrial and medical accidents. For many of these exposures, injuries to the skin have been present and have played a significant role in the progression of the injuries and survivability from the radiation exposure. There are also instances of radiation-induced skin complications in routine clinical radiotherapy and radiation diagnostic imaging procedures. In response to the threat of a radiological or nuclear mass casualty incident, the U.S. Department of Health and Human Services tasked the National Institute of Allergy and Infectious Diseases (NIAID) with identifying and funding early- to mid-stage medical countermeasure (MCM) development to treat radiation-induced injuries, including those to the skin. To appropriately assess the severity of radiation-induced skin injuries and determine efficacy of different approaches to mitigate/treat them, it is necessary to develop animal models that appropriately simulate what is seen in humans who have been exposed. In addition, it is important to understand the techniques that are used in other clinical indications (e.g., thermal burns, diabetic ulcers, etc.) to accurately assess the extent of skin injury and progression of healing. For these reasons, the NIAID partnered with two other U.S. Government funding and regulatory agencies, the Biomedical Advanced Research and Development Authority (BARDA) and the Food and Drug Administration (FDA), to identify state-of-the-art methods in assessment of skin injuries, explore animal models to better understand radiation-induced cutaneous damage and investigate treatment approaches. A two-day workshop was convened in May 2019 highlighting talks from 28 subject matter experts across five scientific sessions. This report provides an overview of information that was presented and the subsequent guided discussions.

POISSON COKRIGING AS A GENERALIZED LINEAR MIXED MODEL

It is often of interest to predict spatially correlated count outcomes that follow a Poisson distribution. For example, in the environmental sciences we may want to predict pollen counts using temperature or precipitation data as auxiliary variables. To predict a Poisson outcome variable in the presence of an auxiliary variable, Poisson cokriging as a Generalized Linear Mixed Model (GLMM) is proposed. This model has a bivariate structure with a Poisson outcome variable and an auxiliary variable. A covariance matrix similar to that used in cokriging is assumed. A simulation study and a real data example using the number of microplastics in the digestive tracts of fish are presented. The results showed that Poisson cokriging methodology can be applied successfully in practice with small average errors and coverage close to 95%. The Poisson cokriging model can be a useful tool for spatial prediction.

In situ measurement of cesium-137 contamination in fruits from the northern Marshall Islands

Radioactive contamination of fruits in the northern Marshall Islands, resulting from the US nuclear weapons testing program in the 1940s and 1950s, is still a human health concern, in particular pertaining to island population resettlement and the economic benefit from farming. Over 200 fruits, primarily coconuts and pandanus, were collected on 11 islands from four atolls in the northern Marshall Islands in 2017. The energy spectra from nuclear gamma decays were measured on a research vessel for each fruit in situ. From these recordings, the level of cesium-137 (¹³⁷Cs) contamination was determined for individual fruits. Comparisons of the results are made to past studies and international food safety standards. There is a broad distribution of values, ranging from below detectable radiation levels to relatively high levels; safety concerns are largest for Bikini Island. A noticeable fraction of fruits from Bikini have significantly higher levels of ¹³⁷Cs contamination compared with those from all other measured islands.