%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 188 0 R 251 0 R 284 0 R 298 0 R 300 0 R 309 0 R 318 0 R 320 0 R 328 0 R 330 0 R ] /Count 11 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R /F4 11 0 R /F5 253 0 R >> /XObject << /I1 12 0 R /I2 13 0 R /I3 210 0 R /I4 262 0 R /I5 263 0 R /I6 272 0 R /I7 273 0 R /I8 282 0 R /I9 283 0 R /I10 286 0 R /I11 287 0 R /I12 288 0 R /I13 289 0 R /I14 290 0 R /I15 291 0 R /I16 292 0 R /I17 293 0 R /I18 294 0 R /I19 295 0 R /I20 296 0 R /I21 297 0 R /I22 304 0 R /I23 313 0 R >> >> /MediaBox [0.000 0.000 612.000 792.000] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20180723034346+00'00') /ModDate (D:20180723034346+00'00') /Title (The Duration of an Exposure Response Gradient between Incident Obstructive Airways Disease and Work at the World Trade Center Site: 2001-2011 PLOS Currents Disasters) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 14 0 R 16 0 R 18 0 R 20 0 R 22 0 R 24 0 R 26 0 R 28 0 R 30 0 R 32 0 R 34 0 R 36 0 R 38 0 R 40 0 R 42 0 R 44 0 R 46 0 R 48 0 R 50 0 R 52 0 R 54 0 R 56 0 R 58 0 R 60 0 R 62 0 R 64 0 R 66 0 R 68 0 R 70 0 R 72 0 R 74 0 R 76 0 R 78 0 R 80 0 R 82 0 R 84 0 R 86 0 R 88 0 R 90 0 R 92 0 R 94 0 R 96 0 R 98 0 R 100 0 R 102 0 R 104 0 R 106 0 R 108 0 R 110 0 R 112 0 R 114 0 R 116 0 R 118 0 R 120 0 R 122 0 R 124 0 R 126 0 R 128 0 R 130 0 R 132 0 R 134 0 R 136 0 R 138 0 R 140 0 R 142 0 R 144 0 R 146 0 R 148 0 R 150 0 R 152 0 R 154 0 R 156 0 R 158 0 R 160 0 R 162 0 R 164 0 R 166 0 R 168 0 R 170 0 R 172 0 R 174 0 R 176 0 R 178 0 R 180 0 R 182 0 R 184 0 R 186 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 25925 >> stream q 375.000 0 0 39.000 222.000 738.000 cm /I2 Do Q q 15.000 659.406 577.500 78.594 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Duration of an Exposure Response Gradient between )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Incident Obstructive Airways Disease and Work at the World )] TJ ET BT 15.000 668.146 Td /F2 21.0 Tf [(Trade Center Site: 2001-2011)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 650.140 Td /F3 9.8 Tf [(May 20, 2015)] TJ ET BT 73.763 650.140 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 78.638 650.140 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 638.299 Td /F1 9.8 Tf [(Charles B. Hall)] TJ ET 0.271 0.267 0.267 rg BT 91.263 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 96.684 638.299 Td /F1 9.8 Tf [(Xiaoxue Liu)] TJ ET 0.271 0.267 0.267 rg BT 147.628 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 153.049 638.299 Td /F1 9.8 Tf [(Rachel Zeig-Owens)] TJ ET 0.271 0.267 0.267 rg BT 238.654 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 244.075 638.299 Td /F1 9.8 Tf [(Mayris P. Webber)] TJ ET 0.271 0.267 0.267 rg BT 321.548 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 326.969 638.299 Td /F1 9.8 Tf [(Thomas K. Aldrich)] TJ ET 0.271 0.267 0.267 rg BT 406.617 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 412.038 638.299 Td /F1 9.8 Tf [(Jessica Weakley)] TJ ET 0.271 0.267 0.267 rg BT 484.637 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 490.058 638.299 Td /F1 9.8 Tf [(Theresa Schwartz)] TJ ET 0.271 0.267 0.267 rg BT 568.623 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 26.250 626.394 Td /F1 9.8 Tf [(Hillel W. Cohen)] TJ ET 0.271 0.267 0.267 rg BT 93.427 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 98.849 626.394 Td /F1 9.8 Tf [(Michelle S. Glaser)] TJ ET 0.271 0.267 0.267 rg BT 177.950 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 183.371 626.394 Td /F1 9.8 Tf [(Brianne L. Olivieri)] TJ ET 0.271 0.267 0.267 rg BT 260.308 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 265.729 626.394 Td /F1 9.8 Tf [(Michael D. Weiden)] TJ ET 0.271 0.267 0.267 rg BT 347.542 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 352.963 626.394 Td /F1 9.8 Tf [(Anna Nolan)] TJ ET 0.271 0.267 0.267 rg BT 403.906 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 409.327 626.394 Td /F1 9.8 Tf [(Kerry J. Kelly)] TJ ET 0.271 0.267 0.267 rg BT 466.755 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 472.176 626.394 Td /F1 9.8 Tf [(David J. Prezant)] TJ ET 0.271 0.267 0.267 rg BT 26.250 614.490 Td /F1 9.8 Tf [(Hall CB, Liu X, Zeig-Owens R, Webber MP, Aldrich TK, Weakley J, Schwartz T, Cohen HW, Glaser MS, Olivieri BL, Weiden )] TJ ET BT 26.250 602.585 Td /F1 9.8 Tf [(MD, Nolan A, Kelly KJ, Prezant DJ. The Duration of an Exposure Response Gradient between Incident Obstructive Airways )] TJ ET BT 26.250 590.680 Td /F1 9.8 Tf [(Disease and Work at the World Trade Center Site: 2001-2011. PLOS Currents Disasters. 2015 May 20 . Edition 1. doi: )] TJ ET BT 26.250 578.775 Td /F1 9.8 Tf [(10.1371/currents.dis.8a93e7682624698558a76a1fa8c5893f.)] TJ ET q 15.000 27.082 577.500 549.313 re W n 0.271 0.267 0.267 rg BT 26.250 549.673 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 529.719 Td /F4 9.8 Tf [(Background)] TJ ET BT 83.132 529.719 Td /F1 9.8 Tf [(: Adverse respiratory effects of World Trade Center \(WTC\) exposure have been widely documented, but the length )] TJ ET BT 26.250 517.814 Td /F1 9.8 Tf [(of time that exposure remains associated with disease is uncertain. We estimate the incidence of new cases of physician-)] TJ ET BT 26.250 505.909 Td /F1 9.8 Tf [(diagnosed obstructive airway disease \(OAD\) as a function of time since 9/11/2001 in WTC-exposed firefighters.)] TJ ET BT 26.250 486.504 Td /F4 9.8 Tf [(Methods:)] TJ ET BT 69.579 486.504 Td /F1 9.8 Tf [( Exposure was categorized by first WTC arrival time: high \(9/11/2001 AM\); moderate \(9/11/2001 PM or 9/12/2001\); or )] TJ ET BT 26.250 474.600 Td /F1 9.8 Tf [(low \(9/13-24/2001\). We modeled relative rates \(RR\) and 95% confidence intervals \(CI\) of OAD incidence by exposure over the )] TJ ET BT 26.250 462.695 Td /F1 9.8 Tf [(first 10 years post-9/11/2001, estimating the time\(s\) of change in the RR with change point models. We further examined the )] TJ ET BT 26.250 450.790 Td /F1 9.8 Tf [(relationship between self-reported lower respiratory symptoms and physician diagnoses.)] TJ ET BT 26.250 431.385 Td /F4 9.8 Tf [(Results:)] TJ ET BT 64.714 431.385 Td /F1 9.8 Tf [( Change points were observed at 15 and 84 months post-9/11/2001, with relative incidence rates for the high versus )] TJ ET BT 26.250 419.481 Td /F1 9.8 Tf [(low exposure group of 4.02 \(95% CI 2.62-6.16\) prior to 15 months, 1.90 \(95% CI 1.49-2.44\) from months 16 to 84, and 1.20 )] TJ ET BT 26.250 407.576 Td /F1 9.8 Tf [(\(95% CI 0.92-1.56\) thereafter. Incidence in all exposure groups increased after the WTC health program began to offer free )] TJ ET BT 26.250 395.671 Td /F1 9.8 Tf [(coverage of OAD medications in month 63. Self-reported lower respiratory symptoms in the first 15 months had 80.6% )] TJ ET BT 26.250 383.766 Td /F1 9.8 Tf [(sensitivity, but only 35.9% specificity, for eventual OAD diagnoses.)] TJ ET BT 26.250 364.362 Td /F4 9.8 Tf [(Conclusions)] TJ ET BT 84.760 364.362 Td /F1 9.8 Tf [(: New OAD diagnoses are associated with WTC exposure for at least seven years. Some portion of the extended )] TJ ET BT 26.250 352.457 Td /F1 9.8 Tf [(duration of that association may be due to delayed diagnoses. Nevertheless, our results support recognizing OAD among )] TJ ET BT 26.250 340.552 Td /F1 9.8 Tf [(rescue workers as WTC-related even when diagnosed years after exposure.)] TJ ET BT 26.250 303.950 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 283.995 Td /F1 9.8 Tf [(This research was supported by National Institute of Occupational Safety and Health Cooperative Agreement U01 OH010412. )] TJ ET BT 26.250 272.091 Td /F1 9.8 Tf [(The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.)] TJ ET BT 26.250 242.988 Td /F4 12.0 Tf [(Background)] TJ ET BT 26.250 223.034 Td /F1 9.8 Tf [(The inhalation of chemicals, particulate matter \(dusts and fibers\), and the incomplete products of combustion during )] TJ ET BT 26.250 211.129 Td /F1 9.8 Tf [(occupational and environmental disasters have long been associated with respiratory disorders.)] TJ ET 0.267 0.267 0.267 rg BT 438.636 212.636 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 443.455 211.129 Td /F1 9.8 Tf [( While there is substantial )] TJ ET BT 26.250 199.224 Td /F1 9.8 Tf [(literature )] TJ ET 0.267 0.267 0.267 rg BT 66.888 200.732 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 71.707 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 74.116 200.732 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 78.935 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 81.344 200.732 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 86.163 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 88.572 200.732 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 93.391 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 95.800 200.732 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 100.619 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 103.028 200.732 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 107.847 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 110.256 200.732 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 115.075 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 117.484 200.732 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 122.303 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 124.712 200.732 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 134.349 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 136.759 200.732 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 146.396 199.224 Td /F1 9.8 Tf [( on the association between respiratory diseases and chronic environmental exposures such as air )] TJ ET BT 26.250 187.320 Td /F1 9.8 Tf [(pollution, and long-term occupational exposure in mining, silica handling, and construction, and other industries, much remains )] TJ ET BT 26.250 175.415 Td /F1 9.8 Tf [(to be learned regarding the biological mechanisms that cause such disease and the presumed latency period between acute )] TJ ET BT 26.250 163.510 Td /F1 9.8 Tf [(exposure and disease onset.)] TJ ET Q q 15.000 659.406 577.500 78.594 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Duration of an Exposure Response Gradient between )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Incident Obstructive Airways Disease and Work at the World )] TJ ET BT 15.000 668.146 Td /F2 21.0 Tf [(Trade Center Site: 2001-2011)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 650.140 Td /F3 9.8 Tf [(May 20, 2015)] TJ ET BT 73.763 650.140 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 78.638 650.140 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 638.299 Td /F1 9.8 Tf [(Charles B. Hall)] TJ ET 0.271 0.267 0.267 rg BT 91.263 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 96.684 638.299 Td /F1 9.8 Tf [(Xiaoxue Liu)] TJ ET 0.271 0.267 0.267 rg BT 147.628 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 153.049 638.299 Td /F1 9.8 Tf [(Rachel Zeig-Owens)] TJ ET 0.271 0.267 0.267 rg BT 238.654 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 244.075 638.299 Td /F1 9.8 Tf [(Mayris P. Webber)] TJ ET 0.271 0.267 0.267 rg BT 321.548 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 326.969 638.299 Td /F1 9.8 Tf [(Thomas K. Aldrich)] TJ ET 0.271 0.267 0.267 rg BT 406.617 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 412.038 638.299 Td /F1 9.8 Tf [(Jessica Weakley)] TJ ET 0.271 0.267 0.267 rg BT 484.637 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 490.058 638.299 Td /F1 9.8 Tf [(Theresa Schwartz)] TJ ET 0.271 0.267 0.267 rg BT 568.623 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 26.250 626.394 Td /F1 9.8 Tf [(Hillel W. Cohen)] TJ ET 0.271 0.267 0.267 rg BT 93.427 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 98.849 626.394 Td /F1 9.8 Tf [(Michelle S. Glaser)] TJ ET 0.271 0.267 0.267 rg BT 177.950 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 183.371 626.394 Td /F1 9.8 Tf [(Brianne L. Olivieri)] TJ ET 0.271 0.267 0.267 rg BT 260.308 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 265.729 626.394 Td /F1 9.8 Tf [(Michael D. Weiden)] TJ ET 0.271 0.267 0.267 rg BT 347.542 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 352.963 626.394 Td /F1 9.8 Tf [(Anna Nolan)] TJ ET 0.271 0.267 0.267 rg BT 403.906 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 409.327 626.394 Td /F1 9.8 Tf [(Kerry J. Kelly)] TJ ET 0.271 0.267 0.267 rg BT 466.755 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 472.176 626.394 Td /F1 9.8 Tf [(David J. Prezant)] TJ ET 0.271 0.267 0.267 rg BT 26.250 614.490 Td /F1 9.8 Tf [(Hall CB, Liu X, Zeig-Owens R, Webber MP, Aldrich TK, Weakley J, Schwartz T, Cohen HW, Glaser MS, Olivieri BL, Weiden )] TJ ET BT 26.250 602.585 Td /F1 9.8 Tf [(MD, Nolan A, Kelly KJ, Prezant DJ. The Duration of an Exposure Response Gradient between Incident Obstructive Airways )] TJ ET BT 26.250 590.680 Td /F1 9.8 Tf [(Disease and Work at the World Trade Center Site: 2001-2011. PLOS Currents Disasters. 2015 May 20 . Edition 1. doi: )] TJ ET BT 26.250 578.775 Td /F1 9.8 Tf [(10.1371/currents.dis.8a93e7682624698558a76a1fa8c5893f.)] TJ ET q 15.000 27.082 577.500 549.313 re W n 0.271 0.267 0.267 rg BT 26.250 549.673 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 529.719 Td /F4 9.8 Tf [(Background)] TJ ET BT 83.132 529.719 Td /F1 9.8 Tf [(: Adverse respiratory effects of World Trade Center \(WTC\) exposure have been widely documented, but the length )] TJ ET BT 26.250 517.814 Td /F1 9.8 Tf [(of time that exposure remains associated with disease is uncertain. We estimate the incidence of new cases of physician-)] TJ ET BT 26.250 505.909 Td /F1 9.8 Tf [(diagnosed obstructive airway disease \(OAD\) as a function of time since 9/11/2001 in WTC-exposed firefighters.)] TJ ET BT 26.250 486.504 Td /F4 9.8 Tf [(Methods:)] TJ ET BT 69.579 486.504 Td /F1 9.8 Tf [( Exposure was categorized by first WTC arrival time: high \(9/11/2001 AM\); moderate \(9/11/2001 PM or 9/12/2001\); or )] TJ ET BT 26.250 474.600 Td /F1 9.8 Tf [(low \(9/13-24/2001\). We modeled relative rates \(RR\) and 95% confidence intervals \(CI\) of OAD incidence by exposure over the )] TJ ET BT 26.250 462.695 Td /F1 9.8 Tf [(first 10 years post-9/11/2001, estimating the time\(s\) of change in the RR with change point models. We further examined the )] TJ ET BT 26.250 450.790 Td /F1 9.8 Tf [(relationship between self-reported lower respiratory symptoms and physician diagnoses.)] TJ ET BT 26.250 431.385 Td /F4 9.8 Tf [(Results:)] TJ ET BT 64.714 431.385 Td /F1 9.8 Tf [( Change points were observed at 15 and 84 months post-9/11/2001, with relative incidence rates for the high versus )] TJ ET BT 26.250 419.481 Td /F1 9.8 Tf [(low exposure group of 4.02 \(95% CI 2.62-6.16\) prior to 15 months, 1.90 \(95% CI 1.49-2.44\) from months 16 to 84, and 1.20 )] TJ ET BT 26.250 407.576 Td /F1 9.8 Tf [(\(95% CI 0.92-1.56\) thereafter. Incidence in all exposure groups increased after the WTC health program began to offer free )] TJ ET BT 26.250 395.671 Td /F1 9.8 Tf [(coverage of OAD medications in month 63. Self-reported lower respiratory symptoms in the first 15 months had 80.6% )] TJ ET BT 26.250 383.766 Td /F1 9.8 Tf [(sensitivity, but only 35.9% specificity, for eventual OAD diagnoses.)] TJ ET BT 26.250 364.362 Td /F4 9.8 Tf [(Conclusions)] TJ ET BT 84.760 364.362 Td /F1 9.8 Tf [(: New OAD diagnoses are associated with WTC exposure for at least seven years. Some portion of the extended )] TJ ET BT 26.250 352.457 Td /F1 9.8 Tf [(duration of that association may be due to delayed diagnoses. Nevertheless, our results support recognizing OAD among )] TJ ET BT 26.250 340.552 Td /F1 9.8 Tf [(rescue workers as WTC-related even when diagnosed years after exposure.)] TJ ET BT 26.250 303.950 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 283.995 Td /F1 9.8 Tf [(This research was supported by National Institute of Occupational Safety and Health Cooperative Agreement U01 OH010412. )] TJ ET BT 26.250 272.091 Td /F1 9.8 Tf [(The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.)] TJ ET BT 26.250 242.988 Td /F4 12.0 Tf [(Background)] TJ ET BT 26.250 223.034 Td /F1 9.8 Tf [(The inhalation of chemicals, particulate matter \(dusts and fibers\), and the incomplete products of combustion during )] TJ ET BT 26.250 211.129 Td /F1 9.8 Tf [(occupational and environmental disasters have long been associated with respiratory disorders.)] TJ ET 0.267 0.267 0.267 rg BT 438.636 212.636 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 443.455 211.129 Td /F1 9.8 Tf [( While there is substantial )] TJ ET BT 26.250 199.224 Td /F1 9.8 Tf [(literature )] TJ ET 0.267 0.267 0.267 rg BT 66.888 200.732 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 71.707 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 74.116 200.732 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 78.935 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 81.344 200.732 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 86.163 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 88.572 200.732 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 93.391 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 95.800 200.732 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 100.619 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 103.028 200.732 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 107.847 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 110.256 200.732 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 115.075 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 117.484 200.732 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 122.303 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 124.712 200.732 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 134.349 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 136.759 200.732 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 146.396 199.224 Td /F1 9.8 Tf [( on the association between respiratory diseases and chronic environmental exposures such as air )] TJ ET BT 26.250 187.320 Td /F1 9.8 Tf [(pollution, and long-term occupational exposure in mining, silica handling, and construction, and other industries, much remains )] TJ ET BT 26.250 175.415 Td /F1 9.8 Tf [(to be learned regarding the biological mechanisms that cause such disease and the presumed latency period between acute )] TJ ET BT 26.250 163.510 Td /F1 9.8 Tf [(exposure and disease onset.)] TJ ET Q q 15.000 659.406 577.500 78.594 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Duration of an Exposure Response Gradient between )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Incident Obstructive Airways Disease and Work at the World )] TJ ET BT 15.000 668.146 Td /F2 21.0 Tf [(Trade Center Site: 2001-2011)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 650.140 Td /F3 9.8 Tf [(May 20, 2015)] TJ ET BT 73.763 650.140 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 78.638 650.140 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 638.299 Td /F1 9.8 Tf [(Charles B. Hall)] TJ ET 0.271 0.267 0.267 rg BT 91.263 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 96.684 638.299 Td /F1 9.8 Tf [(Xiaoxue Liu)] TJ ET 0.271 0.267 0.267 rg BT 147.628 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 153.049 638.299 Td /F1 9.8 Tf [(Rachel Zeig-Owens)] TJ ET 0.271 0.267 0.267 rg BT 238.654 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 244.075 638.299 Td /F1 9.8 Tf [(Mayris P. Webber)] TJ ET 0.271 0.267 0.267 rg BT 321.548 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 326.969 638.299 Td /F1 9.8 Tf [(Thomas K. Aldrich)] TJ ET 0.271 0.267 0.267 rg BT 406.617 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 412.038 638.299 Td /F1 9.8 Tf [(Jessica Weakley)] TJ ET 0.271 0.267 0.267 rg BT 484.637 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 490.058 638.299 Td /F1 9.8 Tf [(Theresa Schwartz)] TJ ET 0.271 0.267 0.267 rg BT 568.623 638.299 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 26.250 626.394 Td /F1 9.8 Tf [(Hillel W. Cohen)] TJ ET 0.271 0.267 0.267 rg BT 93.427 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 98.849 626.394 Td /F1 9.8 Tf [(Michelle S. Glaser)] TJ ET 0.271 0.267 0.267 rg BT 177.950 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 183.371 626.394 Td /F1 9.8 Tf [(Brianne L. Olivieri)] TJ ET 0.271 0.267 0.267 rg BT 260.308 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 265.729 626.394 Td /F1 9.8 Tf [(Michael D. Weiden)] TJ ET 0.271 0.267 0.267 rg BT 347.542 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 352.963 626.394 Td /F1 9.8 Tf [(Anna Nolan)] TJ ET 0.271 0.267 0.267 rg BT 403.906 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 409.327 626.394 Td /F1 9.8 Tf [(Kerry J. Kelly)] TJ ET 0.271 0.267 0.267 rg BT 466.755 626.394 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 472.176 626.394 Td /F1 9.8 Tf [(David J. Prezant)] TJ ET 0.271 0.267 0.267 rg BT 26.250 614.490 Td /F1 9.8 Tf [(Hall CB, Liu X, Zeig-Owens R, Webber MP, Aldrich TK, Weakley J, Schwartz T, Cohen HW, Glaser MS, Olivieri BL, Weiden )] TJ ET BT 26.250 602.585 Td /F1 9.8 Tf [(MD, Nolan A, Kelly KJ, Prezant DJ. The Duration of an Exposure Response Gradient between Incident Obstructive Airways )] TJ ET BT 26.250 590.680 Td /F1 9.8 Tf [(Disease and Work at the World Trade Center Site: 2001-2011. PLOS Currents Disasters. 2015 May 20 . Edition 1. doi: )] TJ ET BT 26.250 578.775 Td /F1 9.8 Tf [(10.1371/currents.dis.8a93e7682624698558a76a1fa8c5893f.)] TJ ET q 15.000 27.082 577.500 549.313 re W n 0.271 0.267 0.267 rg BT 26.250 549.673 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 529.719 Td /F4 9.8 Tf [(Background)] TJ ET BT 83.132 529.719 Td /F1 9.8 Tf [(: Adverse respiratory effects of World Trade Center \(WTC\) exposure have been widely documented, but the length )] TJ ET BT 26.250 517.814 Td /F1 9.8 Tf [(of time that exposure remains associated with disease is uncertain. We estimate the incidence of new cases of physician-)] TJ ET BT 26.250 505.909 Td /F1 9.8 Tf [(diagnosed obstructive airway disease \(OAD\) as a function of time since 9/11/2001 in WTC-exposed firefighters.)] TJ ET BT 26.250 486.504 Td /F4 9.8 Tf [(Methods:)] TJ ET BT 69.579 486.504 Td /F1 9.8 Tf [( Exposure was categorized by first WTC arrival time: high \(9/11/2001 AM\); moderate \(9/11/2001 PM or 9/12/2001\); or )] TJ ET BT 26.250 474.600 Td /F1 9.8 Tf [(low \(9/13-24/2001\). We modeled relative rates \(RR\) and 95% confidence intervals \(CI\) of OAD incidence by exposure over the )] TJ ET BT 26.250 462.695 Td /F1 9.8 Tf [(first 10 years post-9/11/2001, estimating the time\(s\) of change in the RR with change point models. We further examined the )] TJ ET BT 26.250 450.790 Td /F1 9.8 Tf [(relationship between self-reported lower respiratory symptoms and physician diagnoses.)] TJ ET BT 26.250 431.385 Td /F4 9.8 Tf [(Results:)] TJ ET BT 64.714 431.385 Td /F1 9.8 Tf [( Change points were observed at 15 and 84 months post-9/11/2001, with relative incidence rates for the high versus )] TJ ET BT 26.250 419.481 Td /F1 9.8 Tf [(low exposure group of 4.02 \(95% CI 2.62-6.16\) prior to 15 months, 1.90 \(95% CI 1.49-2.44\) from months 16 to 84, and 1.20 )] TJ ET BT 26.250 407.576 Td /F1 9.8 Tf [(\(95% CI 0.92-1.56\) thereafter. Incidence in all exposure groups increased after the WTC health program began to offer free )] TJ ET BT 26.250 395.671 Td /F1 9.8 Tf [(coverage of OAD medications in month 63. Self-reported lower respiratory symptoms in the first 15 months had 80.6% )] TJ ET BT 26.250 383.766 Td /F1 9.8 Tf [(sensitivity, but only 35.9% specificity, for eventual OAD diagnoses.)] TJ ET BT 26.250 364.362 Td /F4 9.8 Tf [(Conclusions)] TJ ET BT 84.760 364.362 Td /F1 9.8 Tf [(: New OAD diagnoses are associated with WTC exposure for at least seven years. Some portion of the extended )] TJ ET BT 26.250 352.457 Td /F1 9.8 Tf [(duration of that association may be due to delayed diagnoses. Nevertheless, our results support recognizing OAD among )] TJ ET BT 26.250 340.552 Td /F1 9.8 Tf [(rescue workers as WTC-related even when diagnosed years after exposure.)] TJ ET BT 26.250 303.950 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 283.995 Td /F1 9.8 Tf [(This research was supported by National Institute of Occupational Safety and Health Cooperative Agreement U01 OH010412. )] TJ ET BT 26.250 272.091 Td /F1 9.8 Tf [(The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.)] TJ ET BT 26.250 242.988 Td /F4 12.0 Tf [(Background)] TJ ET BT 26.250 223.034 Td /F1 9.8 Tf [(The inhalation of chemicals, particulate matter \(dusts and fibers\), and the incomplete products of combustion during )] TJ ET BT 26.250 211.129 Td /F1 9.8 Tf [(occupational and environmental disasters have long been associated with respiratory disorders.)] TJ ET 0.267 0.267 0.267 rg BT 438.636 212.636 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 443.455 211.129 Td /F1 9.8 Tf [( While there is substantial )] TJ ET BT 26.250 199.224 Td /F1 9.8 Tf [(literature )] TJ ET 0.267 0.267 0.267 rg BT 66.888 200.732 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 71.707 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 74.116 200.732 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 78.935 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 81.344 200.732 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 86.163 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 88.572 200.732 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 93.391 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 95.800 200.732 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 100.619 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 103.028 200.732 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 107.847 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 110.256 200.732 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 115.075 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 117.484 200.732 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 122.303 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 124.712 200.732 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 134.349 203.113 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 136.759 200.732 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 146.396 199.224 Td /F1 9.8 Tf [( on the association between respiratory diseases and chronic environmental exposures such as air )] TJ ET BT 26.250 187.320 Td /F1 9.8 Tf [(pollution, and long-term occupational exposure in mining, silica handling, and construction, and other industries, much remains )] TJ ET BT 26.250 175.415 Td /F1 9.8 Tf [(to be learned regarding the biological mechanisms that cause such disease and the presumed latency period between acute )] TJ ET BT 26.250 163.510 Td /F1 9.8 Tf [(exposure and disease onset.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(1)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /Font /Subtype /Type1 /Name /F4 /BaseFont /Helvetica-Bold /Encoding /WinAnsiEncoding >> endobj 12 0 obj << /Type /XObject /Subtype /Image /Width 500 /Height 52 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 500 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 144>> stream x1 0 'ݲ؎"e{dzAdzAdzAdzAdzAdzAdzAdzAdzAdzAdzAdzAtlM0\ endstream endobj 13 0 obj << /Type /XObject /Subtype /Image /Width 500 /Height 52 /SMask 12 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 500 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 3627>> stream x?b!/w N BU!@rܥ>L%|"ɾeB~qbϧG0 0 0 ü<,a ,a ,a /)܋( daKnW>'IR2 0x1ͽ{0 Z4= 4M޶mY}'IĖ2 0ָML}GQ48Iy>i("u>s6ne0 YfB;S}b 5ba,ZP՚ћuFڶ= 0{ǤbA!>m{wwW׵ApssDZdU,K:fs_׿___qykQbfMii{$̂>}JdB um{Lh'پy2c\ifZypE|,Uݝ,h4ڶ],R*\U-rQ9l PUUQ#G80aef_-mI*gߋlil-d:5ec]RUa0\ͼ$ ֌8jE%4BH\m=ϣfY )!vDL^)4axt=3*E<' _?>>.7DYt]׆0gqwр,ajmۢ(HMB$ [ U5;gfw`2R]u]GQD0g[Tt:a1J#,AU}0hwb>&8V~*ȀIH fuiah aMl7\:\>|,L5w(YqOFsoBy|<3^=6.ym۾%)~`XHnݰ‹IDs'oZ7In}wV|C%H{lDsDQ6]4jcЊͭ;*ٶv&A.09e(ji2btXɄy4?!ZEI"+Yɲy%'hZch@C+q,U1TA+FEe_R18;z.􃰢c ( H| $I.hy {ss&` 26:#(RuGQmZtJӅ˲csоj$}3#rl& j }>  ]x] ъ|G[1lfu ϛIaVz0-mvy2h܉ေA^XD`b"W#ֵU{(Y BAaDL]z_ex6 (nMOÈ%֐m`04Ԝ0aℓ.*"^=KeY~-'iM``v,Z꺞fRf1c+! 85BX,HeEљ @N^ԚG`5p |!L]U).?"l5eFQŞu]ɍK'eW/o҆&(i VM_ = E/J,;sqq0 W>rM=gdќ陞qѼ:2X;.˲j#Ņ뺮fbi\ו.u݋1mgXEQꋋ q@P%~VL0%b`eF4M}'@Sp8v;FߊdY]@u[5 (96 V0~1Gj Ňg֏= >\'ͪ$yX`!dhq%I0fF5x]t,hRˮb"3鈰@'5ؽE2>GI@ KȲLrÿ*1ȰT5ffܱYjuqqC3v(uEsI'c^چ#X,hAk"ZH6`XPW,>}fY6t^C8,Fi#nica Jzlf0 >سX,)m_Bs' c oN c>TT'%x&ߘ fi$W܇g[@ mDZ7]:RQjƘ.ğ$:؝, s{HzxqZKmF|Ϗ~p7@ {1$Xu}p(ĉzZaJ%i&0L@#\}GaT~tTQ,asEOxhy.?,aC9oqE=MS9I%8~WmdG:agO\\$,yHg^Ab%Ĩ7Z}џd2!YmN0X-#*ڈ/&W4MAYT?3;f udJ 6%ag9IxINlȦ|[+ ٘{R0' uT?NP%A wD&1=4L&ĵg-G)+0*V} 62T75yiۣrѰڳ>$'?B'IeY0K1WH]NkiR m<˭XF.xaijT==}~&;ہHA7| \( s\? ~_{ޒ{ O?^AVtї~g~~mVfS XtU6wMUv8|xxG-ü[A܆m!g۾勜*N5,sP=0 cibCub=2xa? Lx"(*׾90?po6EF$|z8oLoݻgV_zqoea&p="Z,ca^T˲l6c0 of+$0 oa wa7 wa7 wa7 wa7_i= endstream endobj 14 0 obj << /Type /Annot /Subtype /Link /A 15 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 716.1516 537.6690 736.9416 ] >> endobj 15 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 16 0 obj << /Type /Annot /Subtype /Link /A 17 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 691.2036 574.3980 711.9936 ] >> endobj 17 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 18 0 obj << /Type /Annot /Subtype /Link /A 19 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 666.2556 279.2010 687.0456 ] >> endobj 19 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 20 0 obj << /Type /Annot /Subtype /Link /A 21 0 R /Border [0 0 0] /H /I /Rect [ 78.6382 649.2621 143.8950 658.9146 ] >> endobj 21 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article_category/research-article/) >> endobj 22 0 obj << /Type /Annot /Subtype /Link /A 23 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 637.3973 91.2630 647.3179 ] >> endobj 23 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/charleshall/) >> endobj 24 0 obj << /Type /Annot /Subtype /Link /A 25 0 R /Border [0 0 0] /H /I /Rect [ 96.6840 637.3973 147.6278 647.3179 ] >> endobj 25 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/xiaoxue-liufdny-nyc-gov/) >> endobj 26 0 obj << /Type /Annot /Subtype /Link /A 27 0 R /Border [0 0 0] /H /I /Rect [ 153.0488 637.3973 238.6538 647.3179 ] >> endobj 27 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/rachel-zeig-owensfdny-nyc-gov/) >> endobj 28 0 obj << /Type /Annot /Subtype /Link /A 29 0 R /Border [0 0 0] /H /I /Rect [ 244.0748 637.3973 321.5483 647.3179 ] >> endobj 29 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mayris-webberfdny-nyc-gov/) >> endobj 30 0 obj << /Type /Annot /Subtype /Link /A 31 0 R /Border [0 0 0] /H /I /Rect [ 326.9693 637.3973 406.6170 647.3179 ] >> endobj 31 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/taldrichmontefiore-org/) >> endobj 32 0 obj << /Type /Annot /Subtype /Link /A 33 0 R /Border [0 0 0] /H /I /Rect [ 412.0380 637.3973 484.6365 647.3179 ] >> endobj 33 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/jessicaweakley/) >> endobj 34 0 obj << /Type /Annot /Subtype /Link /A 35 0 R /Border [0 0 0] /H /I /Rect [ 490.0575 637.3973 568.6230 647.3179 ] >> endobj 35 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/theresa-schwartzfdny-nyc-gov/) >> endobj 36 0 obj << /Type /Annot /Subtype /Link /A 37 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 625.4926 93.4275 635.4132 ] >> endobj 37 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/hillel-coheneinstein-yu-edu/) >> endobj 38 0 obj << /Type /Annot /Subtype /Link /A 39 0 R /Border [0 0 0] /H /I /Rect [ 98.8485 625.4926 177.9502 635.4132 ] >> endobj 39 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/glaser-michellegmail-com/) >> endobj 40 0 obj << /Type /Annot /Subtype /Link /A 41 0 R /Border [0 0 0] /H /I /Rect [ 183.3712 625.4926 260.3085 635.4132 ] >> endobj 41 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/brianne-olivierifdny-nyc-gov/) >> endobj 42 0 obj << /Type /Annot /Subtype /Link /A 43 0 R /Border [0 0 0] /H /I /Rect [ 265.7295 625.4926 347.5417 635.4132 ] >> endobj 43 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/michael-weidennyumc-org/) >> endobj 44 0 obj << /Type /Annot /Subtype /Link /A 45 0 R /Border [0 0 0] /H /I /Rect [ 352.9627 625.4926 403.9065 635.4132 ] >> endobj 45 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/nolana01/) >> endobj 46 0 obj << /Type /Annot /Subtype /Link /A 47 0 R /Border [0 0 0] /H /I /Rect [ 409.3275 625.4926 466.7550 635.4132 ] >> endobj 47 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/kerry-kellyfdny-nyc-gov/) >> endobj 48 0 obj << /Type /Annot /Subtype /Link /A 49 0 R /Border [0 0 0] /H /I /Rect [ 472.1760 625.4926 543.7020 635.4132 ] >> endobj 49 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/david-prezantfdny-nyc-gov/) >> endobj 50 0 obj << /Type /Annot /Subtype /Link /A 51 0 R /Border [0 0 0] /H /I /Rect [ 438.6360 211.8347 443.4547 220.6530 ] >> endobj 51 0 obj << /Type /Action >> endobj 52 0 obj << /Type /Annot /Subtype /Link /A 53 0 R /Border [0 0 0] /H /I /Rect [ 66.8880 199.9299 71.7067 208.7483 ] >> endobj 53 0 obj << /Type /Action >> endobj 54 0 obj << /Type /Annot /Subtype /Link /A 55 0 R /Border [0 0 0] /H /I /Rect [ 74.1160 199.9299 78.9347 208.7483 ] >> endobj 55 0 obj << /Type /Action >> endobj 56 0 obj << /Type /Annot /Subtype /Link /A 57 0 R /Border [0 0 0] /H /I /Rect [ 81.3440 199.9299 86.1627 208.7483 ] >> endobj 57 0 obj << /Type /Action >> endobj 58 0 obj << /Type /Annot /Subtype /Link /A 59 0 R /Border [0 0 0] /H /I /Rect [ 88.5720 199.9299 93.3907 208.7483 ] >> endobj 59 0 obj << /Type /Action >> endobj 60 0 obj << /Type /Annot /Subtype /Link /A 61 0 R /Border [0 0 0] /H /I /Rect [ 95.8000 199.9299 100.6187 208.7483 ] >> endobj 61 0 obj << /Type /Action >> endobj 62 0 obj << /Type /Annot /Subtype /Link /A 63 0 R /Border [0 0 0] /H /I /Rect [ 103.0280 199.9299 107.8467 208.7483 ] >> endobj 63 0 obj << /Type /Action >> endobj 64 0 obj << /Type /Annot /Subtype /Link /A 65 0 R /Border [0 0 0] /H /I /Rect [ 110.2560 199.9299 115.0747 208.7483 ] >> endobj 65 0 obj << /Type /Action >> endobj 66 0 obj << /Type /Annot /Subtype /Link /A 67 0 R /Border [0 0 0] /H /I /Rect [ 117.4840 199.9299 122.3027 208.7483 ] >> endobj 67 0 obj << /Type /Action >> endobj 68 0 obj << /Type /Annot /Subtype /Link /A 69 0 R /Border [0 0 0] /H /I /Rect [ 124.7120 199.9299 134.3493 208.7483 ] >> endobj 69 0 obj << /Type /Action >> endobj 70 0 obj << /Type /Annot /Subtype /Link /A 71 0 R /Border [0 0 0] /H /I /Rect [ 136.7587 199.9299 146.3960 208.7483 ] >> endobj 71 0 obj << /Type /Action >> endobj 72 0 obj << /Type /Annot /Subtype /Link /A 73 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 716.1516 537.6690 736.9416 ] >> endobj 73 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 74 0 obj << /Type /Annot /Subtype /Link /A 75 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 691.2036 574.3980 711.9936 ] >> endobj 75 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 76 0 obj << /Type /Annot /Subtype /Link /A 77 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 666.2556 279.2010 687.0456 ] >> endobj 77 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 78 0 obj << /Type /Annot /Subtype /Link /A 79 0 R /Border [0 0 0] /H /I /Rect [ 78.6382 649.2621 143.8950 658.9146 ] >> endobj 79 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article_category/research-article/) >> endobj 80 0 obj << /Type /Annot /Subtype /Link /A 81 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 637.3973 91.2630 647.3179 ] >> endobj 81 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/charleshall/) >> endobj 82 0 obj << /Type /Annot /Subtype /Link /A 83 0 R /Border [0 0 0] /H /I /Rect [ 96.6840 637.3973 147.6278 647.3179 ] >> endobj 83 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/xiaoxue-liufdny-nyc-gov/) >> endobj 84 0 obj << /Type /Annot /Subtype /Link /A 85 0 R /Border [0 0 0] /H /I /Rect [ 153.0488 637.3973 238.6538 647.3179 ] >> endobj 85 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/rachel-zeig-owensfdny-nyc-gov/) >> endobj 86 0 obj << /Type /Annot /Subtype /Link /A 87 0 R /Border [0 0 0] /H /I /Rect [ 244.0748 637.3973 321.5483 647.3179 ] >> endobj 87 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mayris-webberfdny-nyc-gov/) >> endobj 88 0 obj << /Type /Annot /Subtype /Link /A 89 0 R /Border [0 0 0] /H /I /Rect [ 326.9693 637.3973 406.6170 647.3179 ] >> endobj 89 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/taldrichmontefiore-org/) >> endobj 90 0 obj << /Type /Annot /Subtype /Link /A 91 0 R /Border [0 0 0] /H /I /Rect [ 412.0380 637.3973 484.6365 647.3179 ] >> endobj 91 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/jessicaweakley/) >> endobj 92 0 obj << /Type /Annot /Subtype /Link /A 93 0 R /Border [0 0 0] /H /I /Rect [ 490.0575 637.3973 568.6230 647.3179 ] >> endobj 93 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/theresa-schwartzfdny-nyc-gov/) >> endobj 94 0 obj << /Type /Annot /Subtype /Link /A 95 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 625.4926 93.4275 635.4132 ] >> endobj 95 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/hillel-coheneinstein-yu-edu/) >> endobj 96 0 obj << /Type /Annot /Subtype /Link /A 97 0 R /Border [0 0 0] /H /I /Rect [ 98.8485 625.4926 177.9502 635.4132 ] >> endobj 97 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/glaser-michellegmail-com/) >> endobj 98 0 obj << /Type /Annot /Subtype /Link /A 99 0 R /Border [0 0 0] /H /I /Rect [ 183.3712 625.4926 260.3085 635.4132 ] >> endobj 99 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/brianne-olivierifdny-nyc-gov/) >> endobj 100 0 obj << /Type /Annot /Subtype /Link /A 101 0 R /Border [0 0 0] /H /I /Rect [ 265.7295 625.4926 347.5417 635.4132 ] >> endobj 101 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/michael-weidennyumc-org/) >> endobj 102 0 obj << /Type /Annot /Subtype /Link /A 103 0 R /Border [0 0 0] /H /I /Rect [ 352.9627 625.4926 403.9065 635.4132 ] >> endobj 103 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/nolana01/) >> endobj 104 0 obj << /Type /Annot /Subtype /Link /A 105 0 R /Border [0 0 0] /H /I /Rect [ 409.3275 625.4926 466.7550 635.4132 ] >> endobj 105 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/kerry-kellyfdny-nyc-gov/) >> endobj 106 0 obj << /Type /Annot /Subtype /Link /A 107 0 R /Border [0 0 0] /H /I /Rect [ 472.1760 625.4926 543.7020 635.4132 ] >> endobj 107 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/david-prezantfdny-nyc-gov/) >> endobj 108 0 obj << /Type /Annot /Subtype /Link /A 109 0 R /Border [0 0 0] /H /I /Rect [ 438.6360 211.8347 443.4547 220.6530 ] >> endobj 109 0 obj << /Type /Action >> endobj 110 0 obj << /Type /Annot /Subtype /Link /A 111 0 R /Border [0 0 0] /H /I /Rect [ 66.8880 199.9299 71.7067 208.7483 ] >> endobj 111 0 obj << /Type /Action >> endobj 112 0 obj << /Type /Annot /Subtype /Link /A 113 0 R /Border [0 0 0] /H /I /Rect [ 74.1160 199.9299 78.9347 208.7483 ] >> endobj 113 0 obj << /Type /Action >> endobj 114 0 obj << /Type /Annot /Subtype /Link /A 115 0 R /Border [0 0 0] /H /I /Rect [ 81.3440 199.9299 86.1627 208.7483 ] >> endobj 115 0 obj << /Type /Action >> endobj 116 0 obj << /Type /Annot /Subtype /Link /A 117 0 R /Border [0 0 0] /H /I /Rect [ 88.5720 199.9299 93.3907 208.7483 ] >> endobj 117 0 obj << /Type /Action >> endobj 118 0 obj << /Type /Annot /Subtype /Link /A 119 0 R /Border [0 0 0] /H /I /Rect [ 95.8000 199.9299 100.6187 208.7483 ] >> endobj 119 0 obj << /Type /Action >> endobj 120 0 obj << /Type /Annot /Subtype /Link /A 121 0 R /Border [0 0 0] /H /I /Rect [ 103.0280 199.9299 107.8467 208.7483 ] >> endobj 121 0 obj << /Type /Action >> endobj 122 0 obj << /Type /Annot /Subtype /Link /A 123 0 R /Border [0 0 0] /H /I /Rect [ 110.2560 199.9299 115.0747 208.7483 ] >> endobj 123 0 obj << /Type /Action >> endobj 124 0 obj << /Type /Annot /Subtype /Link /A 125 0 R /Border [0 0 0] /H /I /Rect [ 117.4840 199.9299 122.3027 208.7483 ] >> endobj 125 0 obj << /Type /Action >> endobj 126 0 obj << /Type /Annot /Subtype /Link /A 127 0 R /Border [0 0 0] /H /I /Rect [ 124.7120 199.9299 134.3493 208.7483 ] >> endobj 127 0 obj << /Type /Action >> endobj 128 0 obj << /Type /Annot /Subtype /Link /A 129 0 R /Border [0 0 0] /H /I /Rect [ 136.7587 199.9299 146.3960 208.7483 ] >> endobj 129 0 obj << /Type /Action >> endobj 130 0 obj << /Type /Annot /Subtype /Link /A 131 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 716.1516 537.6690 736.9416 ] >> endobj 131 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 132 0 obj << /Type /Annot /Subtype /Link /A 133 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 691.2036 574.3980 711.9936 ] >> endobj 133 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 134 0 obj << /Type /Annot /Subtype /Link /A 135 0 R /Border [0 0 0] /H /I /Rect [ 15.0000 666.2556 279.2010 687.0456 ] >> endobj 135 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article/the-duration-of-an-exposure-response-gradient-between-incident-obstructive-airways-disease-and-work-at-the-world-trade-center-site-2001-2011/) >> endobj 136 0 obj << /Type /Annot /Subtype /Link /A 137 0 R /Border [0 0 0] /H /I /Rect [ 78.6382 649.2621 143.8950 658.9146 ] >> endobj 137 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/article_category/research-article/) >> endobj 138 0 obj << /Type /Annot /Subtype /Link /A 139 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 637.3973 91.2630 647.3179 ] >> endobj 139 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/charleshall/) >> endobj 140 0 obj << /Type /Annot /Subtype /Link /A 141 0 R /Border [0 0 0] /H /I /Rect [ 96.6840 637.3973 147.6278 647.3179 ] >> endobj 141 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/xiaoxue-liufdny-nyc-gov/) >> endobj 142 0 obj << /Type /Annot /Subtype /Link /A 143 0 R /Border [0 0 0] /H /I /Rect [ 153.0488 637.3973 238.6538 647.3179 ] >> endobj 143 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/rachel-zeig-owensfdny-nyc-gov/) >> endobj 144 0 obj << /Type /Annot /Subtype /Link /A 145 0 R /Border [0 0 0] /H /I /Rect [ 244.0748 637.3973 321.5483 647.3179 ] >> endobj 145 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/mayris-webberfdny-nyc-gov/) >> endobj 146 0 obj << /Type /Annot /Subtype /Link /A 147 0 R /Border [0 0 0] /H /I /Rect [ 326.9693 637.3973 406.6170 647.3179 ] >> endobj 147 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/taldrichmontefiore-org/) >> endobj 148 0 obj << /Type /Annot /Subtype /Link /A 149 0 R /Border [0 0 0] /H /I /Rect [ 412.0380 637.3973 484.6365 647.3179 ] >> endobj 149 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/jessicaweakley/) >> endobj 150 0 obj << /Type /Annot /Subtype /Link /A 151 0 R /Border [0 0 0] /H /I /Rect [ 490.0575 637.3973 568.6230 647.3179 ] >> endobj 151 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/theresa-schwartzfdny-nyc-gov/) >> endobj 152 0 obj << /Type /Annot /Subtype /Link /A 153 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 625.4926 93.4275 635.4132 ] >> endobj 153 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/hillel-coheneinstein-yu-edu/) >> endobj 154 0 obj << /Type /Annot /Subtype /Link /A 155 0 R /Border [0 0 0] /H /I /Rect [ 98.8485 625.4926 177.9502 635.4132 ] >> endobj 155 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/glaser-michellegmail-com/) >> endobj 156 0 obj << /Type /Annot /Subtype /Link /A 157 0 R /Border [0 0 0] /H /I /Rect [ 183.3712 625.4926 260.3085 635.4132 ] >> endobj 157 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/brianne-olivierifdny-nyc-gov/) >> endobj 158 0 obj << /Type /Annot /Subtype /Link /A 159 0 R /Border [0 0 0] /H /I /Rect [ 265.7295 625.4926 347.5417 635.4132 ] >> endobj 159 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/michael-weidennyumc-org/) >> endobj 160 0 obj << /Type /Annot /Subtype /Link /A 161 0 R /Border [0 0 0] /H /I /Rect [ 352.9627 625.4926 403.9065 635.4132 ] >> endobj 161 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/nolana01/) >> endobj 162 0 obj << /Type /Annot /Subtype /Link /A 163 0 R /Border [0 0 0] /H /I /Rect [ 409.3275 625.4926 466.7550 635.4132 ] >> endobj 163 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/kerry-kellyfdny-nyc-gov/) >> endobj 164 0 obj << /Type /Annot /Subtype /Link /A 165 0 R /Border [0 0 0] /H /I /Rect [ 472.1760 625.4926 543.7020 635.4132 ] >> endobj 165 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/author/david-prezantfdny-nyc-gov/) >> endobj 166 0 obj << /Type /Annot /Subtype /Link /A 167 0 R /Border [0 0 0] /H /I /Rect [ 438.6360 211.8347 443.4547 220.6530 ] >> endobj 167 0 obj << /Type /Action >> endobj 168 0 obj << /Type /Annot /Subtype /Link /A 169 0 R /Border [0 0 0] /H /I /Rect [ 66.8880 199.9299 71.7067 208.7483 ] >> endobj 169 0 obj << /Type /Action >> endobj 170 0 obj << /Type /Annot /Subtype /Link /A 171 0 R /Border [0 0 0] /H /I /Rect [ 74.1160 199.9299 78.9347 208.7483 ] >> endobj 171 0 obj << /Type /Action >> endobj 172 0 obj << /Type /Annot /Subtype /Link /A 173 0 R /Border [0 0 0] /H /I /Rect [ 81.3440 199.9299 86.1627 208.7483 ] >> endobj 173 0 obj << /Type /Action >> endobj 174 0 obj << /Type /Annot /Subtype /Link /A 175 0 R /Border [0 0 0] /H /I /Rect [ 88.5720 199.9299 93.3907 208.7483 ] >> endobj 175 0 obj << /Type /Action >> endobj 176 0 obj << /Type /Annot /Subtype /Link /A 177 0 R /Border [0 0 0] /H /I /Rect [ 95.8000 199.9299 100.6187 208.7483 ] >> endobj 177 0 obj << /Type /Action >> endobj 178 0 obj << /Type /Annot /Subtype /Link /A 179 0 R /Border [0 0 0] /H /I /Rect [ 103.0280 199.9299 107.8467 208.7483 ] >> endobj 179 0 obj << /Type /Action >> endobj 180 0 obj << /Type /Annot /Subtype /Link /A 181 0 R /Border [0 0 0] /H /I /Rect [ 110.2560 199.9299 115.0747 208.7483 ] >> endobj 181 0 obj << /Type /Action >> endobj 182 0 obj << /Type /Annot /Subtype /Link /A 183 0 R /Border [0 0 0] /H /I /Rect [ 117.4840 199.9299 122.3027 208.7483 ] >> endobj 183 0 obj << /Type /Action >> endobj 184 0 obj << /Type /Annot /Subtype /Link /A 185 0 R /Border [0 0 0] /H /I /Rect [ 124.7120 199.9299 134.3493 208.7483 ] >> endobj 185 0 obj << /Type /Action >> endobj 186 0 obj << /Type /Annot /Subtype /Link /A 187 0 R /Border [0 0 0] /H /I /Rect [ 136.7587 199.9299 146.3960 208.7483 ] >> endobj 187 0 obj << /Type /Action >> endobj 188 0 obj << /Type /Page /Parent 3 0 R /Annots [ 190 0 R 192 0 R 194 0 R 196 0 R 198 0 R 200 0 R 202 0 R 204 0 R 206 0 R 208 0 R 211 0 R 213 0 R 215 0 R 217 0 R 219 0 R 221 0 R 223 0 R 225 0 R 227 0 R 229 0 R 231 0 R 233 0 R 235 0 R 237 0 R 239 0 R 241 0 R 243 0 R 245 0 R 247 0 R 249 0 R ] /Contents 189 0 R >> endobj 189 0 obj << /Length 15337 >> stream 0.271 0.267 0.267 rg q 15.000 -130.211 577.500 907.211 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(The destruction of the World Trade Center \(WTC\) buildings after a terrorist attack on September 11, 2001, resulted in a )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(massive, intense dust cloud that was found to contain a huge variety of irritants including partially combusted and/or pulverized )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(wood, paper, and jet fuel; pulverized construction materials including asbestos, glass, silica, fiberglass, and concrete; complex )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(organic chemicals; lead; and other metals.)] TJ ET 0.267 0.267 0.267 rg BT 208.868 733.269 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 218.505 731.762 Td /F1 9.8 Tf [( Increased incidence of respiratory disease has been reported in firefighters who )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(worked in the rescue/recovery effort and in other worker and non-worker cohorts.)] TJ ET 0.267 0.267 0.267 rg BT 375.222 721.364 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 384.859 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 387.269 721.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 396.906 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 399.315 721.364 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 408.953 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 411.362 721.364 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 420.999 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 423.409 721.364 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 433.046 719.857 Td /F1 9.8 Tf [( Obstructive airway disease )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(\(OAD\), such as asthma and chronic bronchitis, have been shown to be associated with intensity of exposure as measured by )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(arrival time at the WTC site.)] TJ ET 0.267 0.267 0.267 rg BT 146.526 697.555 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 156.163 696.048 Td /F1 9.8 Tf [( New-onset OAD continues to be observed many years after WTC exposure,)] TJ ET 0.267 0.267 0.267 rg BT 486.708 697.555 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 496.345 696.048 Td /F1 9.8 Tf [( contrary to )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(conventional wisdom that irritant-induced asthma is triggered within a relatively short time after exposure.)] TJ ET 0.267 0.267 0.267 rg BT 478.709 685.650 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 488.346 684.143 Td /F1 9.8 Tf [( We set out to )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(determine whether late-onset OAD demonstrated an exposure intensity gradient similar to early-onset disease, which would be )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(consistent with WTC-causation, or whether the exposure gradient disappears over time.)] TJ ET BT 26.250 623.731 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 603.777 Td /F4 9.8 Tf [(Data Sources)] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(Demographic information was obtained from the Fire Department of the City of New York \(FDNY\) employee database. The )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(FDNY medical program, run by the FDNY Bureau of Health Services \(FDNY-BHS\), has used an electronic medical record with )] TJ ET BT 26.250 560.562 Td /F1 9.8 Tf [(ICD-9 coded diagnoses since 1996. Physician diagnoses for this study were obtained from this electronic medical record. Since )] TJ ET BT 26.250 548.658 Td /F1 9.8 Tf [(October 2001, FDNY-BHS also has collected data from self-administered health questionnaires completed during routine )] TJ ET BT 26.250 536.753 Td /F1 9.8 Tf [(monitoring exams conducted every 12-18 months. We used questionnaire information to categorize WTC exposure intensity, )] TJ ET BT 26.250 524.848 Td /F1 9.8 Tf [(smoking status, and the presence of lower respiratory symptoms of cough, shortness of breath, or wheeze.)] TJ ET BT 26.250 505.443 Td /F4 9.8 Tf [(Cohort)] TJ ET BT 26.250 486.039 Td /F1 9.8 Tf [(The study population consisted of uniformed male FDNY firefighters who were on active duty as of 9/11/2001 and had )] TJ ET BT 26.250 474.134 Td /F1 9.8 Tf [(participated in the WTC rescue/recovery effort on or before 9/24/2001. We excluded those who did not consent for research )] TJ ET BT 26.250 462.229 Td /F1 9.8 Tf [(\(1.6%\), those with evidence of pre-9/11 OAD based on FDNY-BHS medical records \(5.1%\), those who did not have a visit with )] TJ ET BT 26.250 450.324 Td /F1 9.8 Tf [(an FDNY-BHS physician prior to 9/11/2011 \(1.3%\), and those with an unknown smoking history \(n=3\) \(Figure 1\). The final )] TJ ET BT 26.250 438.420 Td /F1 9.8 Tf [(analysis cohort consisted of 9,778 individuals.)] TJ ET 0.965 0.965 0.965 rg 26.250 -130.211 555.000 558.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 428.539 m 581.250 428.539 l 581.250 427.789 l 26.250 427.789 l f q 450.000 0 0 543.000 35.250 -124.211 cm /I3 Do Q q 35.250 -130.211 537.000 0.000 re W n Q Q q 15.000 -130.211 577.500 907.211 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(The destruction of the World Trade Center \(WTC\) buildings after a terrorist attack on September 11, 2001, resulted in a )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(massive, intense dust cloud that was found to contain a huge variety of irritants including partially combusted and/or pulverized )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(wood, paper, and jet fuel; pulverized construction materials including asbestos, glass, silica, fiberglass, and concrete; complex )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(organic chemicals; lead; and other metals.)] TJ ET 0.267 0.267 0.267 rg BT 208.868 733.269 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 218.505 731.762 Td /F1 9.8 Tf [( Increased incidence of respiratory disease has been reported in firefighters who )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(worked in the rescue/recovery effort and in other worker and non-worker cohorts.)] TJ ET 0.267 0.267 0.267 rg BT 375.222 721.364 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 384.859 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 387.269 721.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 396.906 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 399.315 721.364 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 408.953 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 411.362 721.364 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 420.999 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 423.409 721.364 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 433.046 719.857 Td /F1 9.8 Tf [( Obstructive airway disease )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(\(OAD\), such as asthma and chronic bronchitis, have been shown to be associated with intensity of exposure as measured by )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(arrival time at the WTC site.)] TJ ET 0.267 0.267 0.267 rg BT 146.526 697.555 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 156.163 696.048 Td /F1 9.8 Tf [( New-onset OAD continues to be observed many years after WTC exposure,)] TJ ET 0.267 0.267 0.267 rg BT 486.708 697.555 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 496.345 696.048 Td /F1 9.8 Tf [( contrary to )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(conventional wisdom that irritant-induced asthma is triggered within a relatively short time after exposure.)] TJ ET 0.267 0.267 0.267 rg BT 478.709 685.650 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 488.346 684.143 Td /F1 9.8 Tf [( We set out to )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(determine whether late-onset OAD demonstrated an exposure intensity gradient similar to early-onset disease, which would be )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(consistent with WTC-causation, or whether the exposure gradient disappears over time.)] TJ ET BT 26.250 623.731 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 603.777 Td /F4 9.8 Tf [(Data Sources)] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(Demographic information was obtained from the Fire Department of the City of New York \(FDNY\) employee database. The )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(FDNY medical program, run by the FDNY Bureau of Health Services \(FDNY-BHS\), has used an electronic medical record with )] TJ ET BT 26.250 560.562 Td /F1 9.8 Tf [(ICD-9 coded diagnoses since 1996. Physician diagnoses for this study were obtained from this electronic medical record. Since )] TJ ET BT 26.250 548.658 Td /F1 9.8 Tf [(October 2001, FDNY-BHS also has collected data from self-administered health questionnaires completed during routine )] TJ ET BT 26.250 536.753 Td /F1 9.8 Tf [(monitoring exams conducted every 12-18 months. We used questionnaire information to categorize WTC exposure intensity, )] TJ ET BT 26.250 524.848 Td /F1 9.8 Tf [(smoking status, and the presence of lower respiratory symptoms of cough, shortness of breath, or wheeze.)] TJ ET BT 26.250 505.443 Td /F4 9.8 Tf [(Cohort)] TJ ET BT 26.250 486.039 Td /F1 9.8 Tf [(The study population consisted of uniformed male FDNY firefighters who were on active duty as of 9/11/2001 and had )] TJ ET BT 26.250 474.134 Td /F1 9.8 Tf [(participated in the WTC rescue/recovery effort on or before 9/24/2001. We excluded those who did not consent for research )] TJ ET BT 26.250 462.229 Td /F1 9.8 Tf [(\(1.6%\), those with evidence of pre-9/11 OAD based on FDNY-BHS medical records \(5.1%\), those who did not have a visit with )] TJ ET BT 26.250 450.324 Td /F1 9.8 Tf [(an FDNY-BHS physician prior to 9/11/2011 \(1.3%\), and those with an unknown smoking history \(n=3\) \(Figure 1\). The final )] TJ ET BT 26.250 438.420 Td /F1 9.8 Tf [(analysis cohort consisted of 9,778 individuals.)] TJ ET 0.965 0.965 0.965 rg 26.250 -130.211 555.000 558.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 428.539 m 581.250 428.539 l 581.250 427.789 l 26.250 427.789 l f q 450.000 0 0 543.000 35.250 -124.211 cm /I3 Do Q q 35.250 -130.211 537.000 0.000 re W n Q Q q 15.000 -130.211 577.500 907.211 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(The destruction of the World Trade Center \(WTC\) buildings after a terrorist attack on September 11, 2001, resulted in a )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(massive, intense dust cloud that was found to contain a huge variety of irritants including partially combusted and/or pulverized )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(wood, paper, and jet fuel; pulverized construction materials including asbestos, glass, silica, fiberglass, and concrete; complex )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(organic chemicals; lead; and other metals.)] TJ ET 0.267 0.267 0.267 rg BT 208.868 733.269 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 218.505 731.762 Td /F1 9.8 Tf [( Increased incidence of respiratory disease has been reported in firefighters who )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(worked in the rescue/recovery effort and in other worker and non-worker cohorts.)] TJ ET 0.267 0.267 0.267 rg BT 375.222 721.364 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 384.859 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 387.269 721.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 396.906 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 399.315 721.364 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 408.953 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 411.362 721.364 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 420.999 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 423.409 721.364 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 433.046 719.857 Td /F1 9.8 Tf [( Obstructive airway disease )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(\(OAD\), such as asthma and chronic bronchitis, have been shown to be associated with intensity of exposure as measured by )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(arrival time at the WTC site.)] TJ ET 0.267 0.267 0.267 rg BT 146.526 697.555 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 156.163 696.048 Td /F1 9.8 Tf [( New-onset OAD continues to be observed many years after WTC exposure,)] TJ ET 0.267 0.267 0.267 rg BT 486.708 697.555 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 496.345 696.048 Td /F1 9.8 Tf [( contrary to )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(conventional wisdom that irritant-induced asthma is triggered within a relatively short time after exposure.)] TJ ET 0.267 0.267 0.267 rg BT 478.709 685.650 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 488.346 684.143 Td /F1 9.8 Tf [( We set out to )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(determine whether late-onset OAD demonstrated an exposure intensity gradient similar to early-onset disease, which would be )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(consistent with WTC-causation, or whether the exposure gradient disappears over time.)] TJ ET BT 26.250 623.731 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 603.777 Td /F4 9.8 Tf [(Data Sources)] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(Demographic information was obtained from the Fire Department of the City of New York \(FDNY\) employee database. The )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(FDNY medical program, run by the FDNY Bureau of Health Services \(FDNY-BHS\), has used an electronic medical record with )] TJ ET BT 26.250 560.562 Td /F1 9.8 Tf [(ICD-9 coded diagnoses since 1996. Physician diagnoses for this study were obtained from this electronic medical record. Since )] TJ ET BT 26.250 548.658 Td /F1 9.8 Tf [(October 2001, FDNY-BHS also has collected data from self-administered health questionnaires completed during routine )] TJ ET BT 26.250 536.753 Td /F1 9.8 Tf [(monitoring exams conducted every 12-18 months. We used questionnaire information to categorize WTC exposure intensity, )] TJ ET BT 26.250 524.848 Td /F1 9.8 Tf [(smoking status, and the presence of lower respiratory symptoms of cough, shortness of breath, or wheeze.)] TJ ET BT 26.250 505.443 Td /F4 9.8 Tf [(Cohort)] TJ ET BT 26.250 486.039 Td /F1 9.8 Tf [(The study population consisted of uniformed male FDNY firefighters who were on active duty as of 9/11/2001 and had )] TJ ET BT 26.250 474.134 Td /F1 9.8 Tf [(participated in the WTC rescue/recovery effort on or before 9/24/2001. We excluded those who did not consent for research )] TJ ET BT 26.250 462.229 Td /F1 9.8 Tf [(\(1.6%\), those with evidence of pre-9/11 OAD based on FDNY-BHS medical records \(5.1%\), those who did not have a visit with )] TJ ET BT 26.250 450.324 Td /F1 9.8 Tf [(an FDNY-BHS physician prior to 9/11/2011 \(1.3%\), and those with an unknown smoking history \(n=3\) \(Figure 1\). The final )] TJ ET BT 26.250 438.420 Td /F1 9.8 Tf [(analysis cohort consisted of 9,778 individuals.)] TJ ET 0.965 0.965 0.965 rg 26.250 -130.211 555.000 558.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 428.539 m 581.250 428.539 l 581.250 427.789 l 26.250 427.789 l f q 450.000 0 0 543.000 35.250 -124.211 cm /I3 Do Q q 35.250 -130.211 537.000 0.000 re W n Q Q q 450.000 0 0 543.000 35.250 -124.211 cm /I3 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(2)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 190 0 obj << /Type /Annot /Subtype /Link /A 191 0 R /Border [0 0 0] /H /I /Rect [ 208.8675 732.4674 218.5048 741.2858 ] >> endobj 191 0 obj << /Type /Action >> endobj 192 0 obj << /Type /Annot /Subtype /Link /A 193 0 R /Border [0 0 0] /H /I /Rect [ 375.2220 720.5627 384.8593 729.3810 ] >> endobj 193 0 obj << /Type /Action >> endobj 194 0 obj << /Type /Annot /Subtype /Link /A 195 0 R /Border [0 0 0] /H /I /Rect [ 387.2687 720.5627 396.9060 729.3810 ] >> endobj 195 0 obj << /Type /Action >> endobj 196 0 obj << /Type /Annot /Subtype /Link /A 197 0 R /Border [0 0 0] /H /I /Rect [ 399.3153 720.5627 408.9527 729.3810 ] >> endobj 197 0 obj << /Type /Action >> endobj 198 0 obj << /Type /Annot /Subtype /Link /A 199 0 R /Border [0 0 0] /H /I /Rect [ 411.3620 720.5627 420.9993 729.3810 ] >> endobj 199 0 obj << /Type /Action >> endobj 200 0 obj << /Type /Annot /Subtype /Link /A 201 0 R /Border [0 0 0] /H /I /Rect [ 423.4087 720.5627 433.0460 729.3810 ] >> endobj 201 0 obj << /Type /Action >> endobj 202 0 obj << /Type /Annot /Subtype /Link /A 203 0 R /Border [0 0 0] /H /I /Rect [ 146.5260 696.7532 156.1633 705.5715 ] >> endobj 203 0 obj << /Type /Action >> endobj 204 0 obj << /Type /Annot /Subtype /Link /A 205 0 R /Border [0 0 0] /H /I /Rect [ 486.7078 696.7532 496.3452 705.5715 ] >> endobj 205 0 obj << /Type /Action >> endobj 206 0 obj << /Type /Annot /Subtype /Link /A 207 0 R /Border [0 0 0] /H /I /Rect [ 478.7085 684.8484 488.3458 693.6667 ] >> endobj 207 0 obj << /Type /Action >> endobj 208 0 obj << /Type /Annot /Subtype /Link /A 209 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 -124.2113 485.2500 418.7887 ] >> endobj 209 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/02/Figure-1_new-page-001-e1432153162759.jpg) >> endobj 210 0 obj << /Type /XObject /Subtype /Image /Width 600 /Height 724 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 59744>> stream JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   X" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?R:EPE((4RQ@zZCE-%^R (hRPEQGzJ^RRE%)((@Q@Q@Gz3A( QIK@(PF8( (!(4P(3I@ Eb(PEf(4P(PEQ@(f ( ( LRҀ3@i)h@z(^PEPEPEPEPE(EQFh()w(3A3EQEvQ((QEQEuEP@((4v(((;RE%-袊((c+ _2/3뚤w/s%BRX^? է .f7ψX^tW5i>|GN?]{'y3VC,/C6i>#a{^? է .N?]zᚴ>#a{ է .=5 .~͚kg#a{ է .=f7ψX^t5i>|G`M?]Zw3Ex?|B͚kt,/ +?ᚴ>#a{5i>|G`M?]Zw(^>f4u,/A6iǟhms#,/Q5gψX^tWٳMǟGצ>#a{+ᚴ>#a{5i>|G_W6i |{5i>|G`N?>|GzhψX^tWٯM=|Gjӿ|@Ex3VC,/?t>#a{Q^Fg~_\=E_3Oq$BJ[xE{Ph(4wQ@(EP(QEQJZ(RPA4QFh;PhҾsvɚ87[q_F7J &ku}EyOĿ~2"{-@./:'-/[[k=̓fIVl0# y.?i[d6kWOY!F|Ȣr ?gɣC`XC';e8#RXH_<٥tG{SjHһ,Si4|U ͣt5;k2JH]!/ޤ6CW4E5 sO5 {sw\MmH]$yPH088h!x[NQ,t˫R)!)jU3.xVn>ƞ- KWy Ir{wfY `1_߅u~Z=J"VΆ2Z8H@H/^ȥ$i |QES*ۍg o?,ժZ\_A1@ȏ!s@wmN]_BѬ/q{Z^xcffG!=nSiOڿ4XW"diتNkV#BSυ/<'mY4URk;xx?:!.26F+:_z&77zq7H\Q,L$t򘜲& 7W[(;PE&<̐:1FڹRHʃTx"H4УNԴM.ر0ە9 oukmjoqvl/yRVa qA+9r*a?5Z;c67wz좼DH.-9`r͵[nWskqYMqmm=Ki\Z3[ͳ΅.sddxCI5cewe pVR XD9YcC:¯?(mÏ'ִ oR5-Yl7R$9}l7ǬEyv~$}r,v>Liv&C!җKtkyN" E>5c7|?|#xkLѦҴ"K<ɸ9IA ;.vcOPse_J5I-=A˫9*l۝\(=Ŗjw0E[4u4jYXN ̇ӟo~h!Qmq}D=8(ʬv@9ȮQfZ|Mˬ^ xy>w<41(pH"8O |z~ hv&wkmu~;cEhB@礍6 ݯo[aM^t-u+d&i$CfF9t0ɸ񏗏m 7<17et}FvĂYO~@U qMA\(Z).A^kw2AL*$yḿP[~wÖܶSjMw-"}rSz0H{cN3oeoo_m-!O9B͑@S%yGMshl"x5k[1$@|B``c"?8?Θd2JVe&O3v6s@'S5o j|Ya] J{fQ _\ܬD,o2 ͫx7~c^ CTirȻsg/iZT \ڕ5V##mq d&TYU dO1N ->5Kk ȼ6+@rO4 h;6ף5xZޕ{2YOD d}Fwc_ |!x7.u!TH[KX`HaiT+9T?B_b֭bפ>"dY8bU!@'?Go{Ư<0Q)3+m  >! Gu&xTx6Z[{LgZ$w:ǧx7xWz ѴK+k&!2JO#a ` xƝ3zG(fMP]M}5k Vi.bI3nuPN96@9> Eߌ)h$׎6m eKt$b!&3Nѵ8,m[7VѦ[}ѸΖN# /o յN-KV`kW;: gwḮ.uJWvyV@Qm͸ X~9^8fhy|=2DIE~QmP͸Bu^>_-M/}5հksUG{IHN=[M_mCLGw7߿|-Yn5o6Zu\K55;Kmb¶S\}zA-W]gg}2 IA|YodzVi^!Ŭ[jw R7UOm¼,*9P {;-#:i۵S.I+lmU,W|g˼ V]ԥm.,.Mu0Ky^h !:#QqvEoPⴙ[WeRܨUдomb4{.%`;}&R4h)'c7 ^^^??;(gJ (4Pڊ(3EQ((((RPEQEQ֊:P(W_N3_K+_9;~-Kᯄ-A粴uO 2"yq7V0HUHK_cIռ]Q]GVw, Xg y?#x%WEx{SRƩ{LL˵grzۣgCD:]q~ I ,Gjǁ@Td TY[j^ִJkk 'N]M/& VBf#h`ytN%q^^[E3}nS!ϙP$ n,#Zֵ[Z6vjO-`YNf|(rb?٧F<9 gMni&n^hL"f-8ƨP/A4oItBQB#BMj NH㑌ˎ^i_m3PJ|9> @D|-,{C6x{gZx)/5-;x"\A9Pr6u+y3x7Q}"/n,4@7c.ŀ*#4ͥAHwKc[hdB2T+Sj'fo--|=Ⱦ&r}4w ` }0=𥜰\VHF&՚&x \h1A$5zmS3\j1YV]m&M^?rƟ )+8f:DrD oxĺvxoZ:%<5cL?Qgg0A;`z~=3_>2!]/P(#s^o[z.vވn"K)e]F]8ծnzoZfPY0fl~Uڸ#֭wS].}e`ʍ9 BU9Z@5WuV7XSECdVی LV&n]73ۘi䳊269a4N㔺hooMA}WPw/ye`B~Xr?j hBM4MC]B 61"c*㷩sC?K&}X9l텝Y]"h.% 8(Fف+ oZkTﴫM26Vl,qPF $8_j엺I]w$̅eI2 ~:uu vڶ.6klH]Q/ۗ_ \WHWlڳƃH$Ij<3&P?w-ZJi_3吣+ J;h۽: kTՒKH/5D4ia@tݖS s?j;}=5af] Bm6lY# 7@|z&ZcR8dy"kI l;\㊇߳ށMr+NJ{4"eMkS ʻ͵]p(Wq_ H!74=6ֳ5uU O_:0$}+O1[^\u]kk,f|1#>Bմ+RUաWY#0!AYH:5i_,eɤX%f}mѯ# (m5ˬ,;$71K:lϚ[~:?w]=/Ct B#*BWxW߈|AyH>L*X\P6Ldrg7kRxf{)}Y6P˜DFp8 _Yľ*:ΓoMV8]FE™4ER؀MzơIci:<E=7U$b eKҢ>IJ6FN>c6mmv׻-4x}Z'JoUQaFY/-OX.5{=fU><֥M#]lU=XW/x? [gDR;^E+cay<mn-m,}+SnESgXr6;@5z^I.5x"Ȧ0% ppo ;guzG~fu}z`;U&:cO'ys[Կh-槢c6-FKS2K4[6C)@ABqs7K_:kɧXHPy0'ܲ1hd\|Ѹdu5/A|y?[RaTfdyI rv 9oӼ ڧjpAy{i~;,eL!B7WR9S}1@e֚O[n?ê&_ZĤI~df ܓWyGw|iOgoke=RF4_>QRkjP5|k%P|d!$W}y)Q$!meʱFGRE8 yk Zx#&H6VfFe!V85x7>/ zp٤n1I@{4xo.?Y_63ͥ{ً7fR 쥖FwgHoMehk?cԬ[^1FxxԒwmo4=vvBgo M/uO Ť+kx]KJر,͒O9$/߆9<;mih6GRMHfVy@,q5ʒ@>(bY6tKWҠӼh#ͼo17B"=O ^xKCPZ\icGKXD5J C`{F?iuҽj ( ( ( ( (ր (EPF9(((PGE(Ҿsvɚ87]q_F7J &km}Iii(qE%QI@ Eh@R@ Eb(((QI\^m:7>4h mu{{k_-lH ̼`9 GGí3fO"/5N"GF㝣PeAYwtnK/PR *O8#q^_zE߄<]OzxuG)bPm؀>Gmotj[mJHź$Y#fVF@rP_y7i(` g+t^&ii:ިf t-S[ydC#<>LVl;dqƶ?LYO⽁.lag(((GZ(;PEPGҊ((((''c3 ^^^??;(gJ ()i((((((tPIK@Q@%-h4Q@ nLq.C<f?gܥ1x'TT.-ʷx'}ZiХ-_ _=4f{)|F Wj?᧼?Bo F_ _iХ-_)+?᧼?Bo F{(F Wj WOx/AjG4Qk᧼?Bo F{)|F Wju _iХ-_(}qx_Y,9zƖ~]t]$~gfqq\Y'|@Zdy1$e8w< ib)F\ZX撼{)|F Wj?᧼?Bo FC+?᧼?Bo F{)|F Wj˟,5Ay YiI=mu5WcU;)<HZ6D̈J WOx/AjG4RWOAjG4R׏Ox/AjG4RWO/AjG4Rx4ROxAj@Fx _iХ-_ _iУ-_( ?iХ-_3+᧼?Bo F)|F Wj њiХ-_ _=iХ-_ ? MG?WװW| 7~"Ax{@_.4j(E mYWQ@4QEEf(((Z;IE-Q@Q@Q@ GFih(PE-QK(;KE&)hJZ #?󷯞 ?5J"?4|0;zX~cW`&?F|3\z^ҊwN_>N)qEQZ(4b _\/m)K_ jp4,-h?*+?<@ j/ǿo5B_!W{_*?<@ =WTx+~=y _k@F+?<@ j/ǿo5B_ W{_*?<@ =ъj/ǿo5B_ F+?<@ j/ǿo5B_ _kG5G7!PWTx+~=y _k@?*j/ǿo5B_ Ey5G7!WW*J8m]"Mtޙ(܂(Q@(  ((?((Ɗ(JZ1t֊(EQERR@;E ( ( ( (E%-PRE|MϞ+({[Ϟ+(/cgbת?V:f_>(f oT//3*B8(Z&"WCQ;LU|3X𵷈4 qc0#`I G"a5 ?z>:w쩴&` &;'NoȲyln Al)rh$8ݹR+hzt?> QYl lo aAv’ۣi L5k 8l+ ï#㊫i^8mzl"G6¹1ѸKx@|AQ&Z׶K\}h\H`ߜm8 c'% FcXX\<Rݐc 5! K@X(އW:ѭuYll7zc\>q`4хv ןh>y->_̷>mּ1y/w&37:Ⱦ#{ MMmk &}VIHO86T̾?HV]Qˤi-Caa{ p°hʂNƖ4R($޵w&sx H ߣ pWo9E|ˣ02kſgX5hk6a}ǹm֟!{|?Zk>]:}.9}A,0@s)p~V+?V]Ggt[HFHɎEV##ֿ??iFꫠX9ۋgczO0QlUZO |Y:R׮amԭ ؁C6R@IPBpP+Wῌt߇UO0'2o/:h슖A숮W sçIO2_Xin׳Q≕;$qB@>.zz_ ;C޷jZNjZ}gYfS)! /xJM>#>4_iLo9B3̐ $@[xZ_<;j?elb3\MN$(|}j>,w[voҮM1DmQ!@R/b?/B,zWҟQ3%$ΪH7z `/ǯ@pƏ ^^?Kƿh(((4Q@(((FhEQEP(( Z(3EQEQEu(((((Q@D?gav򾿫ƃ}nmd WQ>}o|}Y v%ƧEeUGD q~8[w}MCſ -?'4/ m#7#7=Q}ƾ18/iώ_!Yӥ\cԴG:gd᱑E}.Jo%^I4GXBi6jGqpM|6I5leʍvLQk쏀Z >'iҴHtMgL xW4k,='D/ynzdk(?iChxE袊(Mf:`rzPъk6A E3xr(h%-%-%-%W-ƿk+{_?-{%-QE%-%/z f QEQE(Q@ KE@tEPڃE%-wPEPE%-Q@(QEQE(4QEt !#G󷯟!hZk&2Zû6zY`᷺0L}#NJ|-ش2M9D6p7?+"n Κ.LajCV݂./+[bs@`ſGU׵-NhOko9K+e˜<~<-6X,Ʊ ~ t!>tp,7,e^+|wk|=x:w(!]HUOU M_iq,"!%k&۔ 1Pj(.5[x<;e&3kR=dC 4B`!A3֩~u{sieokq}(XbP;>f <@*hhRfIFhk{_?-zk~=|j#H=QQ@z(Eh(-Ph(J^襢 ( ( 1EQEQ@Q@%-QE (/'WӴvRmOP[{M/EԤhdY2PF2s՞>0]* :׏VxxMw!PQ^? Y!5B?Bk@Y*֮?FK֮m2%Q,꫸g՞>1]*c~`GkMn'{h|aH~ж?K/hD+$xT\tǖs_O x:Iqo_K|XG@Ns^Pi%UCYsZY=Ku9漋׆aƶ!)nt7pvJHK`98n)b%Rݟ_>>𾥣V"^擺&I:WWGҴ?Ŗ:ub(-;/]hVxxMw&0RQJN +<<|c&TVx xMw =j ՞>0]* ~Κ<]={ź ~ϭ\iƥ{K֥-b @ + ))hIKI@-PF(3Eh(PGzJ;IE- ;QE(EQA-: ^PR'jQF(@=xSmcNe{+; ؍LaZCOj|g?5l|I}7F?9` ,aS ]e7pG<2,ȡD`y޾\/Ɲkx5/kZ.5D#Dx,"rC}T!5:Cim"\IFFWf>G5v,lqfc5?zm#zEkEu^MbSif+L 2V'D|1&jKa wy*$Y7pyXҵ=sJԬ%6WJ*F}Ak'@񾉮Ή%޲ZH9A)Q>K*#w W/gş>dj@nԏn0Y_I 5swZW:z-2[ǹӍy/y?*HrGlP%Zoǁ¬I";rCmtHT0>Dc:WZ'z׆׵x~y|7=ݖ}za-z$OG!}PaSwšoj?g6Z}kP %Evmvo 2>p'KhpR/cdNW|{%ww>4RRڀ:P)h))hb NP@JZ(E-vPREP(EQK@Q&(Z( ( ( ( );REPEP(@Q@?xSmcNe{x'qO8iu4$g҂+~.|CB:DWFgD>e!P(v}?.}oxKKB]6&XV1G ǘϰvȠISɦzA ׾=\Kj:'E2̾`SSYWZvFQ-g ּC{ۭ^Oy-Рp]X018ͺHv:Ƥ1P<ϲ| W!ĚMK-!T[H_F;UYps' 8}|gO[Y[oI \y1쬒Fr i*]pmۛ ,Px&W[h5>Zs<#n ﭵ Xmn"C4.{G{Ϛo/0j$a&,*+( KoKR!xqTI$W3.k# ?yͫh'[hcK[uDȁ)9 3#oJpR/cdNW|?^]1IKI@ (IڌRLRRE&) (()i(-QEb(PъCGzZ;QF(()hR@R@Q@QEPEf ))h(@Q@Q@=xSmcNe{ x'qO8i ֑\2ƒ;rzga4422l'Ҭ@͌.4d۷iPF=>ӭ4xcdR:`vTPc* {E;"*s>׵Oڊ|i$QȱA Gp;TV, u)hUԪ1Q.j ƞX\]laY$n#=iO,89!P ՚(E$3"4W* (=@4h Tm\.0=?JP{/%ww*Ӽ&ih4QEtJZ(3IK;GJ(J)h(QEQE JZ(ϵ-RҀ ( J^PRQEQQE((((JZ( EQGZ(; ؍L`ֿ<)b6 2("M xI][$@n@Hg#zcxzwM]F'i6٢9F8| s{^.em4*Xt lnd+u r]$aC[=C."G${u;Hyp\<_ 1o:&SsȲ1IJ' ~f'h,I폆4}.YvvA tF 4מ7gh-CH`<4mtk1DBwy_#'7 7^%r^eom iοfcƊ-%x]@wrEzm@̷ZĚ۽F&6C^F *c i}Tޡz[vwpE<Ȭ?xiX8O?io N&ioHwqY3I܉q1r#gDw|uuK.9/O4qhc $Je*3y[ڏ-vAVѦ{k)CBpyU.x6MvZ{MXYLa䎣C;?>cqkھߛMAYŦ}{y{}r7SlT$I8DEUP;E%-|?^]௣ "_J?}!1@b-IF)h)qEPJ^PF(Q@ >bZ1EP1E%-!( Z(B)OJLPR(:F((( ( (EQҊ(1EPEh(<)b6 2Z4Z( JZ((h:4RR J){_7)Uqx+ R/edNPRR))h IK@%-%-RfPJ(9@JZ(4RPڌ@ KIGzZ(%-QIEQE-Q@h((( Q@b(PE__|mK@񯂵 FנDt{iwAP8+=^Exپ>C_>` 7qWz||ÏP>?_ (G7Z-nu IYl$*v>_q9?ƫxoHisIj0YƳXG*aߛg( ~|,? b҈XZ50>c^q}o/پ>ϝ_<?!fAǫ(>?_Z||ǫ':Çm{7 ,x :?PAɴ9dW-x>:Åm/2ρ!8Z&nnWAxɴ@Q|~nK xɴnG2?!8z&ux2ρ!8z& ɴ;ȯXFhxPMZ8k@øQeG_pMǂh(WCމBeW_=?_yy8[xk>~|MQfU[ݔC{7y_eOu=᫫BծM*=N߄z]Yj saOc K:DZ)#FH>ᢑ; hYcee!NAXK ~i6?HntKVQ[xZ& QgF. U}j>-`Ю/O6V6z%6>ǜUEI2Jfm>Oĺ.kFͤ=p2a'i A5?W:ss{ m"(Ep2L cOhѥ5;sIx+Rd'#&>}Fx>[b? eՄضaFv1#R[_'@қ,'6ɽ yK,#op3ôٳv:]jz݂Y59 5`v&4ʩžvIS㿆?K]>-PE6t/,4+!d2ʻ)cW}4ȯ>r y5xUG.UD7G ~ڢJ yN>U տjcFt?ACڨGIWH!1by"uqv 7 ~>o"~Żݞv浴zE.xR4k=Y{227 rNFIh/O /\jV}PY BafZ`ݰJCK}El[J Mi=G`HE 1cs+ >8Cχm4m5^K[ku=BGK1L; !5gM%N.VQQht^8e/޳$3ՉlCNmb;qyK2^KɮUSTwT'zrORIω_ᎺZ+SjIZ_9T oRX)߉#߆euj\J5 lmFD07/Ƿԯ.ӣ5;$o ;'bdǟt_:$zf 7ZKCT  ~*˯⏇_&sU։j2$6CpcTHX*qz o|5ke|A#𦫯lpV|aS,^Tt^> $uKu՞U!xci^F%#U?* RI>4׶SWZ8]J&R૜PGŸkJ; r|kxG ]#L4;[ 7w/ ĕ>RY5/?:^IQZ_ٰ! [Kqi0H\k## HYN[CMgğ Ɨv WđZ,vo1a o(XFm5/ x^fX[ rsb6^ٞB`e`~Q?lm|rڽw_hӫu.<8ZmрGo-Yi~,1\Ct+bU7DQTe Ey?xK_ᔍ4]3Ub2+p;!$Wz@5/ßEkJM"QEQEQG(()(hGj(PE(:Q@Q@ E-QE( |MB}B{[ΚkPa{w6wZA*IYH$\7k67KM:#7sz~~9|0 R90 W ϡo/(w?/om*@saB?^Ÿ?c[ʿP?Ѕ(saB?~?h2i?-@1}).=-$9qz+o|>ƿ"Lm7f[J c}>xh/ċi0 hpqfl]{SJ jϏ4|0;zX~cWqT|_O- 1mGWckm5_ zl^o)r#;)@Ҝr -uT,jzh~\ ߴ]m%\c$v%%f}d Z*J )h@+~# O9ώg]f6կ#]ڥ!r{ @@(E?SY?᭾c_v=c񢼟?MehE?SYzZkoX5?Me(-y?5,~šQ m?W[|) k/;@I^Q m;[|)z k/9G5,~šPxH}Z'; .rGk?قoRuMi!RzCj=Ws0I6sR15[|/) k/;@¸ug"mK;K(N9皡珴VtO [Mm;L>b`gb[|/) k/;@g=cĚwt8.DТӢ5ūz[233dA9 <=^询:|:b0HgXn1[|/) k/9@G^O m?[|/)z᭾c_rkoX5W4v(E?SY?᭾c_r=c k/;G5,~šQ^O m?[|)z-y?5,~š m;W[|/) k/;@zM"`ֿ k/9UcRهἑh𲲜pAbފ((Ef (h(( @7/>]i>!'PIm,./&x($}FL 湏k+5׃G?I`o?" c%uoFKO2Cu2jvm eApa!|9_,i$z֠9X7w ][o?#WU]GRl2K<4%X7w ][ho?#W^%4kK[{[{YedF )XsZt? ]WVj?~PX7w ][o?#WD3E-mL9P& RFO:o?"[n]SUZM[^5;M7Tt;Q8Ynx'֬/,˰ %Um-I`rqӽ~tҺ/txjJ>ݣ5ŏ2=Ii|CܺurnהּJkD9e|qtH1;_N[œg86aڽeoa4v,j]bI=&YjT]}._JUW>垅c&O jrIkwkJ^,o#F;&+]Z +.#<9VsxM$? ]WVj?~p3֛*Rdy5տk+5zm7SGooi\""xG4fNKUg7 ,8\;ԑy7o?#TR uɎ'zNMİXKj0\5 xKvl3 wHWu+뛫kk..-%QJ9RG<P|-:" AzH]|T\Lj46:dkXGB N:+NZoOì\)xt.Qn%QK;jjXGTZ?>]c Skcj:ޑk\궃uŌ7(=^0w/^zng Uw)! Av"Q@/Qk>ڀ+gZϼ_>}Y+gZϼ_:}Y+gZϼ_:}X4[:}/u| GZk>_gPsZwֿ*[:}ֿ*[:}ֿ*_:}'u| EVεxGu| h ֧]SETmQҟEъ?(QEP QEQEQERR@?3}sK oN#_װP^5w<xV4+^?{]^ u(Фt85W|UuJkmM/,n.AWC9]U0d2s //xMVt\K4奼BԢavȿW;OE|---/%q'p_+tbF /b>!񾱬Ś}xu/h_c1Zo2.3J~0Ԥ[x T{)8 lEe?9 ؾA_ Gg^qgwOš]A^i|9m%tV}c]p{At5cM}'SY$bNagrprßZUkhx> _mƠnK僽dr[$p1i=~YJ񅶅+kmjIm\y#ę"3ڃ?Nƺƹk7&Y8K{[XeġA$w'Wx3U="_xIW5,}=<-d&,\||}}}! PM|-YaV%iI-Z3}T,%Y&(DwrIkƹcZc50|OU[[y-> j70,v<.q'7 Ҩ]wLlu+&YH}u|C>oܾx-n3YbwیQ8}0ScNԢAt0i os+'$a־:-=5K(oH0\&-H=X{@'O| ;@'l-d,"4N{2yOc*1o4i]Í&Otuq$],y64'p W|-3GH|KKPR;y/%x  ɂ1+޼Ҝ1@oMy&sHaJտy\_A5濲w4o!=WQEQڊQ@Q@Q@J( ( ( ( ?PEf (@Q@Q@Q@Qހ ( PE((PEPRъ(;؏~^+5;؏~^@ F)hQEQEQE%Ϳi gSj:..钵LI]@=h~|X6MGo4? Pkqw ݊x2X'tk]l_0x,xlb< Mq7dzRo_Q˟ߌucդ$4 @m%dܥ#;J*0Ϸ/>7^<cv\>|)Ry ^7 -3_]q; mkO+EVGZYNXʌ9&]7;> eN(%-RRހ*j /O;Mg7^.kd5&hC z(JZ(Q@ җERR@Qր (Z(;PEPtt JZ(((hQ@Q@Q@f(oN#_װb/▧3"]/ j\Ϡ-#?R,Do i/4}^otS۹ H$kᢤYǨg'4M*|Q.4+Zb7zg޺,?R,DԟR,DOiZj͔ژC-f,6hn܂H8ĺ bmvmj]CRXԛQ)}=ö'PcE9 Ab2ƼO۝:9xݯ|͉DLv =15P}GZӬ殯yq,7Arar2Ha+ԇtrJ_<[}V`Oا(Ƞqx7JԵW:@Y\36 '~rs^t?h?|F"?ᢤYǫ=| JZh?|F"?ᢤYǨ(go'*O%Hz=h?|G"?ᢤYǨ( g'*O%Hz=9.O%Hz*O%Hz=WV]qךk?LѿͿf>|Fԏ\g~ _wX~ľ)|\jV6̈~csssXI=(3^? A|e}_A{|D_7aK A|e}W_A|D_7a@A5|D_7aG._ XP^= A|e}|D_7a@Ex._ XQ A|e} 4W_A/.o XPQ^? A|e}_A{D_7aG._ XPQ޼/,( 2 :W_A|D_7a@Ex.o XR_A{ |D_7aG._ XP|D_7aI A|e}4W7_`Ņпa]?V5!o4u5[{mV1lbvYPEPE ( (QEQڊ QI FG4`zRPF0=RҊ(PF-`Ph@C'cϞx~cWQ}o+zX~cW`?X?VڑiH0(``RހAKI0=)vAEm ڼ~G5ָ1 y8y ޹b6p=W|]5m7\cå'o̢! )\XO 5[~=ǀ/4-)PX`ۋmFKkDqLQѸ:d[W?{^/mƥ~-֧"o'D`*Hu_'SK-fMoMѵ*ŝ1@$ye pdDVn$͏1_;xA<+ k:]"I%ԲDk$'p2#OXB[O,n[V[%kZ 1Hˆm!v@SoLAԌW >&xc:5MjZNZg}:dws-3ʐZ# K;n)Klq mW<9mgA+w6B"KKf:m{ƧʑK@(.QM}`zmŜY*iIcS*G)nk0ϮEi¶WimЩ`lr/,1/㏈𥬾 |2`ڳ'ŪAi;rJ{\?|sлJ[h$ɈPUdb -m43PK`ՇZXE!lc N1_>/Wj7c.ʙu) $ge7 ~|[\xWW5+ǧ)4Vܢ1n'@M¯wwقItծ@<'wgғ⯆їU}Gmk LMLX)\9|??śȴܯm5uKAlv4S 8]65bsh騣]PI\:;k"ɵ.?{'xcÿ/-Y/n1ik8W(J?u"F}|[$Ҽ=/>y.t_][OZLaK#$lVu$&JPs:όZ֑+7 _tWMtDЙc'ƶw_xw_Ԭ<59tG%e J9twmRHC7Gd#!6dz)6>$K[ZڬL]*V\ eFDuY2pwm`4nWp;ͥZx2I]nSa*yK-;F6[ۼjͱ_(X2g#9l'%αc[NK[5o.YRPIF`smsNJ[Cu?\em-ŔXt1Yl }Xd(t-WŰ'>5o5}?֛n'k}Ȩb 8N0½+ׂIz:x/lGldam VvC@U+?ex$qb(QEQEQE(@~PރҊJ^Q@QH}(;QF3E%-PEPE30;z÷g_skio4Dx31$+ !#?o_%x) |}8#ϗw|v:\n?U/??x_6]//???x_6]~X}޷ho_/^~m?y99?G<7Ə~?/???x_6]ua z?GC?ß/.^~mo z_e! ͿG/???x_6]~X}޷ho~~O ?/.,~[4}޷hW??l>-|#CxEH5]\,;Ye&$&wF[9;NHhso,sM9& A hQ}~$kk`ٛm#wpFz̲a*{ou`qҭ7NKWQEQE(< ░u Ni"M]NT8]am-ĩJ^Id`Kxm:xwC_[S#.Wy;y{0cb@' Mǟ:Ƨcg;E$6jm\@ ȓ0 o1< L(.e޹alʳ5O/pʒ 0OF +OF\]Je[XŒw:`0Fq_6xC)K}I_n'T1r" iwÚ_> {9ؙ.{@ԵQTmٯN7#RN+>mڣ,P/${6KR^i}˹ |l7._˒2+^/z Gix1nP2P/$cj? COONJ5:cKh}ݤxv#np@i37g;uxEcYnK֎!{c|0.Xb>мuxVմ'X %-Be{G`JINޯ?4V?kcGu M2;;;KI^ѪU #&{J~% Mnl5[i|yVS+( ~|,? b҈2?F|1_>gOO.3'/^)*_y^Ɵ>Џrt&|$Oרg<3'/G2gO_.z=_x{*ʾȿЏrtɟ ?Gޯ?=?_q_ ?G?Џru~{zT}Ǒ%$O}?^4{z{ʾ;ؾ?~о& >MEnSv|cD$~ s/Yt Xl|E #Ax⽯P۱ϭy޹b6u+M艣Bo˻= t(PEP(TRPrۤ謌 #QPi:5imioim(cQEP0\'Οkx4LI c˞ FGb}jbGAJK@][jZsm24R*GFe`x 5(B@┰A"r(v.sfRnK@P1(1EPEPEP^?(_CGH=_PQEQEQEQEPh (w;Q@ KEsEPEPEPڊQEQҊ(V{~N֯m2EaG78&|} >޾|1XDU~ xHHLݺvǯ' n* ( ( 1EQEw?F~N\O ))hҎPEʊ(@Q@z gO\A#E4ZmˤeaAs]Cyi $J$Eܮ`#|i_(X-} y4-/-F/X>Fe$פx_Ś_t*sqg+fxd>|dViTԡ/~xB^[ӭ:n}8dy>!c~*Լ%m3sfIe2Hd0<08ɮN⧄ I,VɳMUw`)fUQtS<U*<A֕mi!YKTG@kCMt ?1h>$q D1#W ]FG̹Զ quOY]i-~P PÀ3p#/}OGm_M'4-?-ﴏ^{};WW:żQ3s" }Gox+ıhoG ¢E۱7nJP+ {D? m&ZMwW3Zsa] ܐNYFu̱|)yI',RKTG a vq@g4-?,_h[$[k58 K~%pn-R͜\K =@q {D? m&ZMzؑ=j,/5{.YY18 nwМcdPB#_IG^,.5&9K"̪w9r*"G\/!;ZVO}kQZss[oX3Ⱥe& 43?ob&v/3hOB~Ѳp]|+e <<{)a xAVy&B"(,N=f?7m ^u{-:[}Ijm+Ҁ>q'_'W%?+ /߃51;ľֵ3[Ni/dxD~f] #@;?+'_/W%׽j6ֵhNsࠗ۰3~]g}>Q 1WYWX]IPx&>w'_/W%G¿6_Kl0'QD16GՌm#a;u=3]&xEoKkXC+b4w!? |c?.'Xe Ԏ>S{>| _H`Vaj.bdE*MFMt?Aҿc5/)iKzx2't?>Ѓ/W(Ѓ/Q {+*d? _T!J_`<:WUȟAҿ(D;B|G2't (>Ѓ/Q {+*d? _T!J_`x2t?Ѓ/WQ@? { _U ^Öt}#G`]ǽ܁}ɭ(Q@Q@P:Y&oUIZuoo@4m Q?*{M?:GE^@=[Y>xÖ~ K7]>%{c!{M|q_|GL-xI)I5{[%Rq$Иz#nuz=BR&M6#8Rp«=yZ]lj+xuiyom?هEז1$A|¾ (H|%@^ 6k8m-4崽OFK41pP{|gSP5kMӮI U͸d`@׾phK x%(|H0w:0[@-7mS/`Dpzg|?ғx~M^KBidk5"$Ir\M⟳ot]#ēG{Kk[ GIukY6!wdrMx/~BgYcwjW٥[t¬^s@ > M>J׼ xVӛI-ou5Z'-tR~m xRף/siKuqiNrRɖ$ȅTZ:^uMЗD /u[Dn䶸0vKH:Z޻RWyTo2B@ZP`m}Rm<xv'K_xoShx|i7:mc;2%f Jr`UYrC{/:.mo[RWutQ(ya}k׶ \qkQOƻMB-x o7 is,&&7%v~uMSÚƳi93 x[%EɌ17Wy4|emV?W{o^nexEKi2KvM㆗c>6CMo-ԢK,Y8#}Gx<}p^^)Is{< 9AGmmQx=ΏB1뚞kgԊE(p$M X{(\So~"оhO cCDujD g5'ҩ%F#9CI? }'2iz.Kd0aqkw#zT)5/$՚zap8 '1 qxqF!o/ hDң]+Vtd- UdnM}ih|j^"P^A?$%- !4wBvk'U6Zd2r{m99Y]rőH-_EbǞ3:~ t<iE΋%ՖR䥪y㟴}G R _VU@5|-N'kmS ZݵMՆ"!8 N: PTW|d6V 6 $3{VԎ}8WbVk'aS`[sD&dY) nˑ @Exo"L}Ԇ;mU[oDu`?(y NM&[Zχ4 b-t衔!xRX`NID)4Wz4ƅ]nVѼP.7G%M04Q ,20hC"0tar (((PE'JZ((QIZ(()N?J/MKZW^^Aɩ|KJX׻њ((RPE%-v ( ( ) .hQEw+7-/kJ|M"ޫ^8?{M?:GE^^c/ɵ|'GH(Ө(((%PEPEPEPތE!SKC{[KfѬ5}ż¾cs'<ֵ݃=dR^Ѭ54Jj:+`Fy#>Zo׈c{]6M&P`VS*$xj>?1躖_訩Z Q mVsFq@¿jE{ K,td''B.O\]i Z8$j(@t (PQKEKE&isFhZ3@ E.h4R)ҝMo~_%{y}&{-+Ic_(Q@)i3R3Fh(4RIK3@ KEQ( ( (ESW{&+ƥ@Vh?|: >šiVZ\ɮߣL "WG2q~>е A`<S _??>>е A`<S _??>>е A`<S _??>>е A`ExA4j||k7^ExC4j|k^ExA4j||k^(BÏ(oS _?(>>е AW _?Pj||k7GA5Pj|kIP_ { GÏ_V^}F(u<:+ HQ?xNz ?k?r<1ammʹ{Wƞq=6"?xkC2_OҾx,:˽/c棊KX So |8‚i~>е A_)k<S _??>>е A`<W _??~>е A`<W _??>>е A`xC4j|k^G@?P ڟ?Zq װQ@?P_ ڟ?Zq װQ@?P_ ڿ?Zq װQj|k7GC5 _-|8†hBÏ(/~xC4j|k7^Gj_-|8†i?q װ8?a_Ԧ@,$$±&Wk4((Qފ((@RuPEQEbJZ(-Q@Q@Q@%)4PE%-QEQҊ(((J(hگNkaNi ?JM^6&!j6_$\is.-bgsMƏLig9sk A7?3?9\E`]ͪ+=o4gsMƋ>̻T @q.?ϰs. A7?3?9\E`]ͪ|K?^ χymHu\OP$hV4X's ${ךX6KkLc+ԘB$珻\7o0toi0GyJ3nu3V5/oZ_ߏ#|85V&Ǐn|w?M;Y|+^vj>қX[dsnwa,2'f+jZ^w.YԢI4ȣXdlz ?#|84n|U񥞏$o-aϛRk([r }F9`HE/^5kp_[USu4Dژ/UYhiʚ?~>Ѝ KTe|Ma=nhE- ]q`0G4|bVomV9BXb̓8ߏ#|84n|w)/Z-Ԗv{rj݀++*A xX:BoЍ KTZ~,sLou[NՕ&.5]F(= ?q{P":5sop$$EK!q8pۿFq*hB7Ï-/S^o u;B.#:v=s3T%Z-ڥơfd$Fcpq@/iʚ?~>Ѝ KTפxZ-׵?EyQI$ #ڥ㠬 ҵ)6wMk> K@I(B7Ï-/SGiʚ4 -vZ-{w1OR[ Sⶎ4Դna=FkX'\G!'Z:ޠf9ߏ#|84n}-;e/DzlIa!Fc+KW XuOnzPZE<b3l@8_ߏ#|84n|?W յ="+K;y/^=ē"z zۏZuXuvfR9dx@ʜ7pqCw?M?Fq*kѾ4x+^[/ij#R#t嫗n~P[ [_u|c6dhF58~*dwmFr&8ߏ#|84n|J]iJe%HJ,b J@?oZ_~F7u^,дXݵSe'V% : |oh((((((4P֊(QI@ IKE%-t(RPEh((w?xk<\ J&7xkyi[6N,RLr{3_Q9t*Ih>&Llg;Uz?пG^CG9w-Q 7wϷX/Gt/ף z7s w2 nw?r/__#G#_o0?es(;B x_?~y;U_#_ß[o w3mwBz?пG^Cзq;9G0?gs(ϷV#3 zwB 7w?-Paσ-QoGgxE[Y InَWҟOjĽy5 u|;ock$.h dK`ZȲ46C{\Ē\34ʉ%$<3Yŧ~ӣP/2zy$I&sL}NueJ'{Q_,} كtw:冝mjͤAqWT7`M`Z~xT6MΙ-[I[]2+HmуwƩsz\HTdMdpk뚌lZ]<^H(:n..>PSס澌>pU͈&/_ک'|/f[55y-BZf@]Ah8쬅vٛ ~&^C^͎\Wxf`X+Wwckk&{ǨijtKȍo*JUFG*A>>oG/kKmibxovgi,B3)fˍ[AokZV/Xn Pmn<$~c^Ii|CǗ3|-ộ<66Q_/d`DW ƾ;Ө׏):W!`S%t6C@E(((EP( JZ(((4wPEPEPEPEPEPEڳNkaNi ?JM^6&4O~g舥/j#Q@Q@Q@j(c( y޹b6/`Z(QIK@ KEU w\΋qXi]]]>BIzJ~G4iou V!y&dTEQ%:=;:>gtţn^cyd>u_*8gOҾ!nVzٴm<)%΃(pס ckBSJy?! B^"Ӵk¾LW !"PbEQIހ׏):W!`5 |oh(RPIKހ (4PH4f ( (QEQEQEQڊ(J/|tg🉼S=5I@URIS74WAH~#h?Gm$Q^? !OIPC@Ex4D? m?&h=CM{(?Gm$ !OI`<ϯxVFaZ̒az`AH~#ieC 䪨VW&J~{F{nVH- Q7-g|Ciڝgf1< z׭~ 5x>#U;PC_cRH +$?[i4AH~# +$?[i4AH~#h:Q^? !OIPC@Ex4D? m?&h=CM{z-';oxO \SľՆiZE ʑRHi@^?c'w؍}{x?:Ie? ^'<9mK{,W7b]vh |iM-(Woj@Ex'_xs V ?:DßZ PQ^? Ư$տN5&Wu??o@?I9{|jM-[(Ooj@HT7gאu7?o@_I9zP9_I9|jM-[(ʃP.qk?:DßZ Q Ư$տ=N4&u7?o@`׏u7?o@_I9{Z+:DßZ Q Ɵ$տ=N5&u7?o@`_I9|iO-(:׏):W!_I9IW0/xFE{i4~oi p6(PRGz(;IK@Q@Q@JZ(A(+Ǵ;w}?K+zWX#_y@Yi-Ϊxּ(´_&ֵVz{ams`;2#X!(Z_xN:-*`Qy"m-$$~ZMqxAMNmcYiћ"$%N 5j7+1 ZRfL{=3UD ω,TS]@'>u؆$ !2d'M?źZ[kV:sp܍J_$ 3msYr2Λ;W׵o2Gh=yfHĉNx:gM*FS5۶;Fѓ#zK|]5KGg!MIt7T<1ʲ+/E.`"GukRxZI DjnxH (CsPyO׾)<=[X/'abXwC OzZEZj>'k,,X,5Ikt˄ffy-]ǟ'5i5O X]Mk.;U+?GF }'zܗi!\l+r2=[-VQ;[nco:R QѰpyoZ)x6xWWoχsrηQd_IwzP0OMŲ\kzƁ;\M_D6= >P`q-0~##?4KAk6c-ھ=2}~;i߿<4*zϊ|)\Zixu=?Qo 5D"7 }[.r+'zկ|3Cze/"Լ@kӣK#J0Xب-70jēʆ9!C$F x 5|_薚fodӠKx)Eުa < /~ZnF[ϯx5kᵶ+P) >Θלz?)𾣫i)𖆋̷wIyS1i&u'Z@˱#vfȶ,/.െ¦8dhڻ =Uohh2hmض">m1%NI$ך/٧U1ŷWOZ4ly}EK3cs wW~|?AҬkOX[18mPN>{ CFգ6mYF\ʪp\Fhn5}wRksj^I{I,Io%7m(hXm~^"į 2iuMZX/5ٴKi V24a?*,yQ~a;<=\ڪF.NFә1zqQ_ %i/,m&k{ibx╘:\fbINzW^%>#k jw0E-冟tfPNdeq6}_G=4Ré2+ tUxmnTFk:jK&i"JzPB^0icWK]0g tY^6㞘| WGčoLFh+ֺRi\SBҕ-̹ ϫQ 2đ֩q6Hlalʹ=/I4 K7CӬ,&Eq #U f&⋽$iW)kyGhŲ8_0$ RxF=*-SprY#ƆtQ hqrt|.1fnqJ?ߌZ6[Ьei-SP(3$6XFI<gh?e/nl>5nFHy`y_;rjK JúUwRF[6+;T$e%5nG9t=(}W~=I#UDnK3툧rCGC qᏍ^,[^Ԯm_PlӤ+u=Ktyb,XOsxzVcy:ul³B`2,e\FCuW%t>]F8휼;cݽl>p$E]6u'Wu-ays{0AEπ~3|CռMgz,7wiq\d2A-rsV 呒O/ څ{ Ⰹ^x#e=ޟ7 \vz̾ҟVUKk沌 rv:J;'k/`xޓb5wJZ( PEPE%-QEw:((P))h;@Q@Q@b(PEPE%)QE ((( Q@v ;i(k?5/`G=Q@Q@rW½6!Ч ڼ3@I gUx"7$A;vrC +&Lck<;P柪jvwisH?&Q#Fh1gZW1e>)̑F$cX@81g ž4ӼC.wbE0O'Y#?E#X k(WJ>MrFţ`$ I*62qx|MmmnIov yIxJ!ɇYY6;oV[˝I$_zu}R'ʑu#$ K [Yn|9oq.w\G̫sl9\z }%æ۲oIFHe9Uxo#Glʹ+y,?9<qw)5?O^; &ˀݙn AD#I).EUQr8l4GYԚ(" u }I_q9_Ld8TtTuGOhw^-tx\_C d˦ve.&]t KmvM6-"xdw4bvcf@T Uemw|4+y5f7EY"W$";aTH@?xSbdۥj 2-YZ lz+& |7|A iH,좁#,f1v4RRڀ ;'k/`FZ;@h@Q@hEPhZ( ( ( f;EPFhE ( (((Ph@Q@Q@Q@Q@xzWל/%elOkaTqo*nszא0x{ψ_kG3l4٣5??$ >#}MzE!` ?&ÿ6|GX3^A >#}M>?$א0xwψ_kI >#}MzE!` ?&f ch׳K^A >#}M'3l45??$ >#}Mzhy3G͟?&ÿ6|GXLא0x{ψ_kK >#}Mzhy3l4>?$fz'i|;Cg/I|;+ĖM^523OJrȤ(hQEQޒQEQEQEQEQEQҊ(:EPE)(M)h((EQڊ(((@QEQڎ((((@Q@( (Q@vEPEPE(((JQ@Q@Q@( (4b (QIK@;PE JZQEQ(&(hր (4PE ;E))hh(Q(((JZ;QIK@RPE%-RPEQEQފ(Z(PEPE%-t((▀RREP@((@Q@QEP(Rq@ hQEQEf)(h4PEf QҒRqEEQ@(;QE)Q@袀@(jSEzRf(JEPGj(Qڊ(;P9^(sA(hLR4Q@ KEbҊ(b(QEQEюh 1EbQEEPڀ( QEA1F1EhEc1F( Q(b(Q@ endstream endobj 211 0 obj << /Type /Annot /Subtype /Link /A 212 0 R /Border [0 0 0] /H /I /Rect [ 208.8675 732.4674 218.5048 741.2858 ] >> endobj 212 0 obj << /Type /Action >> endobj 213 0 obj << /Type /Annot /Subtype /Link /A 214 0 R /Border [0 0 0] /H /I /Rect [ 375.2220 720.5627 384.8593 729.3810 ] >> endobj 214 0 obj << /Type /Action >> endobj 215 0 obj << /Type /Annot /Subtype /Link /A 216 0 R /Border [0 0 0] /H /I /Rect [ 387.2687 720.5627 396.9060 729.3810 ] >> endobj 216 0 obj << /Type /Action >> endobj 217 0 obj << /Type /Annot /Subtype /Link /A 218 0 R /Border [0 0 0] /H /I /Rect [ 399.3153 720.5627 408.9527 729.3810 ] >> endobj 218 0 obj << /Type /Action >> endobj 219 0 obj << /Type /Annot /Subtype /Link /A 220 0 R /Border [0 0 0] /H /I /Rect [ 411.3620 720.5627 420.9993 729.3810 ] >> endobj 220 0 obj << /Type /Action >> endobj 221 0 obj << /Type /Annot /Subtype /Link /A 222 0 R /Border [0 0 0] /H /I /Rect [ 423.4087 720.5627 433.0460 729.3810 ] >> endobj 222 0 obj << /Type /Action >> endobj 223 0 obj << /Type /Annot /Subtype /Link /A 224 0 R /Border [0 0 0] /H /I /Rect [ 146.5260 696.7532 156.1633 705.5715 ] >> endobj 224 0 obj << /Type /Action >> endobj 225 0 obj << /Type /Annot /Subtype /Link /A 226 0 R /Border [0 0 0] /H /I /Rect [ 486.7078 696.7532 496.3452 705.5715 ] >> endobj 226 0 obj << /Type /Action >> endobj 227 0 obj << /Type /Annot /Subtype /Link /A 228 0 R /Border [0 0 0] /H /I /Rect [ 478.7085 684.8484 488.3458 693.6667 ] >> endobj 228 0 obj << /Type /Action >> endobj 229 0 obj << /Type /Annot /Subtype /Link /A 230 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 -124.2113 485.2500 418.7887 ] >> endobj 230 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/02/Figure-1_new-page-001-e1432153162759.jpg) >> endobj 231 0 obj << /Type /Annot /Subtype /Link /A 232 0 R /Border [0 0 0] /H /I /Rect [ 208.8675 732.4674 218.5048 741.2858 ] >> endobj 232 0 obj << /Type /Action >> endobj 233 0 obj << /Type /Annot /Subtype /Link /A 234 0 R /Border [0 0 0] /H /I /Rect [ 375.2220 720.5627 384.8593 729.3810 ] >> endobj 234 0 obj << /Type /Action >> endobj 235 0 obj << /Type /Annot /Subtype /Link /A 236 0 R /Border [0 0 0] /H /I /Rect [ 387.2687 720.5627 396.9060 729.3810 ] >> endobj 236 0 obj << /Type /Action >> endobj 237 0 obj << /Type /Annot /Subtype /Link /A 238 0 R /Border [0 0 0] /H /I /Rect [ 399.3153 720.5627 408.9527 729.3810 ] >> endobj 238 0 obj << /Type /Action >> endobj 239 0 obj << /Type /Annot /Subtype /Link /A 240 0 R /Border [0 0 0] /H /I /Rect [ 411.3620 720.5627 420.9993 729.3810 ] >> endobj 240 0 obj << /Type /Action >> endobj 241 0 obj << /Type /Annot /Subtype /Link /A 242 0 R /Border [0 0 0] /H /I /Rect [ 423.4087 720.5627 433.0460 729.3810 ] >> endobj 242 0 obj << /Type /Action >> endobj 243 0 obj << /Type /Annot /Subtype /Link /A 244 0 R /Border [0 0 0] /H /I /Rect [ 146.5260 696.7532 156.1633 705.5715 ] >> endobj 244 0 obj << /Type /Action >> endobj 245 0 obj << /Type /Annot /Subtype /Link /A 246 0 R /Border [0 0 0] /H /I /Rect [ 486.7078 696.7532 496.3452 705.5715 ] >> endobj 246 0 obj << /Type /Action >> endobj 247 0 obj << /Type /Annot /Subtype /Link /A 248 0 R /Border [0 0 0] /H /I /Rect [ 478.7085 684.8484 488.3458 693.6667 ] >> endobj 248 0 obj << /Type /Action >> endobj 249 0 obj << /Type /Annot /Subtype /Link /A 250 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 -124.2113 485.2500 418.7887 ] >> endobj 250 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/02/Figure-1_new-page-001-e1432153162759.jpg) >> endobj 251 0 obj << /Type /Page /Parent 3 0 R /Annots [ 254 0 R 256 0 R 258 0 R 260 0 R 264 0 R 266 0 R 268 0 R 270 0 R 274 0 R 276 0 R 278 0 R 280 0 R ] /Contents 252 0 R >> endobj 252 0 obj << /Length 32440 >> stream q 15.000 24.453 577.500 752.547 re W n 0.965 0.965 0.965 rg 26.250 747.845 555.000 29.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 747.845 m 581.250 747.845 l 581.250 748.595 l 26.250 748.595 l f q 35.250 759.095 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 767.476 Td /F4 9.8 Tf [(Fig. 1: Flowchart of exclusions from analysis cohort.)] TJ ET Q BT 26.250 730.821 Td /F4 9.8 Tf [(Exposure measure)] TJ ET BT 26.250 711.417 Td /F1 9.8 Tf [(The measure of exposure intensity was based on the arrival time at the WTC site as self-reported on their first medical )] TJ ET BT 26.250 699.512 Td /F1 9.8 Tf [(monitoring questionnaire. Arrival the morning of 9/11 was defined as high exposure for this cohort, arrival the afternoon of 9/11 )] TJ ET BT 26.250 687.607 Td /F1 9.8 Tf [(or any time on 9/12/2001 was defined as moderate exposure, and arrival any time from 9/13/2001 to 9/24/2001 was defined as )] TJ ET BT 26.250 675.702 Td /F1 9.8 Tf [(low exposure. Persons who did not participate in the rescue/recovery effort prior to 9/25/2001 were excluded from the analysis.)] TJ ET BT 26.250 656.298 Td /F4 9.8 Tf [(Smoking Status)] TJ ET BT 26.250 636.893 Td /F1 9.8 Tf [(Smoking history was characterized by the last known smoking status as reported on the medical monitoring questionnaires. )] TJ ET BT 26.250 624.988 Td /F1 9.8 Tf [(Participants were considered as ever smokers if they reported smoking at any time, and as never smokers if they )] TJ ET BT 26.250 613.083 Td /F1 9.8 Tf [(consistently reported never smoking on all questionnaires. As previously noted, three persons whose smoking status was )] TJ ET BT 26.250 601.179 Td /F1 9.8 Tf [(consistently missing were excluded from the final analytic cohort.)] TJ ET BT 26.250 581.774 Td /F4 9.8 Tf [(Outcome measure)] TJ ET BT 26.250 562.369 Td /F1 9.8 Tf [(The primary outcome was an OAD diagnosis by an FDNY-BHS physician. OAD diagnoses included diagnoses of asthma, )] TJ ET BT 26.250 550.464 Td /F1 9.8 Tf [(chronic bronchitis, or chronic obstructive pulmonary disease \(COPD\)/emphysema. To avoid misclassification of persons with )] TJ ET BT 26.250 538.560 Td /F1 9.8 Tf [(transient symptoms as cases, we required that asthma or COPD/emphysema diagnoses be recorded in the FDNY-BHS medical )] TJ ET BT 26.250 526.655 Td /F1 9.8 Tf [(records on at least two occasions, at least 30 days apart. For chronic bronchitis, we required that two diagnoses occur within )] TJ ET BT 26.250 514.750 Td /F1 9.8 Tf [(one year of each other, followed by at least one additional chronic bronchitis diagnosis during a three year period beginning one )] TJ ET BT 26.250 502.845 Td /F1 9.8 Tf [(year after the date of initial diagnosis. The earliest date of each series of diagnoses was selected as the date of incident OAD. If )] TJ ET BT 26.250 490.941 Td /F1 9.8 Tf [(an individual had a diagnosis of more than one OAD subtype, the first subtype to be diagnosed was used for the analyses. )] TJ ET BT 26.250 479.036 Td /F1 9.8 Tf [(Twelve individuals had more than one first diagnosis on the same day and were assigned the OAD subtype of asthma. For the )] TJ ET BT 26.250 467.131 Td /F1 9.8 Tf [(analyses of the relationship between lower respiratory symptoms and physician diagnosis, the primary outcome was the self-)] TJ ET BT 26.250 455.226 Td /F1 9.8 Tf [(report of a lower respiratory symptom of cough, wheeze, or shortness of breath on the medical monitoring questionnaires )] TJ ET BT 26.250 443.322 Td /F1 9.8 Tf [(described above.)] TJ ET BT 26.250 423.917 Td /F4 9.8 Tf [(Statistical methods)] TJ ET BT 26.250 404.512 Td /F1 9.8 Tf [(Details of the methodological approach have been reported previously.)] TJ ET 0.267 0.267 0.267 rg BT 331.357 406.019 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 340.994 404.512 Td /F1 9.8 Tf [( Briefly, we used piecewise exponential survival )] TJ ET BT 26.250 392.607 Td /F1 9.8 Tf [(models with change points to estimate relative rates across the three exposure groups during follow up \(9/11/2001 to )] TJ ET BT 26.250 380.703 Td /F1 9.8 Tf [(9/10/2011\). Piecewise exponential survival models are similar to Cox regression models, but with baseline hazards that are )] TJ ET BT 26.250 368.798 Td /F1 9.8 Tf [(allowed to change at a fixed number of time intervals rather than with every new event. We allowed the baseline hazard to )] TJ ET BT 26.250 356.893 Td /F1 9.8 Tf [(change every three months over the follow up period. The change points are the times that the relative rates change \(increase )] TJ ET BT 26.250 344.988 Td /F1 9.8 Tf [(or decrease\) during the follow-up period; these change points are estimated from the data using profile likelihood.)] TJ ET 0.267 0.267 0.267 rg BT 514.520 346.496 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 524.158 348.877 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 526.567 346.496 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 536.204 348.877 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 538.614 346.496 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 548.251 344.988 Td /F1 9.8 Tf [( A )] TJ ET BT 26.250 333.084 Td /F1 9.8 Tf [(change point after which relative incidences did not differ significantly \(p<0.05\) from one would show that the exposure-)] TJ ET BT 26.250 321.179 Td /F1 9.8 Tf [(response relationship between WTC exposure intensity and incident OAD was limited to the period prior to the change point. All )] TJ ET BT 26.250 309.274 Td /F1 9.8 Tf [(models included as covariates: age on 9/11/2001, retirement status, if applicable, as a time-dependent predictor, and self-)] TJ ET BT 26.250 297.369 Td /F1 9.8 Tf [(reported smoking status \(ever vs. never\) as of the last completed questionnaire. Seasonality was taken into account through the )] TJ ET BT 26.250 285.465 Td /F1 9.8 Tf [(varying of baseline rates every three months. In sensitivity analyses we estimated the relative rates for OAD subtypes of asthma )] TJ ET BT 26.250 273.560 Td /F1 9.8 Tf [(and of non-asthma \(chronic bronchitis and COPD/emphysema\). SAS version 9.4 \(SAS Institute, Cary, NC, USA, )] TJ ET BT 26.250 261.655 Td /F1 9.8 Tf [(https://www.sas.com\) was used for the analyses.)] TJ ET BT 26.250 242.250 Td /F4 9.8 Tf [(Details of statistical model equations)] TJ ET BT 26.250 222.846 Td /F1 9.8 Tf [(What follows are the equations for statistical models that compare three exposure groups \(low, moderate, high\). Low exposure )] TJ ET BT 26.250 210.941 Td /F1 9.8 Tf [(intensity is assumed to be the reference group. These are all piecewise exponential survival models with change points included )] TJ ET BT 26.250 199.036 Td /F1 9.8 Tf [(to model changing relative risks over time. The models are similar to ones used in a previous report.)] TJ ET BT 26.250 179.631 Td /F1 9.8 Tf [(A null model, assuming constant relative rates of incidence over the entire follow-up period, contains no change points, can be )] TJ ET BT 26.250 167.727 Td /F1 9.8 Tf [(expressed as follows:)] TJ ET q 318.000 0 0 18.750 26.250 139.096 cm /I5 Do Q BT 26.250 122.072 Td /F1 9.8 Tf [(Here, )] TJ ET BT 52.799 122.072 Td /F5 9.8 Tf [(Y)] TJ ET BT 59.303 120.008 Td /F5 8.7 Tf [(ik)] TJ ET BT 65.560 122.072 Td /F1 9.8 Tf [( is the number of incident cases of disease, modeled to follow a Poisson distribution given the covariates, and )] TJ ET BT 540.287 122.072 Td /F5 9.8 Tf [(T)] TJ ET BT 546.245 120.008 Td /F5 8.7 Tf [(ik)] TJ ET BT 552.502 122.072 Td /F1 9.8 Tf [( the )] TJ ET BT 26.250 110.167 Td /F1 9.8 Tf [(total person time at risk for a particular strata corresponding to time interval )] TJ ET BT 352.456 110.167 Td /F5 9.8 Tf [(k)] TJ ET BT 357.331 110.167 Td /F1 9.8 Tf [( and the exposures indicated by the values of )] TJ ET BT 555.695 110.167 Td /F5 9.8 Tf [(x)] TJ ET BT 560.570 108.103 Td /F5 8.7 Tf [(i1)] TJ ET BT 567.312 110.167 Td /F1 9.8 Tf [(, )] TJ ET BT 572.733 110.167 Td /F5 9.8 Tf [(x)] TJ ET BT 26.250 96.198 Td /F5 8.7 Tf [(i2)] TJ ET BT 32.993 98.262 Td /F1 9.8 Tf [(, and the )] TJ ET BT 73.650 98.262 Td /F5 9.8 Tf [(z)] TJ ET BT 78.525 96.198 Td /F5 8.7 Tf [(il)] TJ ET BT 82.373 98.262 Td /F5 9.8 Tf [(s)] TJ ET BT 89.413 98.262 Td /F1 9.8 Tf [( For a ten year follow-up there are )] TJ ET BT 238.978 98.262 Td /F5 9.8 Tf [(n=40)] TJ ET BT 260.935 98.262 Td /F1 9.8 Tf [( three month time intervals and the )] TJ ET BT 413.756 98.262 Td /F5 9.8 Tf [(?)] TJ ET BT 419.177 96.198 Td /F5 8.7 Tf [(k )] TJ ET BT 425.920 98.262 Td /F5 9.8 Tf [(s)] TJ ET BT 432.959 98.262 Td /F1 9.8 Tf [( represent the log of the baseline )] TJ ET BT 26.250 86.358 Td /F1 9.8 Tf [(incidence, i.e. the incidence for the low exposure group for individuals all of whose )] TJ ET BT 383.373 86.358 Td /F5 9.8 Tf [(z)] TJ ET BT 388.248 84.293 Td /F5 8.7 Tf [(ij)] TJ ET BT 392.096 86.358 Td /F5 9.8 Tf [( s)] TJ ET BT 401.846 86.358 Td /F1 9.8 Tf [( take the value zero, with the )] TJ ET BT 528.664 86.358 Td /F5 9.8 Tf [(w)] TJ ET BT 535.704 84.293 Td /F5 8.7 Tf [(ik )] TJ ET BT 544.370 86.358 Td /F5 9.8 Tf [(s)] TJ ET BT 551.410 86.358 Td /F1 9.8 Tf [( as )] TJ ET BT 26.250 74.453 Td /F1 9.8 Tf [(dummy variables that indicate the time interval for the stratum. These correspond to the baseline hazard in a Cox regression )] TJ ET BT 26.250 62.548 Td /F1 9.8 Tf [(model but have true incidence interpretation in this fully parametric approach. )] TJ ET BT 361.689 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 366.564 60.484 Td /F5 8.7 Tf [(i1)] TJ ET BT 373.307 62.548 Td /F1 9.8 Tf [( and )] TJ ET BT 394.991 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 399.866 60.484 Td /F5 8.7 Tf [(i2)] TJ ET BT 406.608 62.548 Td /F1 9.8 Tf [( are dummy exposure variables, with )] TJ ET BT 568.078 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 572.953 62.548 Td /F5 8.7 Tf [(i1)] TJ ET BT 26.250 50.643 Td /F1 9.8 Tf [(taking the value )] TJ ET BT 97.249 50.643 Td /F5 9.8 Tf [(1)] TJ ET BT 102.671 50.643 Td /F1 9.8 Tf [( for moderate exposure and )] TJ ET BT 225.150 50.643 Td /F5 9.8 Tf [(0)] TJ ET BT 230.571 50.643 Td /F1 9.8 Tf [( otherwise, and )] TJ ET BT 299.396 50.643 Td /F5 9.8 Tf [(x)] TJ ET BT 304.271 48.579 Td /F5 8.7 Tf [(i2)] TJ ET BT 311.014 50.643 Td /F1 9.8 Tf [( taking the value )] TJ ET BT 384.724 50.643 Td /F5 9.8 Tf [(1)] TJ ET BT 390.145 50.643 Td /F1 9.8 Tf [( for high exposure and zero otherwise; )] TJ ET BT 558.683 50.643 Td /F5 9.8 Tf [(?)] TJ ET BT 564.104 48.579 Td /F5 8.7 Tf [(1)] TJ ET BT 26.250 38.739 Td /F1 9.8 Tf [(is thus the log relative hazard between the moderate and low exposure groups, and ?)] TJ ET BT 394.235 36.674 Td /F1 8.7 Tf [(2)] TJ ET BT 399.053 38.739 Td /F1 9.8 Tf [( the log relative hazard between the high )] TJ ET Q q 15.000 24.453 577.500 752.547 re W n 0.965 0.965 0.965 rg 26.250 747.845 555.000 29.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 747.845 m 581.250 747.845 l 581.250 748.595 l 26.250 748.595 l f q 35.250 759.095 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 767.476 Td /F4 9.8 Tf [(Fig. 1: Flowchart of exclusions from analysis cohort.)] TJ ET Q BT 26.250 730.821 Td /F4 9.8 Tf [(Exposure measure)] TJ ET BT 26.250 711.417 Td /F1 9.8 Tf [(The measure of exposure intensity was based on the arrival time at the WTC site as self-reported on their first medical )] TJ ET BT 26.250 699.512 Td /F1 9.8 Tf [(monitoring questionnaire. Arrival the morning of 9/11 was defined as high exposure for this cohort, arrival the afternoon of 9/11 )] TJ ET BT 26.250 687.607 Td /F1 9.8 Tf [(or any time on 9/12/2001 was defined as moderate exposure, and arrival any time from 9/13/2001 to 9/24/2001 was defined as )] TJ ET BT 26.250 675.702 Td /F1 9.8 Tf [(low exposure. Persons who did not participate in the rescue/recovery effort prior to 9/25/2001 were excluded from the analysis.)] TJ ET BT 26.250 656.298 Td /F4 9.8 Tf [(Smoking Status)] TJ ET BT 26.250 636.893 Td /F1 9.8 Tf [(Smoking history was characterized by the last known smoking status as reported on the medical monitoring questionnaires. )] TJ ET BT 26.250 624.988 Td /F1 9.8 Tf [(Participants were considered as ever smokers if they reported smoking at any time, and as never smokers if they )] TJ ET BT 26.250 613.083 Td /F1 9.8 Tf [(consistently reported never smoking on all questionnaires. As previously noted, three persons whose smoking status was )] TJ ET BT 26.250 601.179 Td /F1 9.8 Tf [(consistently missing were excluded from the final analytic cohort.)] TJ ET BT 26.250 581.774 Td /F4 9.8 Tf [(Outcome measure)] TJ ET BT 26.250 562.369 Td /F1 9.8 Tf [(The primary outcome was an OAD diagnosis by an FDNY-BHS physician. OAD diagnoses included diagnoses of asthma, )] TJ ET BT 26.250 550.464 Td /F1 9.8 Tf [(chronic bronchitis, or chronic obstructive pulmonary disease \(COPD\)/emphysema. To avoid misclassification of persons with )] TJ ET BT 26.250 538.560 Td /F1 9.8 Tf [(transient symptoms as cases, we required that asthma or COPD/emphysema diagnoses be recorded in the FDNY-BHS medical )] TJ ET BT 26.250 526.655 Td /F1 9.8 Tf [(records on at least two occasions, at least 30 days apart. For chronic bronchitis, we required that two diagnoses occur within )] TJ ET BT 26.250 514.750 Td /F1 9.8 Tf [(one year of each other, followed by at least one additional chronic bronchitis diagnosis during a three year period beginning one )] TJ ET BT 26.250 502.845 Td /F1 9.8 Tf [(year after the date of initial diagnosis. The earliest date of each series of diagnoses was selected as the date of incident OAD. If )] TJ ET BT 26.250 490.941 Td /F1 9.8 Tf [(an individual had a diagnosis of more than one OAD subtype, the first subtype to be diagnosed was used for the analyses. )] TJ ET BT 26.250 479.036 Td /F1 9.8 Tf [(Twelve individuals had more than one first diagnosis on the same day and were assigned the OAD subtype of asthma. For the )] TJ ET BT 26.250 467.131 Td /F1 9.8 Tf [(analyses of the relationship between lower respiratory symptoms and physician diagnosis, the primary outcome was the self-)] TJ ET BT 26.250 455.226 Td /F1 9.8 Tf [(report of a lower respiratory symptom of cough, wheeze, or shortness of breath on the medical monitoring questionnaires )] TJ ET BT 26.250 443.322 Td /F1 9.8 Tf [(described above.)] TJ ET BT 26.250 423.917 Td /F4 9.8 Tf [(Statistical methods)] TJ ET BT 26.250 404.512 Td /F1 9.8 Tf [(Details of the methodological approach have been reported previously.)] TJ ET 0.267 0.267 0.267 rg BT 331.357 406.019 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 340.994 404.512 Td /F1 9.8 Tf [( Briefly, we used piecewise exponential survival )] TJ ET BT 26.250 392.607 Td /F1 9.8 Tf [(models with change points to estimate relative rates across the three exposure groups during follow up \(9/11/2001 to )] TJ ET BT 26.250 380.703 Td /F1 9.8 Tf [(9/10/2011\). Piecewise exponential survival models are similar to Cox regression models, but with baseline hazards that are )] TJ ET BT 26.250 368.798 Td /F1 9.8 Tf [(allowed to change at a fixed number of time intervals rather than with every new event. We allowed the baseline hazard to )] TJ ET BT 26.250 356.893 Td /F1 9.8 Tf [(change every three months over the follow up period. The change points are the times that the relative rates change \(increase )] TJ ET BT 26.250 344.988 Td /F1 9.8 Tf [(or decrease\) during the follow-up period; these change points are estimated from the data using profile likelihood.)] TJ ET 0.267 0.267 0.267 rg BT 514.520 346.496 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 524.158 348.877 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 526.567 346.496 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 536.204 348.877 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 538.614 346.496 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 548.251 344.988 Td /F1 9.8 Tf [( A )] TJ ET BT 26.250 333.084 Td /F1 9.8 Tf [(change point after which relative incidences did not differ significantly \(p<0.05\) from one would show that the exposure-)] TJ ET BT 26.250 321.179 Td /F1 9.8 Tf [(response relationship between WTC exposure intensity and incident OAD was limited to the period prior to the change point. All )] TJ ET BT 26.250 309.274 Td /F1 9.8 Tf [(models included as covariates: age on 9/11/2001, retirement status, if applicable, as a time-dependent predictor, and self-)] TJ ET BT 26.250 297.369 Td /F1 9.8 Tf [(reported smoking status \(ever vs. never\) as of the last completed questionnaire. Seasonality was taken into account through the )] TJ ET BT 26.250 285.465 Td /F1 9.8 Tf [(varying of baseline rates every three months. In sensitivity analyses we estimated the relative rates for OAD subtypes of asthma )] TJ ET BT 26.250 273.560 Td /F1 9.8 Tf [(and of non-asthma \(chronic bronchitis and COPD/emphysema\). SAS version 9.4 \(SAS Institute, Cary, NC, USA, )] TJ ET BT 26.250 261.655 Td /F1 9.8 Tf [(https://www.sas.com\) was used for the analyses.)] TJ ET BT 26.250 242.250 Td /F4 9.8 Tf [(Details of statistical model equations)] TJ ET BT 26.250 222.846 Td /F1 9.8 Tf [(What follows are the equations for statistical models that compare three exposure groups \(low, moderate, high\). Low exposure )] TJ ET BT 26.250 210.941 Td /F1 9.8 Tf [(intensity is assumed to be the reference group. These are all piecewise exponential survival models with change points included )] TJ ET BT 26.250 199.036 Td /F1 9.8 Tf [(to model changing relative risks over time. The models are similar to ones used in a previous report.)] TJ ET BT 26.250 179.631 Td /F1 9.8 Tf [(A null model, assuming constant relative rates of incidence over the entire follow-up period, contains no change points, can be )] TJ ET BT 26.250 167.727 Td /F1 9.8 Tf [(expressed as follows:)] TJ ET q 318.000 0 0 18.750 26.250 139.096 cm /I7 Do Q BT 26.250 122.072 Td /F1 9.8 Tf [(Here, )] TJ ET BT 52.799 122.072 Td /F5 9.8 Tf [(Y)] TJ ET BT 59.303 120.008 Td /F5 8.7 Tf [(ik)] TJ ET BT 65.560 122.072 Td /F1 9.8 Tf [( is the number of incident cases of disease, modeled to follow a Poisson distribution given the covariates, and )] TJ ET BT 540.287 122.072 Td /F5 9.8 Tf [(T)] TJ ET BT 546.245 120.008 Td /F5 8.7 Tf [(ik)] TJ ET BT 552.502 122.072 Td /F1 9.8 Tf [( the )] TJ ET BT 26.250 110.167 Td /F1 9.8 Tf [(total person time at risk for a particular strata corresponding to time interval )] TJ ET BT 352.456 110.167 Td /F5 9.8 Tf [(k)] TJ ET BT 357.331 110.167 Td /F1 9.8 Tf [( and the exposures indicated by the values of )] TJ ET BT 555.695 110.167 Td /F5 9.8 Tf [(x)] TJ ET BT 560.570 108.103 Td /F5 8.7 Tf [(i1)] TJ ET BT 567.312 110.167 Td /F1 9.8 Tf [(, )] TJ ET BT 572.733 110.167 Td /F5 9.8 Tf [(x)] TJ ET BT 26.250 96.198 Td /F5 8.7 Tf [(i2)] TJ ET BT 32.993 98.262 Td /F1 9.8 Tf [(, and the )] TJ ET BT 73.650 98.262 Td /F5 9.8 Tf [(z)] TJ ET BT 78.525 96.198 Td /F5 8.7 Tf [(il)] TJ ET BT 82.373 98.262 Td /F5 9.8 Tf [(s)] TJ ET BT 89.413 98.262 Td /F1 9.8 Tf [( For a ten year follow-up there are )] TJ ET BT 238.978 98.262 Td /F5 9.8 Tf [(n=40)] TJ ET BT 260.935 98.262 Td /F1 9.8 Tf [( three month time intervals and the )] TJ ET BT 413.756 98.262 Td /F5 9.8 Tf [(?)] TJ ET BT 419.177 96.198 Td /F5 8.7 Tf [(k )] TJ ET BT 425.920 98.262 Td /F5 9.8 Tf [(s)] TJ ET BT 432.959 98.262 Td /F1 9.8 Tf [( represent the log of the baseline )] TJ ET BT 26.250 86.358 Td /F1 9.8 Tf [(incidence, i.e. the incidence for the low exposure group for individuals all of whose )] TJ ET BT 383.373 86.358 Td /F5 9.8 Tf [(z)] TJ ET BT 388.248 84.293 Td /F5 8.7 Tf [(ij)] TJ ET BT 392.096 86.358 Td /F5 9.8 Tf [( s)] TJ ET BT 401.846 86.358 Td /F1 9.8 Tf [( take the value zero, with the )] TJ ET BT 528.664 86.358 Td /F5 9.8 Tf [(w)] TJ ET BT 535.704 84.293 Td /F5 8.7 Tf [(ik )] TJ ET BT 544.370 86.358 Td /F5 9.8 Tf [(s)] TJ ET BT 551.410 86.358 Td /F1 9.8 Tf [( as )] TJ ET BT 26.250 74.453 Td /F1 9.8 Tf [(dummy variables that indicate the time interval for the stratum. These correspond to the baseline hazard in a Cox regression )] TJ ET BT 26.250 62.548 Td /F1 9.8 Tf [(model but have true incidence interpretation in this fully parametric approach. )] TJ ET BT 361.689 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 366.564 60.484 Td /F5 8.7 Tf [(i1)] TJ ET BT 373.307 62.548 Td /F1 9.8 Tf [( and )] TJ ET BT 394.991 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 399.866 60.484 Td /F5 8.7 Tf [(i2)] TJ ET BT 406.608 62.548 Td /F1 9.8 Tf [( are dummy exposure variables, with )] TJ ET BT 568.078 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 572.953 62.548 Td /F5 8.7 Tf [(i1)] TJ ET BT 26.250 50.643 Td /F1 9.8 Tf [(taking the value )] TJ ET BT 97.249 50.643 Td /F5 9.8 Tf [(1)] TJ ET BT 102.671 50.643 Td /F1 9.8 Tf [( for moderate exposure and )] TJ ET BT 225.150 50.643 Td /F5 9.8 Tf [(0)] TJ ET BT 230.571 50.643 Td /F1 9.8 Tf [( otherwise, and )] TJ ET BT 299.396 50.643 Td /F5 9.8 Tf [(x)] TJ ET BT 304.271 48.579 Td /F5 8.7 Tf [(i2)] TJ ET BT 311.014 50.643 Td /F1 9.8 Tf [( taking the value )] TJ ET BT 384.724 50.643 Td /F5 9.8 Tf [(1)] TJ ET BT 390.145 50.643 Td /F1 9.8 Tf [( for high exposure and zero otherwise; )] TJ ET BT 558.683 50.643 Td /F5 9.8 Tf [(?)] TJ ET BT 564.104 48.579 Td /F5 8.7 Tf [(1)] TJ ET BT 26.250 38.739 Td /F1 9.8 Tf [(is thus the log relative hazard between the moderate and low exposure groups, and ?)] TJ ET BT 394.235 36.674 Td /F1 8.7 Tf [(2)] TJ ET BT 399.053 38.739 Td /F1 9.8 Tf [( the log relative hazard between the high )] TJ ET Q q 15.000 24.453 577.500 752.547 re W n 0.965 0.965 0.965 rg 26.250 747.845 555.000 29.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 747.845 m 581.250 747.845 l 581.250 748.595 l 26.250 748.595 l f q 35.250 759.095 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 767.476 Td /F4 9.8 Tf [(Fig. 1: Flowchart of exclusions from analysis cohort.)] TJ ET Q BT 26.250 730.821 Td /F4 9.8 Tf [(Exposure measure)] TJ ET BT 26.250 711.417 Td /F1 9.8 Tf [(The measure of exposure intensity was based on the arrival time at the WTC site as self-reported on their first medical )] TJ ET BT 26.250 699.512 Td /F1 9.8 Tf [(monitoring questionnaire. Arrival the morning of 9/11 was defined as high exposure for this cohort, arrival the afternoon of 9/11 )] TJ ET BT 26.250 687.607 Td /F1 9.8 Tf [(or any time on 9/12/2001 was defined as moderate exposure, and arrival any time from 9/13/2001 to 9/24/2001 was defined as )] TJ ET BT 26.250 675.702 Td /F1 9.8 Tf [(low exposure. Persons who did not participate in the rescue/recovery effort prior to 9/25/2001 were excluded from the analysis.)] TJ ET BT 26.250 656.298 Td /F4 9.8 Tf [(Smoking Status)] TJ ET BT 26.250 636.893 Td /F1 9.8 Tf [(Smoking history was characterized by the last known smoking status as reported on the medical monitoring questionnaires. )] TJ ET BT 26.250 624.988 Td /F1 9.8 Tf [(Participants were considered as ever smokers if they reported smoking at any time, and as never smokers if they )] TJ ET BT 26.250 613.083 Td /F1 9.8 Tf [(consistently reported never smoking on all questionnaires. As previously noted, three persons whose smoking status was )] TJ ET BT 26.250 601.179 Td /F1 9.8 Tf [(consistently missing were excluded from the final analytic cohort.)] TJ ET BT 26.250 581.774 Td /F4 9.8 Tf [(Outcome measure)] TJ ET BT 26.250 562.369 Td /F1 9.8 Tf [(The primary outcome was an OAD diagnosis by an FDNY-BHS physician. OAD diagnoses included diagnoses of asthma, )] TJ ET BT 26.250 550.464 Td /F1 9.8 Tf [(chronic bronchitis, or chronic obstructive pulmonary disease \(COPD\)/emphysema. To avoid misclassification of persons with )] TJ ET BT 26.250 538.560 Td /F1 9.8 Tf [(transient symptoms as cases, we required that asthma or COPD/emphysema diagnoses be recorded in the FDNY-BHS medical )] TJ ET BT 26.250 526.655 Td /F1 9.8 Tf [(records on at least two occasions, at least 30 days apart. For chronic bronchitis, we required that two diagnoses occur within )] TJ ET BT 26.250 514.750 Td /F1 9.8 Tf [(one year of each other, followed by at least one additional chronic bronchitis diagnosis during a three year period beginning one )] TJ ET BT 26.250 502.845 Td /F1 9.8 Tf [(year after the date of initial diagnosis. The earliest date of each series of diagnoses was selected as the date of incident OAD. If )] TJ ET BT 26.250 490.941 Td /F1 9.8 Tf [(an individual had a diagnosis of more than one OAD subtype, the first subtype to be diagnosed was used for the analyses. )] TJ ET BT 26.250 479.036 Td /F1 9.8 Tf [(Twelve individuals had more than one first diagnosis on the same day and were assigned the OAD subtype of asthma. For the )] TJ ET BT 26.250 467.131 Td /F1 9.8 Tf [(analyses of the relationship between lower respiratory symptoms and physician diagnosis, the primary outcome was the self-)] TJ ET BT 26.250 455.226 Td /F1 9.8 Tf [(report of a lower respiratory symptom of cough, wheeze, or shortness of breath on the medical monitoring questionnaires )] TJ ET BT 26.250 443.322 Td /F1 9.8 Tf [(described above.)] TJ ET BT 26.250 423.917 Td /F4 9.8 Tf [(Statistical methods)] TJ ET BT 26.250 404.512 Td /F1 9.8 Tf [(Details of the methodological approach have been reported previously.)] TJ ET 0.267 0.267 0.267 rg BT 331.357 406.019 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 340.994 404.512 Td /F1 9.8 Tf [( Briefly, we used piecewise exponential survival )] TJ ET BT 26.250 392.607 Td /F1 9.8 Tf [(models with change points to estimate relative rates across the three exposure groups during follow up \(9/11/2001 to )] TJ ET BT 26.250 380.703 Td /F1 9.8 Tf [(9/10/2011\). Piecewise exponential survival models are similar to Cox regression models, but with baseline hazards that are )] TJ ET BT 26.250 368.798 Td /F1 9.8 Tf [(allowed to change at a fixed number of time intervals rather than with every new event. We allowed the baseline hazard to )] TJ ET BT 26.250 356.893 Td /F1 9.8 Tf [(change every three months over the follow up period. The change points are the times that the relative rates change \(increase )] TJ ET BT 26.250 344.988 Td /F1 9.8 Tf [(or decrease\) during the follow-up period; these change points are estimated from the data using profile likelihood.)] TJ ET 0.267 0.267 0.267 rg BT 514.520 346.496 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 524.158 348.877 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 526.567 346.496 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 536.204 348.877 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 538.614 346.496 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 548.251 344.988 Td /F1 9.8 Tf [( A )] TJ ET BT 26.250 333.084 Td /F1 9.8 Tf [(change point after which relative incidences did not differ significantly \(p<0.05\) from one would show that the exposure-)] TJ ET BT 26.250 321.179 Td /F1 9.8 Tf [(response relationship between WTC exposure intensity and incident OAD was limited to the period prior to the change point. All )] TJ ET BT 26.250 309.274 Td /F1 9.8 Tf [(models included as covariates: age on 9/11/2001, retirement status, if applicable, as a time-dependent predictor, and self-)] TJ ET BT 26.250 297.369 Td /F1 9.8 Tf [(reported smoking status \(ever vs. never\) as of the last completed questionnaire. Seasonality was taken into account through the )] TJ ET BT 26.250 285.465 Td /F1 9.8 Tf [(varying of baseline rates every three months. In sensitivity analyses we estimated the relative rates for OAD subtypes of asthma )] TJ ET BT 26.250 273.560 Td /F1 9.8 Tf [(and of non-asthma \(chronic bronchitis and COPD/emphysema\). SAS version 9.4 \(SAS Institute, Cary, NC, USA, )] TJ ET BT 26.250 261.655 Td /F1 9.8 Tf [(https://www.sas.com\) was used for the analyses.)] TJ ET BT 26.250 242.250 Td /F4 9.8 Tf [(Details of statistical model equations)] TJ ET BT 26.250 222.846 Td /F1 9.8 Tf [(What follows are the equations for statistical models that compare three exposure groups \(low, moderate, high\). Low exposure )] TJ ET BT 26.250 210.941 Td /F1 9.8 Tf [(intensity is assumed to be the reference group. These are all piecewise exponential survival models with change points included )] TJ ET BT 26.250 199.036 Td /F1 9.8 Tf [(to model changing relative risks over time. The models are similar to ones used in a previous report.)] TJ ET BT 26.250 179.631 Td /F1 9.8 Tf [(A null model, assuming constant relative rates of incidence over the entire follow-up period, contains no change points, can be )] TJ ET BT 26.250 167.727 Td /F1 9.8 Tf [(expressed as follows:)] TJ ET q 318.000 0 0 18.750 26.250 139.096 cm /I9 Do Q BT 26.250 122.072 Td /F1 9.8 Tf [(Here, )] TJ ET BT 52.799 122.072 Td /F5 9.8 Tf [(Y)] TJ ET BT 59.303 120.008 Td /F5 8.7 Tf [(ik)] TJ ET BT 65.560 122.072 Td /F1 9.8 Tf [( is the number of incident cases of disease, modeled to follow a Poisson distribution given the covariates, and )] TJ ET BT 540.287 122.072 Td /F5 9.8 Tf [(T)] TJ ET BT 546.245 120.008 Td /F5 8.7 Tf [(ik)] TJ ET BT 552.502 122.072 Td /F1 9.8 Tf [( the )] TJ ET BT 26.250 110.167 Td /F1 9.8 Tf [(total person time at risk for a particular strata corresponding to time interval )] TJ ET BT 352.456 110.167 Td /F5 9.8 Tf [(k)] TJ ET BT 357.331 110.167 Td /F1 9.8 Tf [( and the exposures indicated by the values of )] TJ ET BT 555.695 110.167 Td /F5 9.8 Tf [(x)] TJ ET BT 560.570 108.103 Td /F5 8.7 Tf [(i1)] TJ ET BT 567.312 110.167 Td /F1 9.8 Tf [(, )] TJ ET BT 572.733 110.167 Td /F5 9.8 Tf [(x)] TJ ET BT 26.250 96.198 Td /F5 8.7 Tf [(i2)] TJ ET BT 32.993 98.262 Td /F1 9.8 Tf [(, and the )] TJ ET BT 73.650 98.262 Td /F5 9.8 Tf [(z)] TJ ET BT 78.525 96.198 Td /F5 8.7 Tf [(il)] TJ ET BT 82.373 98.262 Td /F5 9.8 Tf [(s)] TJ ET BT 89.413 98.262 Td /F1 9.8 Tf [( For a ten year follow-up there are )] TJ ET BT 238.978 98.262 Td /F5 9.8 Tf [(n=40)] TJ ET BT 260.935 98.262 Td /F1 9.8 Tf [( three month time intervals and the )] TJ ET BT 413.756 98.262 Td /F5 9.8 Tf [(?)] TJ ET BT 419.177 96.198 Td /F5 8.7 Tf [(k )] TJ ET BT 425.920 98.262 Td /F5 9.8 Tf [(s)] TJ ET BT 432.959 98.262 Td /F1 9.8 Tf [( represent the log of the baseline )] TJ ET BT 26.250 86.358 Td /F1 9.8 Tf [(incidence, i.e. the incidence for the low exposure group for individuals all of whose )] TJ ET BT 383.373 86.358 Td /F5 9.8 Tf [(z)] TJ ET BT 388.248 84.293 Td /F5 8.7 Tf [(ij)] TJ ET BT 392.096 86.358 Td /F5 9.8 Tf [( s)] TJ ET BT 401.846 86.358 Td /F1 9.8 Tf [( take the value zero, with the )] TJ ET BT 528.664 86.358 Td /F5 9.8 Tf [(w)] TJ ET BT 535.704 84.293 Td /F5 8.7 Tf [(ik )] TJ ET BT 544.370 86.358 Td /F5 9.8 Tf [(s)] TJ ET BT 551.410 86.358 Td /F1 9.8 Tf [( as )] TJ ET BT 26.250 74.453 Td /F1 9.8 Tf [(dummy variables that indicate the time interval for the stratum. These correspond to the baseline hazard in a Cox regression )] TJ ET BT 26.250 62.548 Td /F1 9.8 Tf [(model but have true incidence interpretation in this fully parametric approach. )] TJ ET BT 361.689 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 366.564 60.484 Td /F5 8.7 Tf [(i1)] TJ ET BT 373.307 62.548 Td /F1 9.8 Tf [( and )] TJ ET BT 394.991 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 399.866 60.484 Td /F5 8.7 Tf [(i2)] TJ ET BT 406.608 62.548 Td /F1 9.8 Tf [( are dummy exposure variables, with )] TJ ET BT 568.078 62.548 Td /F5 9.8 Tf [(x)] TJ ET BT 572.953 62.548 Td /F5 8.7 Tf [(i1)] TJ ET BT 26.250 50.643 Td /F1 9.8 Tf [(taking the value )] TJ ET BT 97.249 50.643 Td /F5 9.8 Tf [(1)] TJ ET BT 102.671 50.643 Td /F1 9.8 Tf [( for moderate exposure and )] TJ ET BT 225.150 50.643 Td /F5 9.8 Tf [(0)] TJ ET BT 230.571 50.643 Td /F1 9.8 Tf [( otherwise, and )] TJ ET BT 299.396 50.643 Td /F5 9.8 Tf [(x)] TJ ET BT 304.271 48.579 Td /F5 8.7 Tf [(i2)] TJ ET BT 311.014 50.643 Td /F1 9.8 Tf [( taking the value )] TJ ET BT 384.724 50.643 Td /F5 9.8 Tf [(1)] TJ ET BT 390.145 50.643 Td /F1 9.8 Tf [( for high exposure and zero otherwise; )] TJ ET BT 558.683 50.643 Td /F5 9.8 Tf [(?)] TJ ET BT 564.104 48.579 Td /F5 8.7 Tf [(1)] TJ ET BT 26.250 38.739 Td /F1 9.8 Tf [(is thus the log relative hazard between the moderate and low exposure groups, and ?)] TJ ET BT 394.235 36.674 Td /F1 8.7 Tf [(2)] TJ ET BT 399.053 38.739 Td /F1 9.8 Tf [( the log relative hazard between the high )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(3)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 253 0 obj << /Type /Font /Subtype /Type1 /Name /F5 /BaseFont /Helvetica-Oblique /Encoding /WinAnsiEncoding >> endobj 254 0 obj << /Type /Annot /Subtype /Link /A 255 0 R /Border [0 0 0] /H /I /Rect [ 331.3567 405.2177 340.9941 414.0360 ] >> endobj 255 0 obj << /Type /Action >> endobj 256 0 obj << /Type /Annot /Subtype /Link /A 257 0 R /Border [0 0 0] /H /I /Rect [ 514.5203 345.6939 524.1576 354.5123 ] >> endobj 257 0 obj << /Type /Action >> endobj 258 0 obj << /Type /Annot /Subtype /Link /A 259 0 R /Border [0 0 0] /H /I /Rect [ 526.5669 345.6939 536.2043 354.5123 ] >> endobj 259 0 obj << /Type /Action >> endobj 260 0 obj << /Type /Annot /Subtype /Link /A 261 0 R /Border [0 0 0] /H /I /Rect [ 538.6136 345.6939 548.2509 354.5123 ] >> endobj 261 0 obj << /Type /Action >> endobj 262 0 obj << /Type /XObject /Subtype /Image /Width 424 /Height 25 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 424 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 2963>> stream hZg?$I$I&d2d23/L&I&3333333I4IfII$II'}ν/=yo<Ͻs9>#VZڿ?Bm 1yV7#BUj-z2C89dg򜮥'zNj9=/.g6_Hn@ٷ}(}<*+_k+@*u|C_% Eysҕ"ٱ_x\[HnWyEP10*5BIV8hztSRm"y|EGҊ`S)yG+8|L"^ggch8|1/k8f$G?ϊ8Vjx=Rϭ1ܣI#)Ocw-(OD0(}1K O_c@퓍ao+WY|c@mcer @i;] Z>6XU!K5 $l:ƕsTO;Zk'~Dܫ(P׃+1Y*PH. ج#z?LBQ@Q&~2y=wsːMO$K6P`bkO06kUX_O=Y;e (VuݬVbݟd#̀+ Ԇm榐 :˝tQ][o yK ! Fb>Gh5* j>.d+b"Qpeۻ\Q4_a|?u ho Xg/kH*CjE2j31%8Vj3c''e(vc &ד"WG4w > M{oxٹP%=娦9*6Qa}a@71WD0l*)d%aFK3n&7ȗG{{D6]t5q<уw ։ @5GCs }lj^<`OK w1 ma=ր 0<ݵu!$! ݇S1UtX.Ny3B2y/Iz7{k@wvdӨއdy阾Ot9Bԡ|H4m%a(u)CT?4BMIpTo+cʃ.J)˭.5,O{(-4/2׋#b/q}"PM+P G[-TĝVZG-''2EJ Tpa7a d]0ҘH\_[N3hVD=0I\_•:CQ&{f#a^)`? |#xx! P%: V@3 Gl/p@G}Trz3C\ =cC,|ϜVc}/ည1i1 hr a i(Ҳ&Ĝ.YV}a! Gc@ѢWVdP}ęXh1;ʓ4YK9p4:oq8] /V8` Z"8Ԑi "kxj'=r97I\k}ɯo()U9 cp rGYQ61i:j9L2Z>XA/w@ Y9S(#.w ]J&sGLs RcQd h=ev^z CfDkaf >TkPz>\'D͒T=[0LEJֹRo2""T|EݴnpQTj"pL)P4L/[K$EJ$M&_m1y|}HiJ\փXr򳪿gvvy쵮oS0-4I%ZGbh{FND K0ReYɌ<ѰW/drp_ iet]QM`; (3a5]sE7sm?q{?*Oڔ9-rZYpdNK^. 8I45؛Ym^d-+l, m ac[&wb^&F Y7;@KgS}֓:+eltbX>3I'mf{ИO]nrGiw|p{ޢњ)T*cMbCc $F{|m{*\rP> 4@U6=BJAf8kϔE&hjځ(:1c|&J09=?KY> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 54>> stream x1 Om ?|Q endstream endobj 264 0 obj << /Type /Annot /Subtype /Link /A 265 0 R /Border [0 0 0] /H /I /Rect [ 331.3567 405.2177 340.9941 414.0360 ] >> endobj 265 0 obj << /Type /Action >> endobj 266 0 obj << /Type /Annot /Subtype /Link /A 267 0 R /Border [0 0 0] /H /I /Rect [ 514.5203 345.6939 524.1576 354.5123 ] >> endobj 267 0 obj << /Type /Action >> endobj 268 0 obj << /Type /Annot /Subtype /Link /A 269 0 R /Border [0 0 0] /H /I /Rect [ 526.5669 345.6939 536.2043 354.5123 ] >> endobj 269 0 obj << /Type /Action >> endobj 270 0 obj << /Type /Annot /Subtype /Link /A 271 0 R /Border [0 0 0] /H /I /Rect [ 538.6136 345.6939 548.2509 354.5123 ] >> endobj 271 0 obj << /Type /Action >> endobj 272 0 obj << /Type /XObject /Subtype /Image /Width 424 /Height 25 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 424 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 2963>> stream hZg?$I$I&d2d23/L&I&3333333I4IfII$II'}ν/=yo<Ͻs9>#VZڿ?Bm 1yV7#BUj-z2C89dg򜮥'zNj9=/.g6_Hn@ٷ}(}<*+_k+@*u|C_% Eysҕ"ٱ_x\[HnWyEP10*5BIV8hztSRm"y|EGҊ`S)yG+8|L"^ggch8|1/k8f$G?ϊ8Vjx=Rϭ1ܣI#)Ocw-(OD0(}1K O_c@퓍ao+WY|c@mcer @i;] Z>6XU!K5 $l:ƕsTO;Zk'~Dܫ(P׃+1Y*PH. ج#z?LBQ@Q&~2y=wsːMO$K6P`bkO06kUX_O=Y;e (VuݬVbݟd#̀+ Ԇm榐 :˝tQ][o yK ! Fb>Gh5* j>.d+b"Qpeۻ\Q4_a|?u ho Xg/kH*CjE2j31%8Vj3c''e(vc &ד"WG4w > M{oxٹP%=娦9*6Qa}a@71WD0l*)d%aFK3n&7ȗG{{D6]t5q<уw ։ @5GCs }lj^<`OK w1 ma=ր 0<ݵu!$! ݇S1UtX.Ny3B2y/Iz7{k@wvdӨއdy阾Ot9Bԡ|H4m%a(u)CT?4BMIpTo+cʃ.J)˭.5,O{(-4/2׋#b/q}"PM+P G[-TĝVZG-''2EJ Tpa7a d]0ҘH\_[N3hVD=0I\_•:CQ&{f#a^)`? |#xx! P%: V@3 Gl/p@G}Trz3C\ =cC,|ϜVc}/ည1i1 hr a i(Ҳ&Ĝ.YV}a! Gc@ѢWVdP}ęXh1;ʓ4YK9p4:oq8] /V8` Z"8Ԑi "kxj'=r97I\k}ɯo()U9 cp rGYQ61i:j9L2Z>XA/w@ Y9S(#.w ]J&sGLs RcQd h=ev^z CfDkaf >TkPz>\'D͒T=[0LEJֹRo2""T|EݴnpQTj"pL)P4L/[K$EJ$M&_m1y|}HiJ\փXr򳪿gvvy쵮oS0-4I%ZGbh{FND K0ReYɌ<ѰW/drp_ iet]QM`; (3a5]sE7sm?q{?*Oڔ9-rZYpdNK^. 8I45؛Ym^d-+l, m ac[&wb^&F Y7;@KgS}֓:+eltbX>3I'mf{ИO]nrGiw|p{ޢњ)T*cMbCc $F{|m{*\rP> 4@U6=BJAf8kϔE&hjځ(:1c|&J09=?KY> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 54>> stream x1 Om ?|Q endstream endobj 274 0 obj << /Type /Annot /Subtype /Link /A 275 0 R /Border [0 0 0] /H /I /Rect [ 331.3567 405.2177 340.9941 414.0360 ] >> endobj 275 0 obj << /Type /Action >> endobj 276 0 obj << /Type /Annot /Subtype /Link /A 277 0 R /Border [0 0 0] /H /I /Rect [ 514.5203 345.6939 524.1576 354.5123 ] >> endobj 277 0 obj << /Type /Action >> endobj 278 0 obj << /Type /Annot /Subtype /Link /A 279 0 R /Border [0 0 0] /H /I /Rect [ 526.5669 345.6939 536.2043 354.5123 ] >> endobj 279 0 obj << /Type /Action >> endobj 280 0 obj << /Type /Annot /Subtype /Link /A 281 0 R /Border [0 0 0] /H /I /Rect [ 538.6136 345.6939 548.2509 354.5123 ] >> endobj 281 0 obj << /Type /Action >> endobj 282 0 obj << /Type /XObject /Subtype /Image /Width 424 /Height 25 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 424 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 2963>> stream hZg?$I$I&d2d23/L&I&3333333I4IfII$II'}ν/=yo<Ͻs9>#VZڿ?Bm 1yV7#BUj-z2C89dg򜮥'zNj9=/.g6_Hn@ٷ}(}<*+_k+@*u|C_% Eysҕ"ٱ_x\[HnWyEP10*5BIV8hztSRm"y|EGҊ`S)yG+8|L"^ggch8|1/k8f$G?ϊ8Vjx=Rϭ1ܣI#)Ocw-(OD0(}1K O_c@퓍ao+WY|c@mcer @i;] Z>6XU!K5 $l:ƕsTO;Zk'~Dܫ(P׃+1Y*PH. ج#z?LBQ@Q&~2y=wsːMO$K6P`bkO06kUX_O=Y;e (VuݬVbݟd#̀+ Ԇm榐 :˝tQ][o yK ! Fb>Gh5* j>.d+b"Qpeۻ\Q4_a|?u ho Xg/kH*CjE2j31%8Vj3c''e(vc &ד"WG4w > M{oxٹP%=娦9*6Qa}a@71WD0l*)d%aFK3n&7ȗG{{D6]t5q<уw ։ @5GCs }lj^<`OK w1 ma=ր 0<ݵu!$! ݇S1UtX.Ny3B2y/Iz7{k@wvdӨއdy阾Ot9Bԡ|H4m%a(u)CT?4BMIpTo+cʃ.J)˭.5,O{(-4/2׋#b/q}"PM+P G[-TĝVZG-''2EJ Tpa7a d]0ҘH\_[N3hVD=0I\_•:CQ&{f#a^)`? |#xx! P%: V@3 Gl/p@G}Trz3C\ =cC,|ϜVc}/ည1i1 hr a i(Ҳ&Ĝ.YV}a! Gc@ѢWVdP}ęXh1;ʓ4YK9p4:oq8] /V8` Z"8Ԑi "kxj'=r97I\k}ɯo()U9 cp rGYQ61i:j9L2Z>XA/w@ Y9S(#.w ]J&sGLs RcQd h=ev^z CfDkaf >TkPz>\'D͒T=[0LEJֹRo2""T|EݴnpQTj"pL)P4L/[K$EJ$M&_m1y|}HiJ\փXr򳪿gvvy쵮oS0-4I%ZGbh{FND K0ReYɌ<ѰW/drp_ iet]QM`; (3a5]sE7sm?q{?*Oڔ9-rZYpdNK^. 8I45؛Ym^d-+l, m ac[&wb^&F Y7;@KgS}֓:+eltbX>3I'mf{ИO]nrGiw|p{ޢњ)T*cMbCc $F{|m{*\rP> 4@U6=BJAf8kϔE&hjځ(:1c|&J09=?KY> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 54>> stream x1 Om ?|Q endstream endobj 284 0 obj << /Type /Page /Parent 3 0 R /Contents 285 0 R >> endobj 285 0 obj << /Length 18847 >> stream 0.271 0.267 0.267 rg q 15.000 343.204 577.500 433.796 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(and low exposure groups. These relative hazards have true incidence rate ratio interpretation in this fully parametric modeling )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(approach. The )] TJ ET BT 91.829 755.571 Td /F5 9.8 Tf [(z)] TJ ET BT 96.704 753.507 Td /F5 8.7 Tf [(il)] TJ ET BT 100.552 755.571 Td /F5 9.8 Tf [( s)] TJ ET BT 110.302 755.571 Td /F1 9.8 Tf [( are the additional covariates include in the model and the )] TJ ET BT 362.310 755.571 Td /F5 9.8 Tf [(?)] TJ ET BT 367.731 753.507 Td /F5 8.7 Tf [(l)] TJ ET BT 369.655 755.571 Td /F5 9.8 Tf [( s)] TJ ET BT 379.405 755.571 Td /F1 9.8 Tf [( are the log relative hazard for the additional )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(covariates. A Poisson likelihood, mathematically equivalent to that of the exponential survival model, was used for the model fit )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(and as the goodness of fit measure.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(In the non-null model, change points are introduced to allow the relative hazards between exposure groups to vary over the )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(follow-up time, as this expression for a model with)] TJ ET BT 241.364 700.452 Td /F5 9.8 Tf [( p)] TJ ET BT 249.496 700.452 Td /F1 9.8 Tf [( distinct nontrivial change points shows as follows \(equation 2\):)] TJ ET q 355.500 0 0 21.000 26.250 669.571 cm /I11 Do Q q 227.250 0 0 21.000 26.250 641.071 cm /I13 Do Q BT 26.250 624.048 Td /F1 9.8 Tf [(Here, )] TJ ET BT 52.799 624.048 Td /F5 9.8 Tf [(?)] TJ ET BT 58.220 621.983 Td /F5 8.7 Tf [(1j)] TJ ET BT 64.963 624.048 Td /F1 9.8 Tf [( and)] TJ ET BT 83.936 624.048 Td /F5 9.8 Tf [( ?)] TJ ET BT 92.068 621.983 Td /F1 8.7 Tf [(2j)] TJ ET BT 98.811 624.048 Td /F1 9.8 Tf [( are the log relative hazards \(moderate vs. low exposure and high vs. low exposure, respectively\), for the)] TJ ET BT 550.206 624.048 Td /F5 9.8 Tf [( j)] TJ ET BT 555.081 627.936 Td /F5 8.7 Tf [(th)] TJ ET BT 26.250 612.143 Td /F1 9.8 Tf [(period of follow-up, defined as between the change points at time )] TJ ET BT 310.238 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 315.659 610.079 Td /F5 8.7 Tf [(j-1)] TJ ET BT 325.288 612.143 Td /F1 9.8 Tf [( and )] TJ ET BT 346.972 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 352.393 610.079 Td /F5 8.7 Tf [(j)] TJ ET BT 354.317 612.143 Td /F1 9.8 Tf [( , with )] TJ ET BT 382.494 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 387.915 612.143 Td /F5 8.7 Tf [(0)] TJ ET BT 392.734 612.143 Td /F5 9.8 Tf [(=0 )] TJ ET BT 406.560 612.143 Td /F1 9.8 Tf [(and )] TJ ET BT 425.533 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 430.954 610.079 Td /F5 8.7 Tf [(p+1)] TJ ET BT 445.653 612.143 Td /F5 9.8 Tf [(=120)] TJ ET BT 467.610 612.143 Td /F1 9.8 Tf [( months from 9/11/2001, )] TJ ET BT 26.250 600.238 Td /F1 9.8 Tf [(with the time variable )] TJ ET BT 120.532 600.238 Td /F5 9.8 Tf [(t)] TJ ET BT 123.243 598.174 Td /F5 8.7 Tf [(ik)] TJ ET BT 129.500 600.238 Td /F1 9.8 Tf [( defined similarly, and )] TJ ET BT 226.493 600.238 Td /F5 9.8 Tf [(1\(-\))] TJ ET BT 241.655 600.238 Td /F1 9.8 Tf [( is the dummy variable function taking the value )] TJ ET BT 449.749 600.238 Td /F5 9.8 Tf [(1)] TJ ET BT 455.170 600.238 Td /F1 9.8 Tf [( when the argument is true )] TJ ET BT 26.250 588.333 Td /F1 9.8 Tf [(and )] TJ ET BT 45.224 588.333 Td /F5 9.8 Tf [(0)] TJ ET BT 50.645 588.333 Td /F1 9.8 Tf [( otherwise. For )] TJ ET BT 117.832 588.333 Td /F5 9.8 Tf [(p>0, )] TJ ET BT 139.789 588.333 Td /F5 9.8 Tf [(?)] TJ ET BT 145.210 586.269 Td /F5 8.7 Tf [(1)] TJ ET BT 150.028 588.333 Td /F5 9.8 Tf [(,)] TJ ET BT 152.739 588.333 Td /F5 9.8 Tf [(?)] TJ ET BT 158.160 586.269 Td /F5 8.7 Tf [(2,,)] TJ ET BT 176.464 588.333 Td /F5 9.8 Tf [( ?)] TJ ET BT 184.595 586.269 Td /F5 8.7 Tf [(p)] TJ ET BT 189.414 588.333 Td /F1 9.8 Tf [(would be nontrivial change points. For )] TJ ET BT 356.324 588.333 Td /F5 9.8 Tf [(p=0)] TJ ET BT 372.860 588.333 Td /F1 9.8 Tf [( this reduces to model \(1\). Models with different )] TJ ET BT 26.250 576.429 Td /F1 9.8 Tf [(numbers of change points are compared using likelihood ratio tests. A significantly better fit to a model with one or more change )] TJ ET BT 26.250 564.524 Td /F1 9.8 Tf [(points indicates that the exposure-response relationship changes over time. If after some time )] TJ ET BT 433.225 564.524 Td /F5 9.8 Tf [(?)] TJ ET BT 438.646 562.460 Td /F5 8.7 Tf [(j)] TJ ET BT 440.570 564.524 Td /F1 9.8 Tf [(, neither)] TJ ET BT 475.796 564.524 Td /F5 9.8 Tf [( ?)] TJ ET BT 483.928 562.460 Td /F5 8.7 Tf [(1,j+1)] TJ ET BT 502.960 564.524 Td /F1 9.8 Tf [( and)] TJ ET BT 521.934 564.524 Td /F5 9.8 Tf [( ?)] TJ ET BT 530.065 562.460 Td /F5 8.7 Tf [(2,j+1)] TJ ET BT 549.097 564.524 Td /F1 9.8 Tf [( are )] TJ ET BT 26.250 552.619 Td /F1 9.8 Tf [(significantly different from zero, that would show that the exposure-response relationship between WTC exposure and incident )] TJ ET BT 26.250 540.714 Td /F1 9.8 Tf [(OAD is limited to the first )] TJ ET BT 136.240 540.714 Td /F5 9.8 Tf [(?)] TJ ET BT 141.661 540.714 Td /F5 8.7 Tf [(j)] TJ ET BT 143.585 540.714 Td /F1 9.8 Tf [( months of follow-up.)] TJ ET BT 26.250 521.310 Td /F4 9.8 Tf [(Institutional review board)] TJ ET BT 26.250 501.905 Td /F1 9.8 Tf [(The study was approved by the Institutional Review Board of Montefiore Medical Center and the Albert Einstein College of )] TJ ET BT 26.250 490.000 Td /F1 9.8 Tf [(Medicine. All study participants provided written informed consent.)] TJ ET BT 26.250 453.398 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 433.443 Td /F1 9.8 Tf [(Table 1 describes the cohort by exposure intensity. 16.3% were in the high exposure group, 71.5% in the moderate exposure )] TJ ET BT 26.250 421.539 Td /F1 9.8 Tf [(group, and 12.2% in the low exposure group. The three exposure groups were similar in age, other demographics, and smoking )] TJ ET BT 26.250 409.634 Td /F1 9.8 Tf [(history. There was a clear exposure-response gradient across the groups, with higher levels of exposure associated with higher )] TJ ET BT 26.250 397.729 Td /F1 9.8 Tf [(rates of OAD.)] TJ ET Q q 15.000 343.204 577.500 433.796 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(and low exposure groups. These relative hazards have true incidence rate ratio interpretation in this fully parametric modeling )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(approach. The )] TJ ET BT 91.829 755.571 Td /F5 9.8 Tf [(z)] TJ ET BT 96.704 753.507 Td /F5 8.7 Tf [(il)] TJ ET BT 100.552 755.571 Td /F5 9.8 Tf [( s)] TJ ET BT 110.302 755.571 Td /F1 9.8 Tf [( are the additional covariates include in the model and the )] TJ ET BT 362.310 755.571 Td /F5 9.8 Tf [(?)] TJ ET BT 367.731 753.507 Td /F5 8.7 Tf [(l)] TJ ET BT 369.655 755.571 Td /F5 9.8 Tf [( s)] TJ ET BT 379.405 755.571 Td /F1 9.8 Tf [( are the log relative hazard for the additional )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(covariates. A Poisson likelihood, mathematically equivalent to that of the exponential survival model, was used for the model fit )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(and as the goodness of fit measure.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(In the non-null model, change points are introduced to allow the relative hazards between exposure groups to vary over the )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(follow-up time, as this expression for a model with)] TJ ET BT 241.364 700.452 Td /F5 9.8 Tf [( p)] TJ ET BT 249.496 700.452 Td /F1 9.8 Tf [( distinct nontrivial change points shows as follows \(equation 2\):)] TJ ET q 355.500 0 0 21.000 26.250 669.571 cm /I15 Do Q q 227.250 0 0 21.000 26.250 641.071 cm /I17 Do Q BT 26.250 624.048 Td /F1 9.8 Tf [(Here, )] TJ ET BT 52.799 624.048 Td /F5 9.8 Tf [(?)] TJ ET BT 58.220 621.983 Td /F5 8.7 Tf [(1j)] TJ ET BT 64.963 624.048 Td /F1 9.8 Tf [( and)] TJ ET BT 83.936 624.048 Td /F5 9.8 Tf [( ?)] TJ ET BT 92.068 621.983 Td /F1 8.7 Tf [(2j)] TJ ET BT 98.811 624.048 Td /F1 9.8 Tf [( are the log relative hazards \(moderate vs. low exposure and high vs. low exposure, respectively\), for the)] TJ ET BT 550.206 624.048 Td /F5 9.8 Tf [( j)] TJ ET BT 555.081 627.936 Td /F5 8.7 Tf [(th)] TJ ET BT 26.250 612.143 Td /F1 9.8 Tf [(period of follow-up, defined as between the change points at time )] TJ ET BT 310.238 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 315.659 610.079 Td /F5 8.7 Tf [(j-1)] TJ ET BT 325.288 612.143 Td /F1 9.8 Tf [( and )] TJ ET BT 346.972 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 352.393 610.079 Td /F5 8.7 Tf [(j)] TJ ET BT 354.317 612.143 Td /F1 9.8 Tf [( , with )] TJ ET BT 382.494 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 387.915 612.143 Td /F5 8.7 Tf [(0)] TJ ET BT 392.734 612.143 Td /F5 9.8 Tf [(=0 )] TJ ET BT 406.560 612.143 Td /F1 9.8 Tf [(and )] TJ ET BT 425.533 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 430.954 610.079 Td /F5 8.7 Tf [(p+1)] TJ ET BT 445.653 612.143 Td /F5 9.8 Tf [(=120)] TJ ET BT 467.610 612.143 Td /F1 9.8 Tf [( months from 9/11/2001, )] TJ ET BT 26.250 600.238 Td /F1 9.8 Tf [(with the time variable )] TJ ET BT 120.532 600.238 Td /F5 9.8 Tf [(t)] TJ ET BT 123.243 598.174 Td /F5 8.7 Tf [(ik)] TJ ET BT 129.500 600.238 Td /F1 9.8 Tf [( defined similarly, and )] TJ ET BT 226.493 600.238 Td /F5 9.8 Tf [(1\(-\))] TJ ET BT 241.655 600.238 Td /F1 9.8 Tf [( is the dummy variable function taking the value )] TJ ET BT 449.749 600.238 Td /F5 9.8 Tf [(1)] TJ ET BT 455.170 600.238 Td /F1 9.8 Tf [( when the argument is true )] TJ ET BT 26.250 588.333 Td /F1 9.8 Tf [(and )] TJ ET BT 45.224 588.333 Td /F5 9.8 Tf [(0)] TJ ET BT 50.645 588.333 Td /F1 9.8 Tf [( otherwise. For )] TJ ET BT 117.832 588.333 Td /F5 9.8 Tf [(p>0, )] TJ ET BT 139.789 588.333 Td /F5 9.8 Tf [(?)] TJ ET BT 145.210 586.269 Td /F5 8.7 Tf [(1)] TJ ET BT 150.028 588.333 Td /F5 9.8 Tf [(,)] TJ ET BT 152.739 588.333 Td /F5 9.8 Tf [(?)] TJ ET BT 158.160 586.269 Td /F5 8.7 Tf [(2,,)] TJ ET BT 176.464 588.333 Td /F5 9.8 Tf [( ?)] TJ ET BT 184.595 586.269 Td /F5 8.7 Tf [(p)] TJ ET BT 189.414 588.333 Td /F1 9.8 Tf [(would be nontrivial change points. For )] TJ ET BT 356.324 588.333 Td /F5 9.8 Tf [(p=0)] TJ ET BT 372.860 588.333 Td /F1 9.8 Tf [( this reduces to model \(1\). Models with different )] TJ ET BT 26.250 576.429 Td /F1 9.8 Tf [(numbers of change points are compared using likelihood ratio tests. A significantly better fit to a model with one or more change )] TJ ET BT 26.250 564.524 Td /F1 9.8 Tf [(points indicates that the exposure-response relationship changes over time. If after some time )] TJ ET BT 433.225 564.524 Td /F5 9.8 Tf [(?)] TJ ET BT 438.646 562.460 Td /F5 8.7 Tf [(j)] TJ ET BT 440.570 564.524 Td /F1 9.8 Tf [(, neither)] TJ ET BT 475.796 564.524 Td /F5 9.8 Tf [( ?)] TJ ET BT 483.928 562.460 Td /F5 8.7 Tf [(1,j+1)] TJ ET BT 502.960 564.524 Td /F1 9.8 Tf [( and)] TJ ET BT 521.934 564.524 Td /F5 9.8 Tf [( ?)] TJ ET BT 530.065 562.460 Td /F5 8.7 Tf [(2,j+1)] TJ ET BT 549.097 564.524 Td /F1 9.8 Tf [( are )] TJ ET BT 26.250 552.619 Td /F1 9.8 Tf [(significantly different from zero, that would show that the exposure-response relationship between WTC exposure and incident )] TJ ET BT 26.250 540.714 Td /F1 9.8 Tf [(OAD is limited to the first )] TJ ET BT 136.240 540.714 Td /F5 9.8 Tf [(?)] TJ ET BT 141.661 540.714 Td /F5 8.7 Tf [(j)] TJ ET BT 143.585 540.714 Td /F1 9.8 Tf [( months of follow-up.)] TJ ET BT 26.250 521.310 Td /F4 9.8 Tf [(Institutional review board)] TJ ET BT 26.250 501.905 Td /F1 9.8 Tf [(The study was approved by the Institutional Review Board of Montefiore Medical Center and the Albert Einstein College of )] TJ ET BT 26.250 490.000 Td /F1 9.8 Tf [(Medicine. All study participants provided written informed consent.)] TJ ET BT 26.250 453.398 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 433.443 Td /F1 9.8 Tf [(Table 1 describes the cohort by exposure intensity. 16.3% were in the high exposure group, 71.5% in the moderate exposure )] TJ ET BT 26.250 421.539 Td /F1 9.8 Tf [(group, and 12.2% in the low exposure group. The three exposure groups were similar in age, other demographics, and smoking )] TJ ET BT 26.250 409.634 Td /F1 9.8 Tf [(history. There was a clear exposure-response gradient across the groups, with higher levels of exposure associated with higher )] TJ ET BT 26.250 397.729 Td /F1 9.8 Tf [(rates of OAD.)] TJ ET Q q 15.000 343.204 577.500 433.796 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(and low exposure groups. These relative hazards have true incidence rate ratio interpretation in this fully parametric modeling )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(approach. The )] TJ ET BT 91.829 755.571 Td /F5 9.8 Tf [(z)] TJ ET BT 96.704 753.507 Td /F5 8.7 Tf [(il)] TJ ET BT 100.552 755.571 Td /F5 9.8 Tf [( s)] TJ ET BT 110.302 755.571 Td /F1 9.8 Tf [( are the additional covariates include in the model and the )] TJ ET BT 362.310 755.571 Td /F5 9.8 Tf [(?)] TJ ET BT 367.731 753.507 Td /F5 8.7 Tf [(l)] TJ ET BT 369.655 755.571 Td /F5 9.8 Tf [( s)] TJ ET BT 379.405 755.571 Td /F1 9.8 Tf [( are the log relative hazard for the additional )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(covariates. A Poisson likelihood, mathematically equivalent to that of the exponential survival model, was used for the model fit )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(and as the goodness of fit measure.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(In the non-null model, change points are introduced to allow the relative hazards between exposure groups to vary over the )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(follow-up time, as this expression for a model with)] TJ ET BT 241.364 700.452 Td /F5 9.8 Tf [( p)] TJ ET BT 249.496 700.452 Td /F1 9.8 Tf [( distinct nontrivial change points shows as follows \(equation 2\):)] TJ ET q 355.500 0 0 21.000 26.250 669.571 cm /I19 Do Q q 227.250 0 0 21.000 26.250 641.071 cm /I21 Do Q BT 26.250 624.048 Td /F1 9.8 Tf [(Here, )] TJ ET BT 52.799 624.048 Td /F5 9.8 Tf [(?)] TJ ET BT 58.220 621.983 Td /F5 8.7 Tf [(1j)] TJ ET BT 64.963 624.048 Td /F1 9.8 Tf [( and)] TJ ET BT 83.936 624.048 Td /F5 9.8 Tf [( ?)] TJ ET BT 92.068 621.983 Td /F1 8.7 Tf [(2j)] TJ ET BT 98.811 624.048 Td /F1 9.8 Tf [( are the log relative hazards \(moderate vs. low exposure and high vs. low exposure, respectively\), for the)] TJ ET BT 550.206 624.048 Td /F5 9.8 Tf [( j)] TJ ET BT 555.081 627.936 Td /F5 8.7 Tf [(th)] TJ ET BT 26.250 612.143 Td /F1 9.8 Tf [(period of follow-up, defined as between the change points at time )] TJ ET BT 310.238 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 315.659 610.079 Td /F5 8.7 Tf [(j-1)] TJ ET BT 325.288 612.143 Td /F1 9.8 Tf [( and )] TJ ET BT 346.972 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 352.393 610.079 Td /F5 8.7 Tf [(j)] TJ ET BT 354.317 612.143 Td /F1 9.8 Tf [( , with )] TJ ET BT 382.494 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 387.915 612.143 Td /F5 8.7 Tf [(0)] TJ ET BT 392.734 612.143 Td /F5 9.8 Tf [(=0 )] TJ ET BT 406.560 612.143 Td /F1 9.8 Tf [(and )] TJ ET BT 425.533 612.143 Td /F5 9.8 Tf [(?)] TJ ET BT 430.954 610.079 Td /F5 8.7 Tf [(p+1)] TJ ET BT 445.653 612.143 Td /F5 9.8 Tf [(=120)] TJ ET BT 467.610 612.143 Td /F1 9.8 Tf [( months from 9/11/2001, )] TJ ET BT 26.250 600.238 Td /F1 9.8 Tf [(with the time variable )] TJ ET BT 120.532 600.238 Td /F5 9.8 Tf [(t)] TJ ET BT 123.243 598.174 Td /F5 8.7 Tf [(ik)] TJ ET BT 129.500 600.238 Td /F1 9.8 Tf [( defined similarly, and )] TJ ET BT 226.493 600.238 Td /F5 9.8 Tf [(1\(-\))] TJ ET BT 241.655 600.238 Td /F1 9.8 Tf [( is the dummy variable function taking the value )] TJ ET BT 449.749 600.238 Td /F5 9.8 Tf [(1)] TJ ET BT 455.170 600.238 Td /F1 9.8 Tf [( when the argument is true )] TJ ET BT 26.250 588.333 Td /F1 9.8 Tf [(and )] TJ ET BT 45.224 588.333 Td /F5 9.8 Tf [(0)] TJ ET BT 50.645 588.333 Td /F1 9.8 Tf [( otherwise. For )] TJ ET BT 117.832 588.333 Td /F5 9.8 Tf [(p>0, )] TJ ET BT 139.789 588.333 Td /F5 9.8 Tf [(?)] TJ ET BT 145.210 586.269 Td /F5 8.7 Tf [(1)] TJ ET BT 150.028 588.333 Td /F5 9.8 Tf [(,)] TJ ET BT 152.739 588.333 Td /F5 9.8 Tf [(?)] TJ ET BT 158.160 586.269 Td /F5 8.7 Tf [(2,,)] TJ ET BT 176.464 588.333 Td /F5 9.8 Tf [( ?)] TJ ET BT 184.595 586.269 Td /F5 8.7 Tf [(p)] TJ ET BT 189.414 588.333 Td /F1 9.8 Tf [(would be nontrivial change points. For )] TJ ET BT 356.324 588.333 Td /F5 9.8 Tf [(p=0)] TJ ET BT 372.860 588.333 Td /F1 9.8 Tf [( this reduces to model \(1\). Models with different )] TJ ET BT 26.250 576.429 Td /F1 9.8 Tf [(numbers of change points are compared using likelihood ratio tests. A significantly better fit to a model with one or more change )] TJ ET BT 26.250 564.524 Td /F1 9.8 Tf [(points indicates that the exposure-response relationship changes over time. If after some time )] TJ ET BT 433.225 564.524 Td /F5 9.8 Tf [(?)] TJ ET BT 438.646 562.460 Td /F5 8.7 Tf [(j)] TJ ET BT 440.570 564.524 Td /F1 9.8 Tf [(, neither)] TJ ET BT 475.796 564.524 Td /F5 9.8 Tf [( ?)] TJ ET BT 483.928 562.460 Td /F5 8.7 Tf [(1,j+1)] TJ ET BT 502.960 564.524 Td /F1 9.8 Tf [( and)] TJ ET BT 521.934 564.524 Td /F5 9.8 Tf [( ?)] TJ ET BT 530.065 562.460 Td /F5 8.7 Tf [(2,j+1)] TJ ET BT 549.097 564.524 Td /F1 9.8 Tf [( are )] TJ ET BT 26.250 552.619 Td /F1 9.8 Tf [(significantly different from zero, that would show that the exposure-response relationship between WTC exposure and incident )] TJ ET BT 26.250 540.714 Td /F1 9.8 Tf [(OAD is limited to the first )] TJ ET BT 136.240 540.714 Td /F5 9.8 Tf [(?)] TJ ET BT 141.661 540.714 Td /F5 8.7 Tf [(j)] TJ ET BT 143.585 540.714 Td /F1 9.8 Tf [( months of follow-up.)] TJ ET BT 26.250 521.310 Td /F4 9.8 Tf [(Institutional review board)] TJ ET BT 26.250 501.905 Td /F1 9.8 Tf [(The study was approved by the Institutional Review Board of Montefiore Medical Center and the Albert Einstein College of )] TJ ET BT 26.250 490.000 Td /F1 9.8 Tf [(Medicine. All study participants provided written informed consent.)] TJ ET BT 26.250 453.398 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 433.443 Td /F1 9.8 Tf [(Table 1 describes the cohort by exposure intensity. 16.3% were in the high exposure group, 71.5% in the moderate exposure )] TJ ET BT 26.250 421.539 Td /F1 9.8 Tf [(group, and 12.2% in the low exposure group. The three exposure groups were similar in age, other demographics, and smoking )] TJ ET BT 26.250 409.634 Td /F1 9.8 Tf [(history. There was a clear exposure-response gradient across the groups, with higher levels of exposure associated with higher )] TJ ET BT 26.250 397.729 Td /F1 9.8 Tf [(rates of OAD.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(4)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 286 0 obj << /Type /XObject /Subtype /Image /Width 474 /Height 28 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 474 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 3307>> stream hZgr?J&I&3LfffdfLd3I$\I$3$I$Ifҟ}svmϞ@|S驝~_]/b43iEDnggH`/P%Ԗ0tz+ .]2u7k"XƎ BNdCڭ6o6u&ph..x.= lN盉`&Dk+=k#%Goʼ7_J =N;fxo&Fhfc|Rd'8̯2e =g$˙y@L"cCDrZn|u^Cӏ\|nfDtng&2~yUqDQ+ڵ>frŨѰcǫ4p7 p* 6t ?;ahjboG Z+u^+hI ܮ)LUٜuD}-;"9 a d>=~J|Z#ր/-߷qL(V Ops"y@Bn6'BFz>UZy {\'fc&)!#|ܢPp sHO›;u@f` ޫ2n:oG!c䶵s.k|y4 eN&DSX79j up{[2r{s~uZlsqhS(R˒ij>f8X1v S wj(ݧLs wzj yoNFS"[Cxǭ|M0"Fsn\UN'-Oa:.en(R h2;rV0Z {>^ۺ!s46L G ZK<)C(.G%h NQ؊h!ԁ!}+$bI8nfBY$S\>B]'H G 'gy+Ew&-mHg~@JL3@1!✵ozQ5KypFRxv!lnY"'CJR(.Qc:1eE$C{ X欕]{G Qa ]CAVhș{ݵ4">\\[}WXZKȏK:1B$䇓P9'jL+s{ bex.{&َH*}^[͉zI9]?6t2*?' P7pΆ6(N<9P[o[ }Ae$6Ա'`_ts* Sj~FjCُ/50;sKuY(Z#/P~ZB9Db;8'V|گ;q'gW05ݯ?~ꬹ]/$[׽ ]#z3wB+3%ԒMw G endstream endobj 287 0 obj << /Type /XObject /Subtype /Image /Width 474 /Height 28 /SMask 286 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 474 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 61>> stream x1 Om /k endstream endobj 288 0 obj << /Type /XObject /Subtype /Image /Width 303 /Height 28 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 303 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 2074>> stream hYgr9$$L&Ldffn3$3dd$IL2d29d2I['=חsNשUܯo}}{]~_}'߽t8; aTp&r8 L?|DR"_k6T,`@Zj0˲ uW9ࠑCxQq ,}F# K/_!E/z3:וzilkhŅ}cK]_k8c+M廂||E~riRQ!mVq!Z0 JEǐ'ԞC.A0I@ y\8{`NQMXJg:qK{ lY|ג ˩$plaۅxS* Sl"xWck`̭vJ'LjXyƭyI_$e?RڦuBPZ.s(5ȎVBNsaƗ_g[B?C!UA<I7!KmJ3GNٸyZ'hc .U)gmէyy#7zgZ}wug8]iqe@iJXSy0O`́_4/88]R|`,UHcKcu#'JvbWML{B,ח e}Q*1 yq0*J ZEhS#(ByK6%B;!pB=ٳfi|~%ѧ?S#FҩTt㛨!sAG WrBTn;8n:LiP:}#©ݣ*Ք|WD.m;¬\ xtUh pM`$*c6v8PZɵbT["/f_Hԉ0.e+GI &gp"K>闬ԘH(^ǫl0SWІ=SMX ڀ8?b<'ix^r  6Z#W- Е<2VS_εHʦ ~$W2J#jz_5xiTy@$Ǩ:PBea+pJ}FƄxs8t͐CtkTAw[𤻂 ~'t,nK2M}!7_0q+EAZ\Cl2zKXnŖ G[@+~|&M7_ك̜iIj_?D'~( .mt:,h8[B`1&Ƒ77C;$=o+c`!5}l,,yFF-~aջ# U s \&x(z 6/&pM81>l q,TZ|d]ȥ3m؜ރ^# ̄T1U]ۼng%γr04b4=z]|Z`Ac~2TKllN%%@dc`6:?L$}vTyz0^LS&p (wA'+-q=uS^tes w}=QWٓ&,Q%pSQY e=q'ugN@¹[ot]y*: UZ7y<r.#""4͵[ޤ]<'ErLa\$U.*\KAY,][_bo6{XD02_o endstream endobj 289 0 obj << /Type /XObject /Subtype /Image /Width 303 /Height 28 /SMask 288 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 303 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 48>> stream x  Om7c endstream endobj 290 0 obj << /Type /XObject /Subtype /Image /Width 474 /Height 28 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 474 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 3307>> stream hZgr?J&I&3LfffdfLd3I$\I$3$I$Ifҟ}svmϞ@|S驝~_]/b43iEDnggH`/P%Ԗ0tz+ .]2u7k"XƎ BNdCڭ6o6u&ph..x.= lN盉`&Dk+=k#%Goʼ7_J =N;fxo&Fhfc|Rd'8̯2e =g$˙y@L"cCDrZn|u^Cӏ\|nfDtng&2~yUqDQ+ڵ>frŨѰcǫ4p7 p* 6t ?;ahjboG Z+u^+hI ܮ)LUٜuD}-;"9 a d>=~J|Z#ր/-߷qL(V Ops"y@Bn6'BFz>UZy {\'fc&)!#|ܢPp sHO›;u@f` ޫ2n:oG!c䶵s.k|y4 eN&DSX79j up{[2r{s~uZlsqhS(R˒ij>f8X1v S wj(ݧLs wzj yoNFS"[Cxǭ|M0"Fsn\UN'-Oa:.en(R h2;rV0Z {>^ۺ!s46L G ZK<)C(.G%h NQ؊h!ԁ!}+$bI8nfBY$S\>B]'H G 'gy+Ew&-mHg~@JL3@1!✵ozQ5KypFRxv!lnY"'CJR(.Qc:1eE$C{ X欕]{G Qa ]CAVhș{ݵ4">\\[}WXZKȏK:1B$䇓P9'jL+s{ bex.{&َH*}^[͉zI9]?6t2*?' P7pΆ6(N<9P[o[ }Ae$6Ա'`_ts* Sj~FjCُ/50;sKuY(Z#/P~ZB9Db;8'V|گ;q'gW05ݯ?~ꬹ]/$[׽ ]#z3wB+3%ԒMw G endstream endobj 291 0 obj << /Type /XObject /Subtype /Image /Width 474 /Height 28 /SMask 290 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 474 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 61>> stream x1 Om /k endstream endobj 292 0 obj << /Type /XObject /Subtype /Image /Width 303 /Height 28 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 303 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 2074>> stream hYgr9$$L&Ldffn3$3dd$IL2d29d2I['=חsNשUܯo}}{]~_}'߽t8; aTp&r8 L?|DR"_k6T,`@Zj0˲ uW9ࠑCxQq ,}F# K/_!E/z3:וzilkhŅ}cK]_k8c+M廂||E~riRQ!mVq!Z0 JEǐ'ԞC.A0I@ y\8{`NQMXJg:qK{ lY|ג ˩$plaۅxS* Sl"xWck`̭vJ'LjXyƭyI_$e?RڦuBPZ.s(5ȎVBNsaƗ_g[B?C!UA<I7!KmJ3GNٸyZ'hc .U)gmէyy#7zgZ}wug8]iqe@iJXSy0O`́_4/88]R|`,UHcKcu#'JvbWML{B,ח e}Q*1 yq0*J ZEhS#(ByK6%B;!pB=ٳfi|~%ѧ?S#FҩTt㛨!sAG WrBTn;8n:LiP:}#©ݣ*Ք|WD.m;¬\ xtUh pM`$*c6v8PZɵbT["/f_Hԉ0.e+GI &gp"K>闬ԘH(^ǫl0SWІ=SMX ڀ8?b<'ix^r  6Z#W- Е<2VS_εHʦ ~$W2J#jz_5xiTy@$Ǩ:PBea+pJ}FƄxs8t͐CtkTAw[𤻂 ~'t,nK2M}!7_0q+EAZ\Cl2zKXnŖ G[@+~|&M7_ك̜iIj_?D'~( .mt:,h8[B`1&Ƒ77C;$=o+c`!5}l,,yFF-~aջ# U s \&x(z 6/&pM81>l q,TZ|d]ȥ3m؜ރ^# ̄T1U]ۼng%γr04b4=z]|Z`Ac~2TKllN%%@dc`6:?L$}vTyz0^LS&p (wA'+-q=uS^tes w}=QWٓ&,Q%pSQY e=q'ugN@¹[ot]y*: UZ7y<r.#""4͵[ޤ]<'ErLa\$U.*\KAY,][_bo6{XD02_o endstream endobj 293 0 obj << /Type /XObject /Subtype /Image /Width 303 /Height 28 /SMask 292 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 303 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 48>> stream x  Om7c endstream endobj 294 0 obj << /Type /XObject /Subtype /Image /Width 474 /Height 28 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 474 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 3307>> stream hZgr?J&I&3LfffdfLd3I$\I$3$I$Ifҟ}svmϞ@|S驝~_]/b43iEDnggH`/P%Ԗ0tz+ .]2u7k"XƎ BNdCڭ6o6u&ph..x.= lN盉`&Dk+=k#%Goʼ7_J =N;fxo&Fhfc|Rd'8̯2e =g$˙y@L"cCDrZn|u^Cӏ\|nfDtng&2~yUqDQ+ڵ>frŨѰcǫ4p7 p* 6t ?;ahjboG Z+u^+hI ܮ)LUٜuD}-;"9 a d>=~J|Z#ր/-߷qL(V Ops"y@Bn6'BFz>UZy {\'fc&)!#|ܢPp sHO›;u@f` ޫ2n:oG!c䶵s.k|y4 eN&DSX79j up{[2r{s~uZlsqhS(R˒ij>f8X1v S wj(ݧLs wzj yoNFS"[Cxǭ|M0"Fsn\UN'-Oa:.en(R h2;rV0Z {>^ۺ!s46L G ZK<)C(.G%h NQ؊h!ԁ!}+$bI8nfBY$S\>B]'H G 'gy+Ew&-mHg~@JL3@1!✵ozQ5KypFRxv!lnY"'CJR(.Qc:1eE$C{ X欕]{G Qa ]CAVhș{ݵ4">\\[}WXZKȏK:1B$䇓P9'jL+s{ bex.{&َH*}^[͉zI9]?6t2*?' P7pΆ6(N<9P[o[ }Ae$6Ա'`_ts* Sj~FjCُ/50;sKuY(Z#/P~ZB9Db;8'V|گ;q'gW05ݯ?~ꬹ]/$[׽ ]#z3wB+3%ԒMw G endstream endobj 295 0 obj << /Type /XObject /Subtype /Image /Width 474 /Height 28 /SMask 294 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 474 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 61>> stream x1 Om /k endstream endobj 296 0 obj << /Type /XObject /Subtype /Image /Width 303 /Height 28 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 303 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 2074>> stream hYgr9$$L&Ldffn3$3dd$IL2d29d2I['=חsNשUܯo}}{]~_}'߽t8; aTp&r8 L?|DR"_k6T,`@Zj0˲ uW9ࠑCxQq ,}F# K/_!E/z3:וzilkhŅ}cK]_k8c+M廂||E~riRQ!mVq!Z0 JEǐ'ԞC.A0I@ y\8{`NQMXJg:qK{ lY|ג ˩$plaۅxS* Sl"xWck`̭vJ'LjXyƭyI_$e?RڦuBPZ.s(5ȎVBNsaƗ_g[B?C!UA<I7!KmJ3GNٸyZ'hc .U)gmէyy#7zgZ}wug8]iqe@iJXSy0O`́_4/88]R|`,UHcKcu#'JvbWML{B,ח e}Q*1 yq0*J ZEhS#(ByK6%B;!pB=ٳfi|~%ѧ?S#FҩTt㛨!sAG WrBTn;8n:LiP:}#©ݣ*Ք|WD.m;¬\ xtUh pM`$*c6v8PZɵbT["/f_Hԉ0.e+GI &gp"K>闬ԘH(^ǫl0SWІ=SMX ڀ8?b<'ix^r  6Z#W- Е<2VS_εHʦ ~$W2J#jz_5xiTy@$Ǩ:PBea+pJ}FƄxs8t͐CtkTAw[𤻂 ~'t,nK2M}!7_0q+EAZ\Cl2zKXnŖ G[@+~|&M7_ك̜iIj_?D'~( .mt:,h8[B`1&Ƒ77C;$=o+c`!5}l,,yFF-~aջ# U s \&x(z 6/&pM81>l q,TZ|d]ȥ3m؜ރ^# ̄T1U]ۼng%γr04b4=z]|Z`Ac~2TKllN%%@dc`6:?L$}vTyz0^LS&p (wA'+-q=uS^tes w}=QWٓ&,Q%pSQY e=q'ugN@¹[ot]y*: UZ7y<r.#""4͵[ޤ]<'ErLa\$U.*\KAY,][_bo6{XD02_o endstream endobj 297 0 obj << /Type /XObject /Subtype /Image /Width 303 /Height 28 /SMask 296 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 303 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 48>> stream x  Om7c endstream endobj 298 0 obj << /Type /Page /Parent 3 0 R /Contents 299 0 R >> endobj 299 0 obj << /Length 46915 >> stream 0.271 0.267 0.267 rg q 15.000 41.087 577.500 735.913 re W n q 26.250 763.264 555.000 13.736 re W n 0.271 0.267 0.267 rg BT 26.250 766.011 Td /F1 9.8 Tf [(Table 1. Characteristics of FDNY Firefighter Population.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 732.356 555.000 23.407 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 755.764 m 581.250 755.764 l 580.500 755.014 l 27.000 755.014 l f 581.250 755.764 m 581.250 732.356 l 580.500 732.356 l 580.500 755.014 l f 26.250 755.764 m 26.250 732.356 l 27.000 732.356 l 27.000 755.014 l f 0.271 0.267 0.267 rg BT 33.000 741.688 Td /F1 9.0 Tf [(New York City, New York, 9/11/2001-9/10/2011.)] TJ ET 1.000 1.000 1.000 rg 26.250 86.087 555.000 646.269 re f 0.965 0.965 0.965 rg 27.000 707.422 136.002 24.185 re f 0.267 0.267 0.267 rg 26.625 731.231 136.377 0.750 re f 26.625 707.047 0.750 24.935 re f 0.965 0.965 0.965 rg 163.002 707.422 134.603 24.185 re f 0.267 0.267 0.267 rg 163.002 731.231 134.603 0.750 re f 0.271 0.267 0.267 rg BT 167.502 722.082 Td /F4 9.8 Tf [(High Exposure\(N=1,589\))] TJ ET 0.965 0.965 0.965 rg 297.605 707.422 103.630 24.185 re f 0.267 0.267 0.267 rg 297.605 731.231 103.630 0.750 re f 0.271 0.267 0.267 rg BT 302.105 722.082 Td /F4 9.8 Tf [(Moderate Exposure )] TJ ET BT 302.105 710.178 Td /F4 9.8 Tf [(\(N=6,992\))] TJ ET 0.965 0.965 0.965 rg 401.235 707.422 96.258 24.185 re f 0.267 0.267 0.267 rg 401.235 731.231 96.258 0.750 re f 0.271 0.267 0.267 rg BT 405.735 722.082 Td /F4 9.8 Tf [(Low Exposure )] TJ ET BT 405.735 710.178 Td /F4 9.8 Tf [(\(N=1,197\))] TJ ET 0.965 0.965 0.965 rg 497.493 707.422 83.007 24.185 re f 0.267 0.267 0.267 rg 497.493 731.231 83.382 0.750 re f 580.125 707.047 0.750 24.935 re f 0.271 0.267 0.267 rg BT 501.993 722.082 Td /F4 9.8 Tf [(Total \(N=9,778\))] TJ ET 0.267 0.267 0.267 rg 26.625 707.047 136.752 0.750 re f 26.625 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 697.192 Td /F1 9.8 Tf [(Age on 9/11, years, median )] TJ ET BT 31.875 689.560 Td /F1 9.8 Tf [(\(IQR\))] TJ ET 0.267 0.267 0.267 rg 162.627 707.047 135.353 0.750 re f 162.627 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 697.192 Td /F1 9.8 Tf [(39.8 \(34.7-45.2\))] TJ ET 0.267 0.267 0.267 rg 297.230 707.047 104.380 0.750 re f 297.230 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 697.192 Td /F1 9.8 Tf [(39.3 \(34.3-44.8\))] TJ ET 0.267 0.267 0.267 rg 400.860 707.047 97.008 0.750 re f 400.860 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 697.192 Td /F1 9.8 Tf [(40.9 \(35.2-46.2\))] TJ ET 0.267 0.267 0.267 rg 497.118 707.047 83.757 0.750 re f 497.118 683.534 0.750 24.262 re f 580.125 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 697.192 Td /F1 9.8 Tf [(39.6 \(34.5-45.0\))] TJ ET 0.267 0.267 0.267 rg 26.625 683.534 136.752 0.750 re f 26.625 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 673.679 Td /F1 9.8 Tf [(Non-Hispanic White, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 683.534 135.353 0.750 re f 162.627 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 673.679 Td /F1 9.8 Tf [(1455 \(91.6\))] TJ ET 0.267 0.267 0.267 rg 297.230 683.534 104.380 0.750 re f 297.230 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 673.679 Td /F1 9.8 Tf [(6617 \(94.6\))] TJ ET 0.267 0.267 0.267 rg 400.860 683.534 97.008 0.750 re f 400.860 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 673.679 Td /F1 9.8 Tf [(1111 \(92.8\))] TJ ET 0.267 0.267 0.267 rg 497.118 683.534 83.757 0.750 re f 497.118 667.653 0.750 16.631 re f 580.125 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 673.679 Td /F1 9.8 Tf [(9183 \(93.9\))] TJ ET 0.267 0.267 0.267 rg 26.625 667.653 136.752 0.750 re f 26.625 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 657.798 Td /F1 9.8 Tf [(Black or African-American, )] TJ ET BT 31.875 650.167 Td /F1 9.8 Tf [(N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 667.653 135.353 0.750 re f 162.627 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 657.798 Td /F1 9.8 Tf [(63 \(4.0\))] TJ ET 0.267 0.267 0.267 rg 297.230 667.653 104.380 0.750 re f 297.230 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 657.798 Td /F1 9.8 Tf [(145 \(2.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 667.653 97.008 0.750 re f 400.860 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 657.798 Td /F1 9.8 Tf [(37 \(3.1\))] TJ ET 0.267 0.267 0.267 rg 497.118 667.653 83.757 0.750 re f 497.118 644.140 0.750 24.262 re f 580.125 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 657.798 Td /F1 9.8 Tf [(245 \(2.5\))] TJ ET 0.267 0.267 0.267 rg 26.625 644.140 136.752 0.750 re f 26.625 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 634.285 Td /F1 9.8 Tf [(Hispanic, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 644.140 135.353 0.750 re f 162.627 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 634.285 Td /F1 9.8 Tf [(61 \(3.8\))] TJ ET 0.267 0.267 0.267 rg 297.230 644.140 104.380 0.750 re f 297.230 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 634.285 Td /F1 9.8 Tf [(212 \(3.0\))] TJ ET 0.267 0.267 0.267 rg 400.860 644.140 97.008 0.750 re f 400.860 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 634.285 Td /F1 9.8 Tf [(48 \(4.0\))] TJ ET 0.267 0.267 0.267 rg 497.118 644.140 83.757 0.750 re f 497.118 628.259 0.750 16.631 re f 580.125 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 634.285 Td /F1 9.8 Tf [(321 \(3.3\))] TJ ET 0.267 0.267 0.267 rg 26.625 628.259 136.752 0.750 re f 26.625 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 618.404 Td /F1 9.8 Tf [(Current smoker as of last )] TJ ET BT 31.875 610.773 Td /F1 9.8 Tf [(questionnaire, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 628.259 135.353 0.750 re f 162.627 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 618.404 Td /F1 9.8 Tf [(91 \(5.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 628.259 104.380 0.750 re f 297.230 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 618.404 Td /F1 9.8 Tf [(376 \(5.4\))] TJ ET 0.267 0.267 0.267 rg 400.860 628.259 97.008 0.750 re f 400.860 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 618.404 Td /F1 9.8 Tf [(83 \(6.9\))] TJ ET 0.267 0.267 0.267 rg 497.118 628.259 83.757 0.750 re f 497.118 604.747 0.750 24.262 re f 580.125 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 618.404 Td /F1 9.8 Tf [(550 \(5.6\))] TJ ET 0.267 0.267 0.267 rg 26.625 604.747 136.752 0.750 re f 26.625 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 594.892 Td /F1 9.8 Tf [(Former smoker as of last )] TJ ET BT 31.875 587.260 Td /F1 9.8 Tf [(questionnaire, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 604.747 135.353 0.750 re f 162.627 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 594.892 Td /F1 9.8 Tf [(492 \(31.0\))] TJ ET 0.267 0.267 0.267 rg 297.230 604.747 104.380 0.750 re f 297.230 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 594.892 Td /F1 9.8 Tf [(2,211 \(31.6\))] TJ ET 0.267 0.267 0.267 rg 400.860 604.747 97.008 0.750 re f 400.860 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 594.892 Td /F1 9.8 Tf [(389 \(32.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 604.747 83.757 0.750 re f 497.118 581.234 0.750 24.262 re f 580.125 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 594.892 Td /F1 9.8 Tf [(3,092 \(31.6\))] TJ ET 0.267 0.267 0.267 rg 26.625 581.234 136.752 0.750 re f 26.625 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 571.379 Td /F1 9.8 Tf [(Retire during study, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 581.234 135.353 0.750 re f 162.627 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 571.379 Td /F1 9.8 Tf [(488 \(30.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 581.234 104.380 0.750 re f 297.230 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 571.379 Td /F1 9.8 Tf [(2,122 \(30.4\))] TJ ET 0.267 0.267 0.267 rg 400.860 581.234 97.008 0.750 re f 400.860 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 571.379 Td /F1 9.8 Tf [(449 \(37.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 581.234 83.757 0.750 re f 497.118 565.353 0.750 16.631 re f 580.125 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 571.379 Td /F1 9.8 Tf [(3,059 \(31.3\))] TJ ET 0.267 0.267 0.267 rg 26.625 565.353 136.752 0.750 re f 26.625 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 555.498 Td /F1 9.8 Tf [(Physician visits, median )] TJ ET BT 31.875 547.867 Td /F1 9.8 Tf [(\(IQR\))] TJ ET 0.267 0.267 0.267 rg 162.627 565.353 135.353 0.750 re f 162.627 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 555.498 Td /F1 9.8 Tf [(27 \(12-46\))] TJ ET 0.267 0.267 0.267 rg 297.230 565.353 104.380 0.750 re f 297.230 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 555.498 Td /F1 9.8 Tf [(28 \(13-47\))] TJ ET 0.267 0.267 0.267 rg 400.860 565.353 97.008 0.750 re f 400.860 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 555.498 Td /F1 9.8 Tf [(26 \(11-46\))] TJ ET 0.267 0.267 0.267 rg 497.118 565.353 83.757 0.750 re f 497.118 541.840 0.750 24.262 re f 580.125 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 555.498 Td /F1 9.8 Tf [(28 \(13-47\))] TJ ET 0.267 0.267 0.267 rg 26.625 541.840 136.752 0.750 re f 26.625 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 31.875 531.985 Td /F1 9.8 Tf [(Mean physician visits per )] TJ ET BT 31.875 524.354 Td /F1 9.8 Tf [(year \(95% CI\))] TJ ET 0.267 0.267 0.267 rg 162.627 541.840 135.353 0.750 re f 162.627 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 167.877 531.985 Td /F1 9.8 Tf [(4.1 \(2.2-6.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 541.840 104.380 0.750 re f 297.230 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 302.480 531.985 Td /F1 9.8 Tf [(3.8 \(2.0-6.0\))] TJ ET 0.267 0.267 0.267 rg 400.860 541.840 97.008 0.750 re f 400.860 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 406.110 531.985 Td /F1 9.8 Tf [(3.5 \(1.6-5.8\))] TJ ET 0.267 0.267 0.267 rg 497.118 541.840 83.757 0.750 re f 497.118 518.328 0.750 24.263 re f 580.125 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 502.368 531.985 Td /F1 9.8 Tf [(3.8 \(2.0-6.1\))] TJ ET 0.267 0.267 0.267 rg 26.625 518.328 136.752 0.750 re f 26.625 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 508.473 Td /F1 9.8 Tf [(OAD, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 518.328 135.353 0.750 re f 162.627 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 508.473 Td /F1 9.8 Tf [(466 \(29.3\))] TJ ET 0.267 0.267 0.267 rg 297.230 518.328 104.380 0.750 re f 297.230 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 508.473 Td /F1 9.8 Tf [(1,613 \(23.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 518.328 97.008 0.750 re f 400.860 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 508.473 Td /F1 9.8 Tf [(207 \(17.3\))] TJ ET 0.267 0.267 0.267 rg 497.118 518.328 83.757 0.750 re f 497.118 502.447 0.750 16.631 re f 580.125 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 508.473 Td /F1 9.8 Tf [(2,286 \(23.4\))] TJ ET 0.267 0.267 0.267 rg 26.625 502.447 136.752 0.750 re f 26.625 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 492.592 Td /F1 9.8 Tf [(Asthma, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 502.447 135.353 0.750 re f 162.627 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 492.592 Td /F1 9.8 Tf [(275 \(17.3\))] TJ ET 0.267 0.267 0.267 rg 297.230 502.447 104.380 0.750 re f 297.230 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 492.592 Td /F1 9.8 Tf [(902 \(12.9\))] TJ ET 0.267 0.267 0.267 rg 400.860 502.447 97.008 0.750 re f 400.860 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 492.592 Td /F1 9.8 Tf [(112 \(9.4\))] TJ ET 0.267 0.267 0.267 rg 497.118 502.447 83.757 0.750 re f 497.118 486.565 0.750 16.631 re f 580.125 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 492.592 Td /F1 9.8 Tf [(1,289 \(13.2\))] TJ ET 0.267 0.267 0.267 rg 26.625 486.565 136.752 0.750 re f 26.625 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 476.710 Td /F1 9.8 Tf [(Non-Asthma OAD, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 486.565 135.353 0.750 re f 162.627 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 476.710 Td /F1 9.8 Tf [(191 \(12\))] TJ ET 0.267 0.267 0.267 rg 297.230 486.565 104.380 0.750 re f 297.230 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 476.710 Td /F1 9.8 Tf [(711 \(10.2\))] TJ ET 0.267 0.267 0.267 rg 400.860 486.565 97.008 0.750 re f 400.860 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 476.710 Td /F1 9.8 Tf [(95 \(7.9\))] TJ ET 0.267 0.267 0.267 rg 497.118 486.565 83.757 0.750 re f 497.118 470.684 0.750 16.631 re f 580.125 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 476.710 Td /F1 9.8 Tf [(997 \(10.2\))] TJ ET 0.267 0.267 0.267 rg 26.625 470.684 136.752 0.750 re f 26.625 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 31.875 460.829 Td /F1 9.8 Tf [(Overall OAD incidence per )] TJ ET BT 31.875 453.198 Td /F1 9.8 Tf [(100 person-years)] TJ ET 0.267 0.267 0.267 rg 162.627 470.684 135.353 0.750 re f 162.627 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 167.877 460.829 Td /F1 9.8 Tf [(3.70)] TJ ET 0.267 0.267 0.267 rg 297.230 470.684 104.380 0.750 re f 297.230 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 302.480 460.829 Td /F1 9.8 Tf [(2.72)] TJ ET 0.267 0.267 0.267 rg 400.860 470.684 97.008 0.750 re f 400.860 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 406.110 460.829 Td /F1 9.8 Tf [(2.02)] TJ ET 0.267 0.267 0.267 rg 497.118 470.684 83.757 0.750 re f 497.118 125.856 0.750 345.578 re f 580.125 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 502.368 460.829 Td /F1 9.8 Tf [(2.78)] TJ ET 0.267 0.267 0.267 rg 26.625 125.856 136.752 0.750 re f 26.625 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 116.001 Td /F1 9.8 Tf [(Total person-time, months)] TJ ET 0.267 0.267 0.267 rg 162.627 125.856 135.353 0.750 re f 162.627 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 116.001 Td /F1 9.8 Tf [(145,943.33)] TJ ET 0.267 0.267 0.267 rg 297.230 125.856 104.380 0.750 re f 297.230 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 116.001 Td /F1 9.8 Tf [(685,610.48)] TJ ET 0.267 0.267 0.267 rg 400.860 125.856 97.008 0.750 re f 400.860 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 116.001 Td /F1 9.8 Tf [(118,837.19)] TJ ET 0.267 0.267 0.267 rg 497.118 125.856 83.757 0.750 re f 497.118 109.975 0.750 16.631 re f 580.125 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 116.001 Td /F1 9.8 Tf [(950,391.00)] TJ ET 0.267 0.267 0.267 rg 26.625 109.975 136.752 0.750 re f 26.625 86.462 136.752 0.750 re f 26.625 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 100.120 Td /F1 9.8 Tf [(Person-time, months, mean )] TJ ET BT 31.875 92.488 Td /F1 9.8 Tf [(\(SD\))] TJ ET 0.267 0.267 0.267 rg 162.627 109.975 135.353 0.750 re f 162.627 86.462 135.353 0.750 re f 162.627 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 100.120 Td /F1 9.8 Tf [(91.8 \(38.2\))] TJ ET 0.267 0.267 0.267 rg 297.230 109.975 104.380 0.750 re f 297.230 86.462 104.380 0.750 re f 297.230 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 100.120 Td /F1 9.8 Tf [(98.1 \(33.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 109.975 97.008 0.750 re f 400.860 86.462 97.008 0.750 re f 400.860 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 100.120 Td /F1 9.8 Tf [(99.3 \(32.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 109.975 83.757 0.750 re f 497.118 86.462 83.757 0.750 re f 497.118 86.462 0.750 24.262 re f 580.125 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 100.120 Td /F1 9.8 Tf [(97.2 \(34.0\))] TJ ET Q q 15.000 41.087 577.500 735.913 re W n q 26.250 763.264 555.000 13.736 re W n 0.271 0.267 0.267 rg BT 26.250 766.011 Td /F1 9.8 Tf [(Table 1. Characteristics of FDNY Firefighter Population.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 732.356 555.000 23.407 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 755.764 m 581.250 755.764 l 580.500 755.014 l 27.000 755.014 l f 581.250 755.764 m 581.250 732.356 l 580.500 732.356 l 580.500 755.014 l f 26.250 755.764 m 26.250 732.356 l 27.000 732.356 l 27.000 755.014 l f 0.271 0.267 0.267 rg BT 33.000 741.688 Td /F1 9.0 Tf [(New York City, New York, 9/11/2001-9/10/2011.)] TJ ET 1.000 1.000 1.000 rg 26.250 86.087 555.000 646.269 re f 0.965 0.965 0.965 rg 27.000 707.422 136.002 24.185 re f 0.267 0.267 0.267 rg 26.625 731.231 136.377 0.750 re f 26.625 707.047 0.750 24.935 re f 0.965 0.965 0.965 rg 163.002 707.422 134.603 24.185 re f 0.267 0.267 0.267 rg 163.002 731.231 134.603 0.750 re f 0.271 0.267 0.267 rg BT 167.502 722.082 Td /F4 9.8 Tf [(High Exposure\(N=1,589\))] TJ ET 0.965 0.965 0.965 rg 297.605 707.422 103.630 24.185 re f 0.267 0.267 0.267 rg 297.605 731.231 103.630 0.750 re f 0.271 0.267 0.267 rg BT 302.105 722.082 Td /F4 9.8 Tf [(Moderate Exposure )] TJ ET BT 302.105 710.178 Td /F4 9.8 Tf [(\(N=6,992\))] TJ ET 0.965 0.965 0.965 rg 401.235 707.422 96.258 24.185 re f 0.267 0.267 0.267 rg 401.235 731.231 96.258 0.750 re f 0.271 0.267 0.267 rg BT 405.735 722.082 Td /F4 9.8 Tf [(Low Exposure )] TJ ET BT 405.735 710.178 Td /F4 9.8 Tf [(\(N=1,197\))] TJ ET 0.965 0.965 0.965 rg 497.493 707.422 83.007 24.185 re f 0.267 0.267 0.267 rg 497.493 731.231 83.382 0.750 re f 580.125 707.047 0.750 24.935 re f 0.271 0.267 0.267 rg BT 501.993 722.082 Td /F4 9.8 Tf [(Total \(N=9,778\))] TJ ET 0.267 0.267 0.267 rg 26.625 707.047 136.752 0.750 re f 26.625 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 697.192 Td /F1 9.8 Tf [(Age on 9/11, years, median )] TJ ET BT 31.875 689.560 Td /F1 9.8 Tf [(\(IQR\))] TJ ET 0.267 0.267 0.267 rg 162.627 707.047 135.353 0.750 re f 162.627 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 697.192 Td /F1 9.8 Tf [(39.8 \(34.7-45.2\))] TJ ET 0.267 0.267 0.267 rg 297.230 707.047 104.380 0.750 re f 297.230 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 697.192 Td /F1 9.8 Tf [(39.3 \(34.3-44.8\))] TJ ET 0.267 0.267 0.267 rg 400.860 707.047 97.008 0.750 re f 400.860 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 697.192 Td /F1 9.8 Tf [(40.9 \(35.2-46.2\))] TJ ET 0.267 0.267 0.267 rg 497.118 707.047 83.757 0.750 re f 497.118 683.534 0.750 24.262 re f 580.125 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 697.192 Td /F1 9.8 Tf [(39.6 \(34.5-45.0\))] TJ ET 0.267 0.267 0.267 rg 26.625 683.534 136.752 0.750 re f 26.625 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 673.679 Td /F1 9.8 Tf [(Non-Hispanic White, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 683.534 135.353 0.750 re f 162.627 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 673.679 Td /F1 9.8 Tf [(1455 \(91.6\))] TJ ET 0.267 0.267 0.267 rg 297.230 683.534 104.380 0.750 re f 297.230 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 673.679 Td /F1 9.8 Tf [(6617 \(94.6\))] TJ ET 0.267 0.267 0.267 rg 400.860 683.534 97.008 0.750 re f 400.860 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 673.679 Td /F1 9.8 Tf [(1111 \(92.8\))] TJ ET 0.267 0.267 0.267 rg 497.118 683.534 83.757 0.750 re f 497.118 667.653 0.750 16.631 re f 580.125 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 673.679 Td /F1 9.8 Tf [(9183 \(93.9\))] TJ ET 0.267 0.267 0.267 rg 26.625 667.653 136.752 0.750 re f 26.625 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 657.798 Td /F1 9.8 Tf [(Black or African-American, )] TJ ET BT 31.875 650.167 Td /F1 9.8 Tf [(N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 667.653 135.353 0.750 re f 162.627 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 657.798 Td /F1 9.8 Tf [(63 \(4.0\))] TJ ET 0.267 0.267 0.267 rg 297.230 667.653 104.380 0.750 re f 297.230 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 657.798 Td /F1 9.8 Tf [(145 \(2.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 667.653 97.008 0.750 re f 400.860 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 657.798 Td /F1 9.8 Tf [(37 \(3.1\))] TJ ET 0.267 0.267 0.267 rg 497.118 667.653 83.757 0.750 re f 497.118 644.140 0.750 24.262 re f 580.125 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 657.798 Td /F1 9.8 Tf [(245 \(2.5\))] TJ ET 0.267 0.267 0.267 rg 26.625 644.140 136.752 0.750 re f 26.625 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 634.285 Td /F1 9.8 Tf [(Hispanic, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 644.140 135.353 0.750 re f 162.627 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 634.285 Td /F1 9.8 Tf [(61 \(3.8\))] TJ ET 0.267 0.267 0.267 rg 297.230 644.140 104.380 0.750 re f 297.230 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 634.285 Td /F1 9.8 Tf [(212 \(3.0\))] TJ ET 0.267 0.267 0.267 rg 400.860 644.140 97.008 0.750 re f 400.860 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 634.285 Td /F1 9.8 Tf [(48 \(4.0\))] TJ ET 0.267 0.267 0.267 rg 497.118 644.140 83.757 0.750 re f 497.118 628.259 0.750 16.631 re f 580.125 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 634.285 Td /F1 9.8 Tf [(321 \(3.3\))] TJ ET 0.267 0.267 0.267 rg 26.625 628.259 136.752 0.750 re f 26.625 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 618.404 Td /F1 9.8 Tf [(Current smoker as of last )] TJ ET BT 31.875 610.773 Td /F1 9.8 Tf [(questionnaire, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 628.259 135.353 0.750 re f 162.627 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 618.404 Td /F1 9.8 Tf [(91 \(5.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 628.259 104.380 0.750 re f 297.230 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 618.404 Td /F1 9.8 Tf [(376 \(5.4\))] TJ ET 0.267 0.267 0.267 rg 400.860 628.259 97.008 0.750 re f 400.860 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 618.404 Td /F1 9.8 Tf [(83 \(6.9\))] TJ ET 0.267 0.267 0.267 rg 497.118 628.259 83.757 0.750 re f 497.118 604.747 0.750 24.262 re f 580.125 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 618.404 Td /F1 9.8 Tf [(550 \(5.6\))] TJ ET 0.267 0.267 0.267 rg 26.625 604.747 136.752 0.750 re f 26.625 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 594.892 Td /F1 9.8 Tf [(Former smoker as of last )] TJ ET BT 31.875 587.260 Td /F1 9.8 Tf [(questionnaire, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 604.747 135.353 0.750 re f 162.627 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 594.892 Td /F1 9.8 Tf [(492 \(31.0\))] TJ ET 0.267 0.267 0.267 rg 297.230 604.747 104.380 0.750 re f 297.230 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 594.892 Td /F1 9.8 Tf [(2,211 \(31.6\))] TJ ET 0.267 0.267 0.267 rg 400.860 604.747 97.008 0.750 re f 400.860 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 594.892 Td /F1 9.8 Tf [(389 \(32.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 604.747 83.757 0.750 re f 497.118 581.234 0.750 24.262 re f 580.125 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 594.892 Td /F1 9.8 Tf [(3,092 \(31.6\))] TJ ET 0.267 0.267 0.267 rg 26.625 581.234 136.752 0.750 re f 26.625 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 571.379 Td /F1 9.8 Tf [(Retire during study, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 581.234 135.353 0.750 re f 162.627 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 571.379 Td /F1 9.8 Tf [(488 \(30.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 581.234 104.380 0.750 re f 297.230 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 571.379 Td /F1 9.8 Tf [(2,122 \(30.4\))] TJ ET 0.267 0.267 0.267 rg 400.860 581.234 97.008 0.750 re f 400.860 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 571.379 Td /F1 9.8 Tf [(449 \(37.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 581.234 83.757 0.750 re f 497.118 565.353 0.750 16.631 re f 580.125 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 571.379 Td /F1 9.8 Tf [(3,059 \(31.3\))] TJ ET 0.267 0.267 0.267 rg 26.625 565.353 136.752 0.750 re f 26.625 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 555.498 Td /F1 9.8 Tf [(Physician visits, median )] TJ ET BT 31.875 547.867 Td /F1 9.8 Tf [(\(IQR\))] TJ ET 0.267 0.267 0.267 rg 162.627 565.353 135.353 0.750 re f 162.627 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 555.498 Td /F1 9.8 Tf [(27 \(12-46\))] TJ ET 0.267 0.267 0.267 rg 297.230 565.353 104.380 0.750 re f 297.230 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 555.498 Td /F1 9.8 Tf [(28 \(13-47\))] TJ ET 0.267 0.267 0.267 rg 400.860 565.353 97.008 0.750 re f 400.860 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 555.498 Td /F1 9.8 Tf [(26 \(11-46\))] TJ ET 0.267 0.267 0.267 rg 497.118 565.353 83.757 0.750 re f 497.118 541.840 0.750 24.262 re f 580.125 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 555.498 Td /F1 9.8 Tf [(28 \(13-47\))] TJ ET 0.267 0.267 0.267 rg 26.625 541.840 136.752 0.750 re f 26.625 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 31.875 531.985 Td /F1 9.8 Tf [(Mean physician visits per )] TJ ET BT 31.875 524.354 Td /F1 9.8 Tf [(year \(95% CI\))] TJ ET 0.267 0.267 0.267 rg 162.627 541.840 135.353 0.750 re f 162.627 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 167.877 531.985 Td /F1 9.8 Tf [(4.1 \(2.2-6.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 541.840 104.380 0.750 re f 297.230 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 302.480 531.985 Td /F1 9.8 Tf [(3.8 \(2.0-6.0\))] TJ ET 0.267 0.267 0.267 rg 400.860 541.840 97.008 0.750 re f 400.860 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 406.110 531.985 Td /F1 9.8 Tf [(3.5 \(1.6-5.8\))] TJ ET 0.267 0.267 0.267 rg 497.118 541.840 83.757 0.750 re f 497.118 518.328 0.750 24.263 re f 580.125 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 502.368 531.985 Td /F1 9.8 Tf [(3.8 \(2.0-6.1\))] TJ ET 0.267 0.267 0.267 rg 26.625 518.328 136.752 0.750 re f 26.625 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 508.473 Td /F1 9.8 Tf [(OAD, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 518.328 135.353 0.750 re f 162.627 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 508.473 Td /F1 9.8 Tf [(466 \(29.3\))] TJ ET 0.267 0.267 0.267 rg 297.230 518.328 104.380 0.750 re f 297.230 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 508.473 Td /F1 9.8 Tf [(1,613 \(23.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 518.328 97.008 0.750 re f 400.860 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 508.473 Td /F1 9.8 Tf [(207 \(17.3\))] TJ ET 0.267 0.267 0.267 rg 497.118 518.328 83.757 0.750 re f 497.118 502.447 0.750 16.631 re f 580.125 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 508.473 Td /F1 9.8 Tf [(2,286 \(23.4\))] TJ ET 0.267 0.267 0.267 rg 26.625 502.447 136.752 0.750 re f 26.625 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 492.592 Td /F1 9.8 Tf [(Asthma, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 502.447 135.353 0.750 re f 162.627 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 492.592 Td /F1 9.8 Tf [(275 \(17.3\))] TJ ET 0.267 0.267 0.267 rg 297.230 502.447 104.380 0.750 re f 297.230 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 492.592 Td /F1 9.8 Tf [(902 \(12.9\))] TJ ET 0.267 0.267 0.267 rg 400.860 502.447 97.008 0.750 re f 400.860 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 492.592 Td /F1 9.8 Tf [(112 \(9.4\))] TJ ET 0.267 0.267 0.267 rg 497.118 502.447 83.757 0.750 re f 497.118 486.565 0.750 16.631 re f 580.125 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 492.592 Td /F1 9.8 Tf [(1,289 \(13.2\))] TJ ET 0.267 0.267 0.267 rg 26.625 486.565 136.752 0.750 re f 26.625 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 476.710 Td /F1 9.8 Tf [(Non-Asthma OAD, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 486.565 135.353 0.750 re f 162.627 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 476.710 Td /F1 9.8 Tf [(191 \(12\))] TJ ET 0.267 0.267 0.267 rg 297.230 486.565 104.380 0.750 re f 297.230 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 476.710 Td /F1 9.8 Tf [(711 \(10.2\))] TJ ET 0.267 0.267 0.267 rg 400.860 486.565 97.008 0.750 re f 400.860 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 476.710 Td /F1 9.8 Tf [(95 \(7.9\))] TJ ET 0.267 0.267 0.267 rg 497.118 486.565 83.757 0.750 re f 497.118 470.684 0.750 16.631 re f 580.125 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 476.710 Td /F1 9.8 Tf [(997 \(10.2\))] TJ ET 0.267 0.267 0.267 rg 26.625 470.684 136.752 0.750 re f 26.625 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 31.875 460.829 Td /F1 9.8 Tf [(Overall OAD incidence per )] TJ ET BT 31.875 453.198 Td /F1 9.8 Tf [(100 person-years)] TJ ET 0.267 0.267 0.267 rg 162.627 470.684 135.353 0.750 re f 162.627 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 167.877 460.829 Td /F1 9.8 Tf [(3.70)] TJ ET 0.267 0.267 0.267 rg 297.230 470.684 104.380 0.750 re f 297.230 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 302.480 460.829 Td /F1 9.8 Tf [(2.72)] TJ ET 0.267 0.267 0.267 rg 400.860 470.684 97.008 0.750 re f 400.860 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 406.110 460.829 Td /F1 9.8 Tf [(2.02)] TJ ET 0.267 0.267 0.267 rg 497.118 470.684 83.757 0.750 re f 497.118 125.856 0.750 345.578 re f 580.125 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 502.368 460.829 Td /F1 9.8 Tf [(2.78)] TJ ET 0.267 0.267 0.267 rg 26.625 125.856 136.752 0.750 re f 26.625 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 116.001 Td /F1 9.8 Tf [(Total person-time, months)] TJ ET 0.267 0.267 0.267 rg 162.627 125.856 135.353 0.750 re f 162.627 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 116.001 Td /F1 9.8 Tf [(145,943.33)] TJ ET 0.267 0.267 0.267 rg 297.230 125.856 104.380 0.750 re f 297.230 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 116.001 Td /F1 9.8 Tf [(685,610.48)] TJ ET 0.267 0.267 0.267 rg 400.860 125.856 97.008 0.750 re f 400.860 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 116.001 Td /F1 9.8 Tf [(118,837.19)] TJ ET 0.267 0.267 0.267 rg 497.118 125.856 83.757 0.750 re f 497.118 109.975 0.750 16.631 re f 580.125 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 116.001 Td /F1 9.8 Tf [(950,391.00)] TJ ET 0.267 0.267 0.267 rg 26.625 109.975 136.752 0.750 re f 26.625 86.462 136.752 0.750 re f 26.625 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 100.120 Td /F1 9.8 Tf [(Person-time, months, mean )] TJ ET BT 31.875 92.488 Td /F1 9.8 Tf [(\(SD\))] TJ ET 0.267 0.267 0.267 rg 162.627 109.975 135.353 0.750 re f 162.627 86.462 135.353 0.750 re f 162.627 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 100.120 Td /F1 9.8 Tf [(91.8 \(38.2\))] TJ ET 0.267 0.267 0.267 rg 297.230 109.975 104.380 0.750 re f 297.230 86.462 104.380 0.750 re f 297.230 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 100.120 Td /F1 9.8 Tf [(98.1 \(33.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 109.975 97.008 0.750 re f 400.860 86.462 97.008 0.750 re f 400.860 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 100.120 Td /F1 9.8 Tf [(99.3 \(32.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 109.975 83.757 0.750 re f 497.118 86.462 83.757 0.750 re f 497.118 86.462 0.750 24.262 re f 580.125 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 100.120 Td /F1 9.8 Tf [(97.2 \(34.0\))] TJ ET Q q 15.000 41.087 577.500 735.913 re W n q 26.250 763.264 555.000 13.736 re W n 0.271 0.267 0.267 rg BT 26.250 766.011 Td /F1 9.8 Tf [(Table 1. Characteristics of FDNY Firefighter Population.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 732.356 555.000 23.407 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 755.764 m 581.250 755.764 l 580.500 755.014 l 27.000 755.014 l f 581.250 755.764 m 581.250 732.356 l 580.500 732.356 l 580.500 755.014 l f 26.250 755.764 m 26.250 732.356 l 27.000 732.356 l 27.000 755.014 l f 0.271 0.267 0.267 rg BT 33.000 741.688 Td /F1 9.0 Tf [(New York City, New York, 9/11/2001-9/10/2011.)] TJ ET 1.000 1.000 1.000 rg 26.250 86.087 555.000 646.269 re f 0.965 0.965 0.965 rg 27.000 707.422 136.002 24.185 re f 0.267 0.267 0.267 rg 26.625 731.231 136.377 0.750 re f 26.625 707.047 0.750 24.935 re f 0.965 0.965 0.965 rg 163.002 707.422 134.603 24.185 re f 0.267 0.267 0.267 rg 163.002 731.231 134.603 0.750 re f 0.271 0.267 0.267 rg BT 167.502 722.082 Td /F4 9.8 Tf [(High Exposure\(N=1,589\))] TJ ET 0.965 0.965 0.965 rg 297.605 707.422 103.630 24.185 re f 0.267 0.267 0.267 rg 297.605 731.231 103.630 0.750 re f 0.271 0.267 0.267 rg BT 302.105 722.082 Td /F4 9.8 Tf [(Moderate Exposure )] TJ ET BT 302.105 710.178 Td /F4 9.8 Tf [(\(N=6,992\))] TJ ET 0.965 0.965 0.965 rg 401.235 707.422 96.258 24.185 re f 0.267 0.267 0.267 rg 401.235 731.231 96.258 0.750 re f 0.271 0.267 0.267 rg BT 405.735 722.082 Td /F4 9.8 Tf [(Low Exposure )] TJ ET BT 405.735 710.178 Td /F4 9.8 Tf [(\(N=1,197\))] TJ ET 0.965 0.965 0.965 rg 497.493 707.422 83.007 24.185 re f 0.267 0.267 0.267 rg 497.493 731.231 83.382 0.750 re f 580.125 707.047 0.750 24.935 re f 0.271 0.267 0.267 rg BT 501.993 722.082 Td /F4 9.8 Tf [(Total \(N=9,778\))] TJ ET 0.267 0.267 0.267 rg 26.625 707.047 136.752 0.750 re f 26.625 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 697.192 Td /F1 9.8 Tf [(Age on 9/11, years, median )] TJ ET BT 31.875 689.560 Td /F1 9.8 Tf [(\(IQR\))] TJ ET 0.267 0.267 0.267 rg 162.627 707.047 135.353 0.750 re f 162.627 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 697.192 Td /F1 9.8 Tf [(39.8 \(34.7-45.2\))] TJ ET 0.267 0.267 0.267 rg 297.230 707.047 104.380 0.750 re f 297.230 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 697.192 Td /F1 9.8 Tf [(39.3 \(34.3-44.8\))] TJ ET 0.267 0.267 0.267 rg 400.860 707.047 97.008 0.750 re f 400.860 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 697.192 Td /F1 9.8 Tf [(40.9 \(35.2-46.2\))] TJ ET 0.267 0.267 0.267 rg 497.118 707.047 83.757 0.750 re f 497.118 683.534 0.750 24.262 re f 580.125 683.534 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 697.192 Td /F1 9.8 Tf [(39.6 \(34.5-45.0\))] TJ ET 0.267 0.267 0.267 rg 26.625 683.534 136.752 0.750 re f 26.625 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 673.679 Td /F1 9.8 Tf [(Non-Hispanic White, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 683.534 135.353 0.750 re f 162.627 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 673.679 Td /F1 9.8 Tf [(1455 \(91.6\))] TJ ET 0.267 0.267 0.267 rg 297.230 683.534 104.380 0.750 re f 297.230 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 673.679 Td /F1 9.8 Tf [(6617 \(94.6\))] TJ ET 0.267 0.267 0.267 rg 400.860 683.534 97.008 0.750 re f 400.860 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 673.679 Td /F1 9.8 Tf [(1111 \(92.8\))] TJ ET 0.267 0.267 0.267 rg 497.118 683.534 83.757 0.750 re f 497.118 667.653 0.750 16.631 re f 580.125 667.653 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 673.679 Td /F1 9.8 Tf [(9183 \(93.9\))] TJ ET 0.267 0.267 0.267 rg 26.625 667.653 136.752 0.750 re f 26.625 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 657.798 Td /F1 9.8 Tf [(Black or African-American, )] TJ ET BT 31.875 650.167 Td /F1 9.8 Tf [(N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 667.653 135.353 0.750 re f 162.627 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 657.798 Td /F1 9.8 Tf [(63 \(4.0\))] TJ ET 0.267 0.267 0.267 rg 297.230 667.653 104.380 0.750 re f 297.230 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 657.798 Td /F1 9.8 Tf [(145 \(2.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 667.653 97.008 0.750 re f 400.860 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 657.798 Td /F1 9.8 Tf [(37 \(3.1\))] TJ ET 0.267 0.267 0.267 rg 497.118 667.653 83.757 0.750 re f 497.118 644.140 0.750 24.262 re f 580.125 644.140 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 657.798 Td /F1 9.8 Tf [(245 \(2.5\))] TJ ET 0.267 0.267 0.267 rg 26.625 644.140 136.752 0.750 re f 26.625 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 634.285 Td /F1 9.8 Tf [(Hispanic, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 644.140 135.353 0.750 re f 162.627 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 634.285 Td /F1 9.8 Tf [(61 \(3.8\))] TJ ET 0.267 0.267 0.267 rg 297.230 644.140 104.380 0.750 re f 297.230 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 634.285 Td /F1 9.8 Tf [(212 \(3.0\))] TJ ET 0.267 0.267 0.267 rg 400.860 644.140 97.008 0.750 re f 400.860 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 634.285 Td /F1 9.8 Tf [(48 \(4.0\))] TJ ET 0.267 0.267 0.267 rg 497.118 644.140 83.757 0.750 re f 497.118 628.259 0.750 16.631 re f 580.125 628.259 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 634.285 Td /F1 9.8 Tf [(321 \(3.3\))] TJ ET 0.267 0.267 0.267 rg 26.625 628.259 136.752 0.750 re f 26.625 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 618.404 Td /F1 9.8 Tf [(Current smoker as of last )] TJ ET BT 31.875 610.773 Td /F1 9.8 Tf [(questionnaire, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 628.259 135.353 0.750 re f 162.627 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 618.404 Td /F1 9.8 Tf [(91 \(5.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 628.259 104.380 0.750 re f 297.230 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 618.404 Td /F1 9.8 Tf [(376 \(5.4\))] TJ ET 0.267 0.267 0.267 rg 400.860 628.259 97.008 0.750 re f 400.860 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 618.404 Td /F1 9.8 Tf [(83 \(6.9\))] TJ ET 0.267 0.267 0.267 rg 497.118 628.259 83.757 0.750 re f 497.118 604.747 0.750 24.262 re f 580.125 604.747 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 618.404 Td /F1 9.8 Tf [(550 \(5.6\))] TJ ET 0.267 0.267 0.267 rg 26.625 604.747 136.752 0.750 re f 26.625 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 594.892 Td /F1 9.8 Tf [(Former smoker as of last )] TJ ET BT 31.875 587.260 Td /F1 9.8 Tf [(questionnaire, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 604.747 135.353 0.750 re f 162.627 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 594.892 Td /F1 9.8 Tf [(492 \(31.0\))] TJ ET 0.267 0.267 0.267 rg 297.230 604.747 104.380 0.750 re f 297.230 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 594.892 Td /F1 9.8 Tf [(2,211 \(31.6\))] TJ ET 0.267 0.267 0.267 rg 400.860 604.747 97.008 0.750 re f 400.860 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 594.892 Td /F1 9.8 Tf [(389 \(32.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 604.747 83.757 0.750 re f 497.118 581.234 0.750 24.262 re f 580.125 581.234 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 594.892 Td /F1 9.8 Tf [(3,092 \(31.6\))] TJ ET 0.267 0.267 0.267 rg 26.625 581.234 136.752 0.750 re f 26.625 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 571.379 Td /F1 9.8 Tf [(Retire during study, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 581.234 135.353 0.750 re f 162.627 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 571.379 Td /F1 9.8 Tf [(488 \(30.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 581.234 104.380 0.750 re f 297.230 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 571.379 Td /F1 9.8 Tf [(2,122 \(30.4\))] TJ ET 0.267 0.267 0.267 rg 400.860 581.234 97.008 0.750 re f 400.860 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 571.379 Td /F1 9.8 Tf [(449 \(37.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 581.234 83.757 0.750 re f 497.118 565.353 0.750 16.631 re f 580.125 565.353 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 571.379 Td /F1 9.8 Tf [(3,059 \(31.3\))] TJ ET 0.267 0.267 0.267 rg 26.625 565.353 136.752 0.750 re f 26.625 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 555.498 Td /F1 9.8 Tf [(Physician visits, median )] TJ ET BT 31.875 547.867 Td /F1 9.8 Tf [(\(IQR\))] TJ ET 0.267 0.267 0.267 rg 162.627 565.353 135.353 0.750 re f 162.627 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 555.498 Td /F1 9.8 Tf [(27 \(12-46\))] TJ ET 0.267 0.267 0.267 rg 297.230 565.353 104.380 0.750 re f 297.230 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 555.498 Td /F1 9.8 Tf [(28 \(13-47\))] TJ ET 0.267 0.267 0.267 rg 400.860 565.353 97.008 0.750 re f 400.860 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 555.498 Td /F1 9.8 Tf [(26 \(11-46\))] TJ ET 0.267 0.267 0.267 rg 497.118 565.353 83.757 0.750 re f 497.118 541.840 0.750 24.262 re f 580.125 541.840 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 555.498 Td /F1 9.8 Tf [(28 \(13-47\))] TJ ET 0.267 0.267 0.267 rg 26.625 541.840 136.752 0.750 re f 26.625 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 31.875 531.985 Td /F1 9.8 Tf [(Mean physician visits per )] TJ ET BT 31.875 524.354 Td /F1 9.8 Tf [(year \(95% CI\))] TJ ET 0.267 0.267 0.267 rg 162.627 541.840 135.353 0.750 re f 162.627 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 167.877 531.985 Td /F1 9.8 Tf [(4.1 \(2.2-6.7\))] TJ ET 0.267 0.267 0.267 rg 297.230 541.840 104.380 0.750 re f 297.230 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 302.480 531.985 Td /F1 9.8 Tf [(3.8 \(2.0-6.0\))] TJ ET 0.267 0.267 0.267 rg 400.860 541.840 97.008 0.750 re f 400.860 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 406.110 531.985 Td /F1 9.8 Tf [(3.5 \(1.6-5.8\))] TJ ET 0.267 0.267 0.267 rg 497.118 541.840 83.757 0.750 re f 497.118 518.328 0.750 24.263 re f 580.125 518.328 0.750 24.263 re f 0.271 0.267 0.267 rg BT 502.368 531.985 Td /F1 9.8 Tf [(3.8 \(2.0-6.1\))] TJ ET 0.267 0.267 0.267 rg 26.625 518.328 136.752 0.750 re f 26.625 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 508.473 Td /F1 9.8 Tf [(OAD, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 518.328 135.353 0.750 re f 162.627 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 508.473 Td /F1 9.8 Tf [(466 \(29.3\))] TJ ET 0.267 0.267 0.267 rg 297.230 518.328 104.380 0.750 re f 297.230 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 508.473 Td /F1 9.8 Tf [(1,613 \(23.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 518.328 97.008 0.750 re f 400.860 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 508.473 Td /F1 9.8 Tf [(207 \(17.3\))] TJ ET 0.267 0.267 0.267 rg 497.118 518.328 83.757 0.750 re f 497.118 502.447 0.750 16.631 re f 580.125 502.447 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 508.473 Td /F1 9.8 Tf [(2,286 \(23.4\))] TJ ET 0.267 0.267 0.267 rg 26.625 502.447 136.752 0.750 re f 26.625 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 492.592 Td /F1 9.8 Tf [(Asthma, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 502.447 135.353 0.750 re f 162.627 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 492.592 Td /F1 9.8 Tf [(275 \(17.3\))] TJ ET 0.267 0.267 0.267 rg 297.230 502.447 104.380 0.750 re f 297.230 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 492.592 Td /F1 9.8 Tf [(902 \(12.9\))] TJ ET 0.267 0.267 0.267 rg 400.860 502.447 97.008 0.750 re f 400.860 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 492.592 Td /F1 9.8 Tf [(112 \(9.4\))] TJ ET 0.267 0.267 0.267 rg 497.118 502.447 83.757 0.750 re f 497.118 486.565 0.750 16.631 re f 580.125 486.565 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 492.592 Td /F1 9.8 Tf [(1,289 \(13.2\))] TJ ET 0.267 0.267 0.267 rg 26.625 486.565 136.752 0.750 re f 26.625 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 476.710 Td /F1 9.8 Tf [(Non-Asthma OAD, N \(%\))] TJ ET 0.267 0.267 0.267 rg 162.627 486.565 135.353 0.750 re f 162.627 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 476.710 Td /F1 9.8 Tf [(191 \(12\))] TJ ET 0.267 0.267 0.267 rg 297.230 486.565 104.380 0.750 re f 297.230 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 476.710 Td /F1 9.8 Tf [(711 \(10.2\))] TJ ET 0.267 0.267 0.267 rg 400.860 486.565 97.008 0.750 re f 400.860 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 476.710 Td /F1 9.8 Tf [(95 \(7.9\))] TJ ET 0.267 0.267 0.267 rg 497.118 486.565 83.757 0.750 re f 497.118 470.684 0.750 16.631 re f 580.125 470.684 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 476.710 Td /F1 9.8 Tf [(997 \(10.2\))] TJ ET 0.267 0.267 0.267 rg 26.625 470.684 136.752 0.750 re f 26.625 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 31.875 460.829 Td /F1 9.8 Tf [(Overall OAD incidence per )] TJ ET BT 31.875 453.198 Td /F1 9.8 Tf [(100 person-years)] TJ ET 0.267 0.267 0.267 rg 162.627 470.684 135.353 0.750 re f 162.627 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 167.877 460.829 Td /F1 9.8 Tf [(3.70)] TJ ET 0.267 0.267 0.267 rg 297.230 470.684 104.380 0.750 re f 297.230 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 302.480 460.829 Td /F1 9.8 Tf [(2.72)] TJ ET 0.267 0.267 0.267 rg 400.860 470.684 97.008 0.750 re f 400.860 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 406.110 460.829 Td /F1 9.8 Tf [(2.02)] TJ ET 0.267 0.267 0.267 rg 497.118 470.684 83.757 0.750 re f 497.118 125.856 0.750 345.578 re f 580.125 125.856 0.750 345.578 re f 0.271 0.267 0.267 rg BT 502.368 460.829 Td /F1 9.8 Tf [(2.78)] TJ ET 0.267 0.267 0.267 rg 26.625 125.856 136.752 0.750 re f 26.625 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 116.001 Td /F1 9.8 Tf [(Total person-time, months)] TJ ET 0.267 0.267 0.267 rg 162.627 125.856 135.353 0.750 re f 162.627 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 167.877 116.001 Td /F1 9.8 Tf [(145,943.33)] TJ ET 0.267 0.267 0.267 rg 297.230 125.856 104.380 0.750 re f 297.230 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 302.480 116.001 Td /F1 9.8 Tf [(685,610.48)] TJ ET 0.267 0.267 0.267 rg 400.860 125.856 97.008 0.750 re f 400.860 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 406.110 116.001 Td /F1 9.8 Tf [(118,837.19)] TJ ET 0.267 0.267 0.267 rg 497.118 125.856 83.757 0.750 re f 497.118 109.975 0.750 16.631 re f 580.125 109.975 0.750 16.631 re f 0.271 0.267 0.267 rg BT 502.368 116.001 Td /F1 9.8 Tf [(950,391.00)] TJ ET 0.267 0.267 0.267 rg 26.625 109.975 136.752 0.750 re f 26.625 86.462 136.752 0.750 re f 26.625 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 31.875 100.120 Td /F1 9.8 Tf [(Person-time, months, mean )] TJ ET BT 31.875 92.488 Td /F1 9.8 Tf [(\(SD\))] TJ ET 0.267 0.267 0.267 rg 162.627 109.975 135.353 0.750 re f 162.627 86.462 135.353 0.750 re f 162.627 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 167.877 100.120 Td /F1 9.8 Tf [(91.8 \(38.2\))] TJ ET 0.267 0.267 0.267 rg 297.230 109.975 104.380 0.750 re f 297.230 86.462 104.380 0.750 re f 297.230 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 302.480 100.120 Td /F1 9.8 Tf [(98.1 \(33.1\))] TJ ET 0.267 0.267 0.267 rg 400.860 109.975 97.008 0.750 re f 400.860 86.462 97.008 0.750 re f 400.860 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 406.110 100.120 Td /F1 9.8 Tf [(99.3 \(32.5\))] TJ ET 0.267 0.267 0.267 rg 497.118 109.975 83.757 0.750 re f 497.118 86.462 83.757 0.750 re f 497.118 86.462 0.750 24.262 re f 580.125 86.462 0.750 24.262 re f 0.271 0.267 0.267 rg BT 502.368 100.120 Td /F1 9.8 Tf [(97.2 \(34.0\))] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(5)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 300 0 obj << /Type /Page /Parent 3 0 R /Annots [ 302 0 R 305 0 R 307 0 R ] /Contents 301 0 R >> endobj 301 0 obj << /Length 7099 >> stream 0.271 0.267 0.267 rg 0.267 0.267 0.267 RG q 15.000 61.105 577.500 715.895 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(The rate of visits to FDNY-BHS physicians differed by exposure group only in the first year after 9/11/2001. After the first year, )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(rates gradually declined throughout the follow-up period as the acute effects of WTC exposure diminished \(Figure 2\). This is )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(important because, on average, the opportunity to be diagnosed with OAD by an FDNY-BHS physician did not vary by exposure )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(group after the first year of follow-up.)] TJ ET 0.965 0.965 0.965 rg 26.250 226.976 555.000 494.905 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 721.881 m 581.250 721.881 l 581.250 721.131 l 26.250 721.131 l f 26.250 226.976 m 581.250 226.976 l 581.250 227.726 l 26.250 227.726 l f q 450.000 0 0 450.000 35.250 262.131 cm /I22 Do Q q 35.250 238.226 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 246.607 Td /F4 9.8 Tf [(Fig. 2: Average annual number of encounters with FDNY-BHS physicians since 9/11/2001)] TJ ET Q BT 26.250 209.952 Td /F1 9.8 Tf [(Analyses showed that a model in which relative rates of OAD changed twice during the 10 year study period best fit the data, )] TJ ET BT 26.250 198.048 Td /F1 9.8 Tf [(with change points at 15 and 84 months post-9/11 in the best fitting model. A model with two change points fit significantly better )] TJ ET BT 26.250 186.143 Td /F1 9.8 Tf [(than a model with a one change point \(likelihood ratio test p=0.042\), but adding a third change point did not improve the fit over )] TJ ET BT 26.250 174.238 Td /F1 9.8 Tf [(the 2 change point model \(likelihood ratio test p=0.24\). Table 2 shows the relative rates for the three periods identified by the )] TJ ET BT 26.250 162.333 Td /F1 9.8 Tf [(change points; the effect of exposure on incident physician-diagnosed OAD was strong in the first 15 months, smaller for )] TJ ET BT 26.250 150.429 Td /F1 9.8 Tf [(months 16 through 84, and no longer statistically significant for months 85 through 120. Similar results were observed in models )] TJ ET BT 26.250 138.524 Td /F1 9.8 Tf [(restricting the outcome to asthma, or to non-asthma OAD subtypes.)] TJ ET Q q 15.000 61.105 577.500 715.895 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(The rate of visits to FDNY-BHS physicians differed by exposure group only in the first year after 9/11/2001. After the first year, )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(rates gradually declined throughout the follow-up period as the acute effects of WTC exposure diminished \(Figure 2\). This is )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(important because, on average, the opportunity to be diagnosed with OAD by an FDNY-BHS physician did not vary by exposure )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(group after the first year of follow-up.)] TJ ET 0.965 0.965 0.965 rg 26.250 226.976 555.000 494.905 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 721.881 m 581.250 721.881 l 581.250 721.131 l 26.250 721.131 l f 26.250 226.976 m 581.250 226.976 l 581.250 227.726 l 26.250 227.726 l f q 450.000 0 0 450.000 35.250 262.131 cm /I22 Do Q q 35.250 238.226 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 246.607 Td /F4 9.8 Tf [(Fig. 2: Average annual number of encounters with FDNY-BHS physicians since 9/11/2001)] TJ ET Q BT 26.250 209.952 Td /F1 9.8 Tf [(Analyses showed that a model in which relative rates of OAD changed twice during the 10 year study period best fit the data, )] TJ ET BT 26.250 198.048 Td /F1 9.8 Tf [(with change points at 15 and 84 months post-9/11 in the best fitting model. A model with two change points fit significantly better )] TJ ET BT 26.250 186.143 Td /F1 9.8 Tf [(than a model with a one change point \(likelihood ratio test p=0.042\), but adding a third change point did not improve the fit over )] TJ ET BT 26.250 174.238 Td /F1 9.8 Tf [(the 2 change point model \(likelihood ratio test p=0.24\). Table 2 shows the relative rates for the three periods identified by the )] TJ ET BT 26.250 162.333 Td /F1 9.8 Tf [(change points; the effect of exposure on incident physician-diagnosed OAD was strong in the first 15 months, smaller for )] TJ ET BT 26.250 150.429 Td /F1 9.8 Tf [(months 16 through 84, and no longer statistically significant for months 85 through 120. Similar results were observed in models )] TJ ET BT 26.250 138.524 Td /F1 9.8 Tf [(restricting the outcome to asthma, or to non-asthma OAD subtypes.)] TJ ET Q q 15.000 61.105 577.500 715.895 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(The rate of visits to FDNY-BHS physicians differed by exposure group only in the first year after 9/11/2001. After the first year, )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(rates gradually declined throughout the follow-up period as the acute effects of WTC exposure diminished \(Figure 2\). This is )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(important because, on average, the opportunity to be diagnosed with OAD by an FDNY-BHS physician did not vary by exposure )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(group after the first year of follow-up.)] TJ ET 0.965 0.965 0.965 rg 26.250 226.976 555.000 494.905 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 721.881 m 581.250 721.881 l 581.250 721.131 l 26.250 721.131 l f 26.250 226.976 m 581.250 226.976 l 581.250 227.726 l 26.250 227.726 l f q 450.000 0 0 450.000 35.250 262.131 cm /I22 Do Q q 35.250 238.226 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 246.607 Td /F4 9.8 Tf [(Fig. 2: Average annual number of encounters with FDNY-BHS physicians since 9/11/2001)] TJ ET Q BT 26.250 209.952 Td /F1 9.8 Tf [(Analyses showed that a model in which relative rates of OAD changed twice during the 10 year study period best fit the data, )] TJ ET BT 26.250 198.048 Td /F1 9.8 Tf [(with change points at 15 and 84 months post-9/11 in the best fitting model. A model with two change points fit significantly better )] TJ ET BT 26.250 186.143 Td /F1 9.8 Tf [(than a model with a one change point \(likelihood ratio test p=0.042\), but adding a third change point did not improve the fit over )] TJ ET BT 26.250 174.238 Td /F1 9.8 Tf [(the 2 change point model \(likelihood ratio test p=0.24\). Table 2 shows the relative rates for the three periods identified by the )] TJ ET BT 26.250 162.333 Td /F1 9.8 Tf [(change points; the effect of exposure on incident physician-diagnosed OAD was strong in the first 15 months, smaller for )] TJ ET BT 26.250 150.429 Td /F1 9.8 Tf [(months 16 through 84, and no longer statistically significant for months 85 through 120. Similar results were observed in models )] TJ ET BT 26.250 138.524 Td /F1 9.8 Tf [(restricting the outcome to asthma, or to non-asthma OAD subtypes.)] TJ ET Q q 450.000 0 0 450.000 35.250 262.131 cm /I22 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(6)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 302 0 obj << /Type /Annot /Subtype /Link /A 303 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 262.1310 485.2500 712.1310 ] >> endobj 303 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/03/Figure-2_new-ch2.jpeg) >> endobj 304 0 obj << /Type /XObject /Subtype /Image /Width 600 /Height 600 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 33299>> stream JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   XX" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?R(((((((E (((((@QEQEu(:EQEQEQҊ(((EPڎQ@Q@Q@Q@Z( :Eu(((((EQEt(((3@f(4f (4QFh&hzQIK@(%- )(PIK@u4RR 'jZ(ERQ@ Eh-Rw8JZ(hJ^ (I@ Eu4QIE-PE%/ZJZ)=h4u84QIRE -QIE-Q@Q@Q@RP@A@ E%-QEEQڊ((QҊ(( JZ((EPEPE%- %-( (I@ EPRRIKI@ EPREQGJ( ;QFh(@f ( (QENPGj(( QE%-PIKEQE( (4Q@%-f(~PFhGj(4RRFhQE&iM%-)h(3KҊ(IJ(QE%-P:RRFh(Rf(4RR(PڊQEQEQGj (K(@׏}|9aԵ(onc(mfYmɮc 9zj>:ǟ?nuzey/[WΎBjy෵KMeaGy oèohA^8PFJI=lá1kZbd{ie` ʙ0FO4hkWa`2X (&t hֺNgZm]9d&jݺ ^ڟ?|L^xKuدf "\P:WX2~J鴆1EPIKGZ(((((QE((4QE%-((JZ(@%-QEQEQE (EQEQEQE(@Q@%-QE;O9]W+?,L3տQ˪Q@Q@E(4@zotyK 脱YOBA侧G[ܽkmKR՜IځG;RJ(i=h(Qހ (Z^:Qފ(4袖 J(ZJ Qڀ PEZAERQ@E袊NQK@'z^RE%-%-yb\ץKO9]W+?,KGjCE-3㓎+俇>M#A7xIKa}yR$$M嶦6),G͌_gǶڮM%4|h̺foT*By\0>A|@/qǷ* HhI6x%jy$.d*ΩeeIqwIC} <]xϊ4+/5=.y"dR@ ^xgMW𽎝.ah#h"DP<7`].}`0NAGj|%I|FJs?mI!?.6Hvu5K!i e+}w@<z1-N/y#/GWWϿo'y_lHX)\q^#O~<9rMYW?<ҦcmT#;[tdd&(b()1yOG_L3~K阠LqK(bԔQ@J;QGJ! JKzM.|_cee`GBW|O\|)ޯfDq!1qLvEyV<5sq@yI d ya+JWo=*#b~/KH sEy'ߋz[Q4|s[mɸCOzحa8ԏ4N VUjiiMjRQZEPu4Q@wIڀ SIJh -RQE-%/QڊQ@ KIEZC@ H)h4E%-(RPKIK@zJSI@ EJZJ^(?u_.NSUFK.I-J(_I[h˛jRio'FU̾~Q _l }&J6:"{q%m4^ļ]>n6NvݨZJ}iD?" &sk&6QH!s] I1ڌU SJ}+LѬu;FmW~-[LEeG>ZZ5jIՋ0b>WCkuoJPXr3Sv-2-̾q?x1F))hK(:ǟ?nuzeyOG_LKERR@)i(@_[GuM[FZDkK:*ۃ޼wCkCYtGZ̓.F[FB }u8oghWt, &e,sO$יIGZkLK:ߊ1[K+|c8Z,]F9n8.IV=ρ߇g%K@' Jm+ƿ at ڴڔy=c^98X ^⟈z(bmq:2@lדu4Г]ߺ?xBq>i&B=댞kni ^\4S|:| =+G߳-R$4`)lk,-m%ƁUT *R {(5n4וe3[_?#ng݉.9\:\rdUVbrc`30Eh\Azށ-fXοܹsTF+J۝X2~·_kD߉7 o%]G k8UPv~$KdX~iEumSj4k}vk UQ)4 $ϯ..y;rHr8 [& }O?<5cZ|׮<h ?T/`rD烎tFV5 iZ#2ܣ=jՠ*s^&j䭅ZX\mlo.#;pL!rxVx>mSG{io,se r-51>R1O$7~u%PʼMn MBЦ{\?",`G<ץJ "5SEc:ǟ?nuzeyOG_L;Q(1GJL))hLba84W_b$#Rf(1wZ}CO,;Y$2eu#z\)KT81xoE8;N:h+wh]_z~G[I^Lmp}57z|2UvVC"2;^|l> ^D dm ,[쭓lN&<_5}E8ki2FA*~P?u.$ $ٖcib}Zi-$}9hd:YmUvŕޤ+J[='BKs'''@s\hӯ -Z>KSJ/Xm%ѯ=Sю-t(1Eb@ K)(i)Mi)M&)qE%-%- QIK@ Z(@IZJ_ŽPb~I@KQGzJ? SEyb\ץךZ(eza/E? )Md q_~*~à[n{6sMz(&kmPwp85mXH>e趕naF˕s=dW7 [ψǁ/FT4F 3#4!ST-$=O,{{HcvYN:⡲}֐+wOսȎE ([:溏4uAwe:]N$ݒ6⾃ NKݭM}tO~Y⤝FXnsi_mY ۳%Ή~ՙY^dm9p1fDcĿ4+[ &y~ky.LQ"T'!C?OA4U [8c.7 d]LΒ99Ϯip_$ }UO5GO?4]a"Pb) ^ڐpVҫ/hZ??;n#/^^^3h}ÚQl*,$#i秭?[Iחu J1Z,=G?|;1op(9Y+"UqS5?e]fB6并_XjRm?twuW?i-h_#cjonQf'EtO$q+'\*2me*dBk:~R<{/Dp(-N'7|/xIMF<-@bԈ㽹O*+z+89p=9#0цC)54U:U̾('Go&sFt*^¢;?&xgm>)e8gM V @008k4}{N wVmYHHKIX + %k?xoJm*Eh+I9>=Eu/xᶨ d5sf |Ix1F{bEph_H5q=Ŵ{=JwVJ1y|+W]SzTpX"{N:N}Wx9 -VO*Cn0O5~ҞXI4yP+ݜ#\칭nͦcˆKX]pS c %h~'Bk^&LFY?wQX8D'P~U!56u|YnZ^3l+VlZ+C|";^÷7mĈgّCU;o6:-#kV P PyQqa4]mw?*9ngT/V NGn}Wi=<7k2}hA\s>)< Uqk Nx[TrXF'®YL7v$ k|1=+ x5l%GF\d?Uh\њ(J)h4PQKFhIKE%(( JZ((IKE%)J)h3Q˚KO9]W?,LJ)hW|?òh/q⣢I9m?D@d2yy&Ö?'u A5I"- QX =3=^Yuh":&qovŤq!;N+V^w2y5점68ul{5.9 rӪ2RxkVBѴXb}- iCM3X߉uZMWšu#+9ېcA圫 g@*m?xJ_[NX'!F X5x^? ZvR:%sO GCcֽOWq%c߉OkKI?x_UNj4_nlg-J=FßQ־yOG_L@Š(((hJ)i /4tZ(撀 ZNԴQIK@J1IE-%P)(hIK@5E- +/[ƙ]:{ NIG*9dzϽk1JQRN2WL(+_6ľ `>O'c > G<'c&SGDԝVp~^S:s@xYP$U(ʲ[_ۣvY5;GÒ0km8H#jAW*Se=]bϚF/AQTݥKj 5,pRZd`d\y;*xȯ''/twKe|EaU"c@omA%Bbd IF9!㟅a7~g #4,d:Z|)ÆFl&VkiSUHdt# +jӎiO[yKozt,^J)m8k?)$hkxGz ]oú܂aMntM+(X^,n[{z7]{N]'}Hh6!rE@ԞUXg$zK{nXeIC#ە# -X84j{g aqF)3E0 \QIEQI@ ERREPh)i)h?u_0יj(ez]-Q@u?CU. ݍyPLƭ_ῌ|oxm׾1ܧQ*DC NG:u7g-umGJ=/Ck{pO!.$W]c_c[j~.AxBci;M:2UUDnGE "/[(r[h,rM>…mbrHJjĶ (Qހp<% KG\##&u?(Sr?%m^g͍sgE1/:)uw?QO'e^,R(`3# kڙkA]RRӢ_CMV;ΌE-5./_ xH N]X0kobws۷m4mvHʰ9v#sw'JisšxKq!K HmHס~оu3s)ZSYMo , q|sX9ׯີXo2n = ] eY9QnIRTRVWs8HZ?^޼y#/GWPRE袊J;@%-h -PPihNԴQ@ GjZ%PQK((( JZ:RE%# Ө@u'?%z~|?Fx^7\ޏw;bٌS]k5"1e 1OB|?yU0/ںy7Du* nF:bs+{Oxsyx{V4Iv+i*q88#s_\`QYOZGVY ||cK>2>!t. ~B /4fDNb`k5Kþ kkoxg$*mq @G;YR˜gJ$X'n-=*Utdu  gGqX2Z4u+c*Xʖ]\!<²=8ʼztlhc^t߇3OZ8ԌA s+2|:RI*!v@'>?i- 'Ѽ&&xn 1R걫S[WԿi$%r~j^:Yt?7^ aE8Ͷ! \c#\-(9}J^6G 0G1UP:;W7^Sx~틙 1cԒ9={NJ uʕ9N)3)ХV< >c៌eYBۆxu'??p]xǺvI[]+TkYZ=EIH98N(]F+ \=iEv*Y>;ѽ7|o/E:et[g,ѥ"6wuVE?P]B% w ffXHe |axAP޸_hvFP^80݌9WGgB_;:r~|Ə)Vz#|+t|2IƶaNrv6ʢLm ,3 }O?i=~76:By2n<fO~H '.o|c= VQR"P(؇*=pxyC%i:&fIrJ?V>ÿ?2?*N|;A3#t/_)i']_[Wᾁ*0dj+´ߤaɞ:ʪ6~i aHI8U߆xr= šEG#J ,qk))?f]/syii')أgUu斟r6Ys^ҠaEPQKQ@Ą5m5Ho"kmVFq2/1c :s^C%Svʹ7[Ad0bʻBk]Fz[ ^O# 2) ˞^IXʍ9QOz3f5I5/ZeмY  ZmeO?Yg}:ZԺ+z6՞fs1lgOgotOvnϚ(/?m{"x_3xt:x?7^IGթy~5z"_xO鄋   l9"7pn[n3 /j>&wuN~|9Yrsncv0ey~q}kiτ>1f yk)y2\K#{C\>G] gzf1R=qoǡt%e$W:M}*Qu᷌gD/dv(q36|K\9hͭ:"A@N՟7u]4Ud "h֫. V䌞 ff!o!k%HY,zW𰓼+NI!dJ;)Q=jET=੾A]Sd>-#_i_<_k\5\9|+?6fKG ~m -Qngw8i Qeao%JƊY>טxwƠ蚏|%'|?6HėaQE#.ʗ5;+;V{ihUц>\ދE|6%)csjueo_l[NOX ([b}vݎk{>/мIXдeGnUAv ONk#_<-ĸM&Yni43ۓkvW|3wxJ|;rxLtӵHgeĐ&3~K锆QQEQE%exŚ'4IZEQH @eQ$޸N| [t/CyM3AEC]ӿ??]z](?>Q-?>Q-JOi߄T|o.iτ[ux3AEG<AEC<y>Q-9ymצRw3AEC<>P-I@i 9ym 9ymצRPN| [tN| [uv3AEC<AEG<h>Q-?>P-JOiτT|o._QGkmhn&0Eq ]),q;W߳of:FKu(nĀA9G̟uy_KLio0ݞ:XMw[xDU-(ǭyOG_L3~K(KEy"^cwg^^iAȗ<צP[Jq,zpj?p?g|OV6~YmQ >Еk :b)C.pNYuJks_[Sd71Jp5ƟKu|?|]mc>JZ1(f#ʈ*˔Vn]RzFkZƗku \_n"C7= za|mRI亍tW̷15c z/<;Q˝sip^Kfj}]$dҶY2(yS+3= P_W,Kū;65 $W,p2>=x4 [߄|MwY淶'k ƍ#]2+q = 5x͇,k7;ٳIg,`\[R}o4mWImuM21,S,̇#*^"/՛R{mZ RC "$KYѭʉ .0AMhR[÷)WXB3de*HD>bnPzSk?<ב5ocLy TpaqӴ>׼3?4躏mÙ{MB)m# LPmz{VZ'1j+Slb{CX16l20} 2i='Ú~ZѮ4mD De Gw}7ic71.<5+.YA 0mɩ/~EލW&{{95fK+@9|Iq/x4_h~vЦletl$A3ƪsf ~,#H(cYK-ĖƩl7.ʅG!R|M⫏ D%L</yׂ:c#MwRx~.mOO&E- m ]2W@8 b|*i% Eh:^ ۤGy':(bIW.W9h۔QLBQK__ t_ )tyPQKEPRE%PRE%PJZ()hPfZ((-fQ@ K(3Q˪KO9][?,L(3E-R=E|qƽyu<*oXrd`pG})1x_"|+k;_t?el e$dWc+8p5?h}4۶ݠƧnݸ;Udajlr@i*dQEQ@g<cv+:ǟ?nuzgz((ERRw3Knlkh??7:ғZ_}Oh"%Ay$W MKz)AJwu\nەG\z1_;hS>)aq]LSW֭",fF̱y*3PGB:'~&6t|clvmϳ?wwQ=ϱtozN=xԴHg@"+0b[<Þtjc;ޙ~p?ģM46 qko7O]7'OhZVZn=kw2#m=%U$xeit[nx/w/C\ɝ0FHGIiV3.9㶾p#YUA=~GShOú7]^}WKNXf HEAKdrN,ԟd'(IFoO|S@ݢ_7gݢEb@`HH%FN:^m yy,oz j0Fm\J@d3 ~vwv1OBܧĞ .hJ7:&>j. S$ȣ9`>'8=kொ~+߈Wڕtg|'i*wF~'I$6p@)!@9R<}n ӿޙ4[K^C=B7gv>BC.Ll9 .[_h7WGCрdu#ꧣ!jEbC@i<cv;יt?ݥ(Phvy"^cwg^Ey"^cwg^ڀS|+S=Yn4]xzP(@Ov,5§MO zQugSZq 5Y~`}W§MO <_wY7z|Chbd$a9?Ut])kJ2$?;Y:7j}\iwd@y2Wr~VSG5zWl߬xZQ<7xo4ײi#qwMmmԫ`84h64y-2ͱTW0Df=߇ AXΟ3O4y2NdG1آ\迂w֩^"O^i+qo;78Gin/t-y$C_%za3[KL4Q@4Q;RPR;P))M%- (J^RRf;@;f(3Eyb\צW)Yezfh)hPMPGb1_ xÚK9֌< h]JKԵi!07q_q3d|ksHzΚ5wᷗP9SOk(0.! n\@-G?k^ƭ VXW 焍2OV,kP(w.ThVAFjw\%otѰWz+#>Kv?5}V/AאָKowX才8*@!!F btK͞aA[o- o83-&qijbjsdg8<cv;Ͽ&#:W%fdwG෇tM3H,c+ $QA]UÏ i(-kO \i%a r{ 3G>1;yi~ {t}bq,4`w7"(f䜞jS6 >5m{xěnڃ9(U}? f|cw>ᗃ!Ck|)xRMzƝ H($SJ- x#PJU@8G?x?h@}Qڼo4} f=2i?o4} f=2l!o/|cw>^?oh7P[]S9vcp69wP撗f1GZ(&)q@JZ(vf? LPњ? ? ;ړ(GIZ)? _€€қ;[Sܕ񤥤h#Z^_4츌,rG#G$nG]WY6ﭴE!LS,Qz @$y_G_L5ЭM h?"o.2?fφ+At6|5ZM3kmB7G3gS27^K@e h?"o.f+AuP6|5Z_ O5ƀYXIXm ~~2ܚ.hokWui. ?ЭM h?"o.2< D]͟ V&(3lkB7G3__(h?"o.fφ+AuP55Z D]ze߀Wa~&˹y9m~~fφ+Au%-w_dK<.d&P55Z D]ze V&lkB7^I@g h?"o.fφZL2kkB7G3_oRP6|5Z D]zm/֗n&̹q!]>~&56ZK,4O;_=XǙ3ssW_o |=ywC<褕RXf85P3KE%Q@ EPGJ(4P( (4PޒP+ 5ý>k;Vl45Qo&l]@)~D"wWVmݕ麂"&7E FeH*̤0 A=t/2my:I&rr9me~;['wu+?xZ\0Gio2U'@psJ:)hտiKI(Fh(@G4)>\ExNa[iBPo\eqJcKC,71$a`Ͽ5os 俓[TCfD;!?Ȯ5mQE&i-f(.hL-s[ލ}W iBݎ5\G~4W;uwdu>]Z<`@2F&7!(늿߅5_$jL[ s}ל|)Ѧ'RQ?.OK'\/ Lq;(0@ qJ:-}+KI\QE%/z(J\HisHzP<McJ}]խ$[4!k])f?7|#e~b"I שΗ0G4m9:ȯ6g'/.\h&X'4;p/F!`<g\ N7-ٷͅ:FFT}nQcRPtfI֌Ҹ|'Sޗ_ojVf$Õ: W-м3Ox~7HA 98;d:34Wr޽lΑ /to2Tg3ld|.v3znms-ťK42rVЂ+?῎0aVo&Bϩ00!~y76 `׹;Eԗn "Ua #oD_C9E&hQE-:ъ( JZ(;bQEZ(? )h@ E-ii;Pj)h_ҀԴPRRQKI@fGzIKҀZ(IKE%-PQK֊N@)i(Z((4P*)i(i)h=ԔP(i(@ IKE'ncڏ/jiԢ(i)i(EQE-Q QEPh4QEQE֊((3J3KIK)(3I@J\RQIE.h)(1n#wtW>k9fmsV-<.I0A.OitM}L/ms#0aʗp:30 }+|5|RL7^; :<[oN<`~fA- ۈykh-xw\V|@U~42ZN?%ٝ#5 oD]gDϗnҤ2(pcIŖ7>%%CdzDU~,jLL~C;FFk_ i5juDR5koXIcxIZ\M[Ef4QHs%𤢊3KIK@ Fh њ){PI(.h4RPfE4Q@h4PEg;E (('zZ3@()(4QERv (QҊ))h4f7/^;:?+o&M;s9]-h/ƚzjχujldOo7ʰ 1b2 X^ +$/XntmB}I\3nv#͓ y[`yWjphZLx>\}?JhyƳ3F'/mvOKu|6r$}ޢxJL} Yfv;5O'e絷*M/vkE5µ4 JZ33E%-f (4f4RPE.h44QK((EQ@ h:EEQ);E.i( Z(4Q@ Fh(%PKEQE/JJ(PQEQ@(J(PEPEPA(ZJ(((_JJ(Q@Q@PJ1E(;EQE endstream endobj 305 0 obj << /Type /Annot /Subtype /Link /A 306 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 262.1310 485.2500 712.1310 ] >> endobj 306 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/03/Figure-2_new-ch2.jpeg) >> endobj 307 0 obj << /Type /Annot /Subtype /Link /A 308 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 262.1310 485.2500 712.1310 ] >> endobj 308 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/03/Figure-2_new-ch2.jpeg) >> endobj 309 0 obj << /Type /Page /Parent 3 0 R /Annots [ 311 0 R 314 0 R 316 0 R ] /Contents 310 0 R >> endobj 310 0 obj << /Length 34711 >> stream 0.271 0.267 0.267 rg q 15.000 34.894 577.500 742.106 re W n q 26.250 749.527 555.000 27.473 re W n 0.271 0.267 0.267 rg BT 26.250 766.011 Td /F1 9.8 Tf [(Table 2. Incidence rate ratios \(hazard ratios\) for incidence of physician-diagnosed obstructive airway disease \(OAD\) as a )] TJ ET BT 26.250 752.275 Td /F1 9.8 Tf [(function of exposure intensity for the three periods identified as the times of rate ratio change that best fit the data.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 709.462 555.000 32.565 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 742.027 m 581.250 742.027 l 580.500 741.277 l 27.000 741.277 l f 581.250 742.027 m 581.250 709.462 l 580.500 709.462 l 580.500 741.277 l f 26.250 742.027 m 26.250 709.462 l 27.000 709.462 l 27.000 741.277 l f 0.271 0.267 0.267 rg BT 33.000 727.951 Td /F1 9.0 Tf [(The analysis controls for age on 9/11, retirement status \(time dependent\), smoking status \(ever vs. never\), and implicitly for seasonality )] TJ ET BT 33.000 718.794 Td /F1 9.0 Tf [(\(by quarter\).)] TJ ET 1.000 1.000 1.000 rg 26.250 540.847 555.000 168.616 re f 0.965 0.965 0.965 rg 27.000 684.528 75.586 24.185 re f 0.267 0.267 0.267 rg 26.625 708.337 75.961 0.750 re f 26.625 684.153 0.750 24.935 re f 0.271 0.267 0.267 rg BT 31.500 699.189 Td /F4 9.8 Tf [(Period)] TJ ET 0.965 0.965 0.965 rg 102.586 684.528 97.007 24.185 re f 0.267 0.267 0.267 rg 102.586 708.337 97.007 0.750 re f 0.271 0.267 0.267 rg BT 107.086 699.189 Td /F4 9.8 Tf [(Exposure Contrast)] TJ ET 0.965 0.965 0.965 rg 199.593 684.528 122.064 24.185 re f 0.267 0.267 0.267 rg 199.593 708.337 122.064 0.750 re f 0.271 0.267 0.267 rg BT 204.093 699.189 Td /F4 9.8 Tf [(Any OAD Rate Ratio )] TJ ET BT 204.093 687.284 Td /F4 9.8 Tf [(\(95% CI\))] TJ ET 0.965 0.965 0.965 rg 321.656 684.528 118.876 24.185 re f 0.267 0.267 0.267 rg 321.656 708.337 118.876 0.750 re f 0.271 0.267 0.267 rg BT 326.156 699.189 Td /F4 9.8 Tf [(Asthma Rate Ratio )] TJ ET BT 326.156 687.284 Td /F4 9.8 Tf [(\(95% CI\))] TJ ET 0.965 0.965 0.965 rg 440.532 684.528 139.968 24.185 re f 0.267 0.267 0.267 rg 440.532 708.337 140.343 0.750 re f 580.125 684.153 0.750 24.935 re f 0.271 0.267 0.267 rg BT 445.032 699.189 Td /F4 9.8 Tf [(Non-Asthma OAD Rate )] TJ ET BT 445.032 687.284 Td /F4 9.8 Tf [(Ratio \(95% CI\))] TJ ET 0.267 0.267 0.267 rg 26.625 684.153 76.336 0.750 re f 26.625 668.647 0.750 16.256 re f 26.625 652.765 0.750 15.881 re f 26.625 636.509 0.750 16.256 re f 102.211 684.153 97.757 0.750 re f 102.211 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 674.298 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 684.153 122.814 0.750 re f 199.218 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 674.298 Td /F1 9.8 Tf [(4.02 \(2.62,6.16\))] TJ ET 0.267 0.267 0.267 rg 321.281 684.153 119.626 0.750 re f 321.281 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 674.298 Td /F1 9.8 Tf [(4.47 \(2.48, 8.06\))] TJ ET 0.267 0.267 0.267 rg 440.157 684.153 140.718 0.750 re f 440.157 668.272 0.750 16.631 re f 580.125 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 674.298 Td /F1 9.8 Tf [(3.56 \(1.91, 6.66\))] TJ ET 0.267 0.267 0.267 rg 102.211 668.272 97.757 0.750 re f 102.211 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 658.417 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 668.272 122.814 0.750 re f 199.218 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 658.417 Td /F1 9.8 Tf [(2.11 \(1.71,2.61\))] TJ ET 0.267 0.267 0.267 rg 321.281 668.272 119.626 0.750 re f 321.281 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 658.417 Td /F1 9.8 Tf [(2.05 \(1.56, 2.70\))] TJ ET 0.267 0.267 0.267 rg 440.157 668.272 140.718 0.750 re f 440.157 652.390 0.750 16.631 re f 580.125 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 658.417 Td /F1 9.8 Tf [(2.21 \(1.60, 3.07\))] TJ ET 0.267 0.267 0.267 rg 102.211 652.390 97.757 0.750 re f 102.211 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 642.535 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 652.390 122.814 0.750 re f 199.218 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 642.535 Td /F1 9.8 Tf [(1.90 \(1.26,2.86\))] TJ ET 0.267 0.267 0.267 rg 321.281 652.390 119.626 0.750 re f 321.281 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 642.535 Td /F1 9.8 Tf [(2.18 \(1.24, 3.84\))] TJ ET 0.267 0.267 0.267 rg 440.157 652.390 140.718 0.750 re f 440.157 636.509 0.750 16.631 re f 580.125 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 642.535 Td /F1 9.8 Tf [(1.61 \(0.89, 2.92\))] TJ ET 0.267 0.267 0.267 rg 26.625 636.509 76.336 0.750 re f 26.625 621.003 0.750 16.256 re f 26.625 605.122 0.750 15.881 re f 26.625 588.865 0.750 16.256 re f 0.271 0.267 0.267 rg BT 31.875 626.654 Td /F1 9.8 Tf [(15-84 months)] TJ ET 0.267 0.267 0.267 rg 102.211 636.509 97.757 0.750 re f 102.211 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 626.654 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 636.509 122.814 0.750 re f 199.218 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 626.654 Td /F1 9.8 Tf [(1.90 \(1.49,2.44\))] TJ ET 0.267 0.267 0.267 rg 321.281 636.509 119.626 0.750 re f 321.281 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 626.654 Td /F1 9.8 Tf [(2.02 \(1.47, 2.77\))] TJ ET 0.267 0.267 0.267 rg 440.157 636.509 140.718 0.750 re f 440.157 620.628 0.750 16.631 re f 580.125 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 626.654 Td /F1 9.8 Tf [(1.74 \(1.17, 2.59\))] TJ ET 0.267 0.267 0.267 rg 102.211 620.628 97.757 0.750 re f 102.211 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 610.773 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 620.628 122.814 0.750 re f 199.218 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 610.773 Td /F1 9.8 Tf [(1.20 \(1.03,1.39\))] TJ ET 0.267 0.267 0.267 rg 321.281 620.628 119.626 0.750 re f 321.281 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 610.773 Td /F1 9.8 Tf [(1.28 \(1.06, 1.56\))] TJ ET 0.267 0.267 0.267 rg 440.157 620.628 140.718 0.750 re f 440.157 604.747 0.750 16.631 re f 580.125 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 610.773 Td /F1 9.8 Tf [(1.06 \(0.83, 1.36\))] TJ ET 0.267 0.267 0.267 rg 102.211 604.747 97.757 0.750 re f 102.211 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 594.892 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 604.747 122.814 0.750 re f 199.218 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 594.892 Td /F1 9.8 Tf [(1.59 \(1.28,1.98\))] TJ ET 0.267 0.267 0.267 rg 321.281 604.747 119.626 0.750 re f 321.281 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 594.892 Td /F1 9.8 Tf [(1.57 \(1.19, 2.08\))] TJ ET 0.267 0.267 0.267 rg 440.157 604.747 140.718 0.750 re f 440.157 588.865 0.750 16.631 re f 580.125 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 594.892 Td /F1 9.8 Tf [(1.64 \(1.16, 2.32\))] TJ ET 0.267 0.267 0.267 rg 26.625 588.865 76.336 0.750 re f 26.625 541.222 76.336 0.750 re f 26.625 573.359 0.750 16.256 re f 26.625 557.478 0.750 15.881 re f 26.625 541.222 0.750 16.256 re f 0.271 0.267 0.267 rg BT 31.875 579.010 Td /F1 9.8 Tf [(85-120 months)] TJ ET 0.267 0.267 0.267 rg 102.211 588.865 97.757 0.750 re f 102.211 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 579.010 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 588.865 122.814 0.750 re f 199.218 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 579.010 Td /F1 9.8 Tf [(1.20 \(0.92,1.56\))] TJ ET 0.267 0.267 0.267 rg 321.281 588.865 119.626 0.750 re f 321.281 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 579.010 Td /F1 9.8 Tf [(1.36 \(0.93,1.99\))] TJ ET 0.267 0.267 0.267 rg 440.157 588.865 140.718 0.750 re f 440.157 572.984 0.750 16.631 re f 580.125 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 579.010 Td /F1 9.8 Tf [(1.03 \(0.71, 1.51\))] TJ ET 0.267 0.267 0.267 rg 102.211 572.984 97.757 0.750 re f 102.211 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 563.129 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 572.984 122.814 0.750 re f 199.218 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 563.129 Td /F1 9.8 Tf [(1.17 \(0.97,1.42\))] TJ ET 0.267 0.267 0.267 rg 321.281 572.984 119.626 0.750 re f 321.281 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 563.129 Td /F1 9.8 Tf [(1.21 \(0.92,1.58\))] TJ ET 0.267 0.267 0.267 rg 440.157 572.984 140.718 0.750 re f 440.157 557.103 0.750 16.631 re f 580.125 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 563.129 Td /F1 9.8 Tf [(1.14 \(0.86, 1.51\))] TJ ET 0.267 0.267 0.267 rg 102.211 557.103 97.757 0.750 re f 102.211 541.222 97.757 0.750 re f 102.211 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 547.248 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 557.103 122.814 0.750 re f 199.218 541.222 122.814 0.750 re f 199.218 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 547.248 Td /F1 9.8 Tf [(1.02 \(0.82,1.27\))] TJ ET 0.267 0.267 0.267 rg 321.281 557.103 119.626 0.750 re f 321.281 541.222 119.626 0.750 re f 321.281 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 547.248 Td /F1 9.8 Tf [(1.13 \(0.82,1.55\))] TJ ET 0.267 0.267 0.267 rg 440.157 557.103 140.718 0.750 re f 440.157 541.222 140.718 0.750 re f 440.157 541.222 0.750 16.631 re f 580.125 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 547.248 Td /F1 9.8 Tf [(0.91 \(0.67,1.23\))] TJ ET BT 26.250 486.323 Td /F1 9.8 Tf [(Figure 3 shows the estimated incidence of new physician-diagnosed OAD by quarter for each of the exposure groups. The )] TJ ET BT 26.250 474.418 Td /F1 9.8 Tf [(incidence rates for the low exposure group correspond to the values of a baseline hazard function in a Cox regression model. )] TJ ET BT 26.250 462.513 Td /F1 9.8 Tf [(The incidence graphs show the large exposure effects early after 9/11/2001, and continued elevated incidence in the high and )] TJ ET BT 26.250 450.609 Td /F1 9.8 Tf [(moderate exposure groups through month 84 compared to the low exposure group. Seasonal effects are clearly apparent, with )] TJ ET BT 26.250 438.704 Td /F1 9.8 Tf [(higher incidence in winter months. The increase in physician-diagnosed OAD after the WTC medication program took effect in )] TJ ET BT 26.250 426.799 Td /F1 9.8 Tf [(2007 \(year six\) is seen in all exposure groups. Retirement status was weakly associated with OAD diagnosis, with retired )] TJ ET BT 26.250 414.894 Td /F1 9.8 Tf [(persons having non-significantly lower rates of OAD \(incidence rate ratio 0.89, 95% CI [0.79-1.00]\). Surprisingly, smoking was )] TJ ET BT 26.250 402.990 Td /F1 9.8 Tf [(not associated with OAD diagnoses \(incidence rate ratio 1.03 for ever smokers vs. never smokers, 95% CI [0.94-1.12]\).)] TJ ET 0.965 0.965 0.965 rg 26.250 61.799 555.000 331.310 re f 0.267 0.267 0.267 rg 26.250 393.109 m 581.250 393.109 l 581.250 392.359 l 26.250 392.359 l f 26.250 61.799 m 581.250 61.799 l 581.250 62.549 l 26.250 62.549 l f q 450.000 0 0 274.500 35.250 108.859 cm /I23 Do Q q 35.250 73.049 537.000 29.810 re W n 0.271 0.267 0.267 rg BT 35.250 93.335 Td /F4 9.8 Tf [(Fig. 3: Incidence of physician-diagnosed OAD in WTC firefighters exposed to the WTC rescue/recovery effort since )] TJ ET BT 35.250 81.430 Td /F4 9.8 Tf [(9/11/2001 and by exposure intensity.)] TJ ET Q Q q 15.000 34.894 577.500 742.106 re W n q 26.250 749.527 555.000 27.473 re W n 0.271 0.267 0.267 rg BT 26.250 766.011 Td /F1 9.8 Tf [(Table 2. Incidence rate ratios \(hazard ratios\) for incidence of physician-diagnosed obstructive airway disease \(OAD\) as a )] TJ ET BT 26.250 752.275 Td /F1 9.8 Tf [(function of exposure intensity for the three periods identified as the times of rate ratio change that best fit the data.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 709.462 555.000 32.565 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 742.027 m 581.250 742.027 l 580.500 741.277 l 27.000 741.277 l f 581.250 742.027 m 581.250 709.462 l 580.500 709.462 l 580.500 741.277 l f 26.250 742.027 m 26.250 709.462 l 27.000 709.462 l 27.000 741.277 l f 0.271 0.267 0.267 rg BT 33.000 727.951 Td /F1 9.0 Tf [(The analysis controls for age on 9/11, retirement status \(time dependent\), smoking status \(ever vs. never\), and implicitly for seasonality )] TJ ET BT 33.000 718.794 Td /F1 9.0 Tf [(\(by quarter\).)] TJ ET 1.000 1.000 1.000 rg 26.250 540.847 555.000 168.616 re f 0.965 0.965 0.965 rg 27.000 684.528 75.586 24.185 re f 0.267 0.267 0.267 rg 26.625 708.337 75.961 0.750 re f 26.625 684.153 0.750 24.935 re f 0.271 0.267 0.267 rg BT 31.500 699.189 Td /F4 9.8 Tf [(Period)] TJ ET 0.965 0.965 0.965 rg 102.586 684.528 97.007 24.185 re f 0.267 0.267 0.267 rg 102.586 708.337 97.007 0.750 re f 0.271 0.267 0.267 rg BT 107.086 699.189 Td /F4 9.8 Tf [(Exposure Contrast)] TJ ET 0.965 0.965 0.965 rg 199.593 684.528 122.064 24.185 re f 0.267 0.267 0.267 rg 199.593 708.337 122.064 0.750 re f 0.271 0.267 0.267 rg BT 204.093 699.189 Td /F4 9.8 Tf [(Any OAD Rate Ratio )] TJ ET BT 204.093 687.284 Td /F4 9.8 Tf [(\(95% CI\))] TJ ET 0.965 0.965 0.965 rg 321.656 684.528 118.876 24.185 re f 0.267 0.267 0.267 rg 321.656 708.337 118.876 0.750 re f 0.271 0.267 0.267 rg BT 326.156 699.189 Td /F4 9.8 Tf [(Asthma Rate Ratio )] TJ ET BT 326.156 687.284 Td /F4 9.8 Tf [(\(95% CI\))] TJ ET 0.965 0.965 0.965 rg 440.532 684.528 139.968 24.185 re f 0.267 0.267 0.267 rg 440.532 708.337 140.343 0.750 re f 580.125 684.153 0.750 24.935 re f 0.271 0.267 0.267 rg BT 445.032 699.189 Td /F4 9.8 Tf [(Non-Asthma OAD Rate )] TJ ET BT 445.032 687.284 Td /F4 9.8 Tf [(Ratio \(95% CI\))] TJ ET 0.267 0.267 0.267 rg 26.625 684.153 76.336 0.750 re f 26.625 668.647 0.750 16.256 re f 26.625 652.765 0.750 15.881 re f 26.625 636.509 0.750 16.256 re f 102.211 684.153 97.757 0.750 re f 102.211 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 674.298 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 684.153 122.814 0.750 re f 199.218 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 674.298 Td /F1 9.8 Tf [(4.02 \(2.62,6.16\))] TJ ET 0.267 0.267 0.267 rg 321.281 684.153 119.626 0.750 re f 321.281 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 674.298 Td /F1 9.8 Tf [(4.47 \(2.48, 8.06\))] TJ ET 0.267 0.267 0.267 rg 440.157 684.153 140.718 0.750 re f 440.157 668.272 0.750 16.631 re f 580.125 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 674.298 Td /F1 9.8 Tf [(3.56 \(1.91, 6.66\))] TJ ET 0.267 0.267 0.267 rg 102.211 668.272 97.757 0.750 re f 102.211 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 658.417 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 668.272 122.814 0.750 re f 199.218 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 658.417 Td /F1 9.8 Tf [(2.11 \(1.71,2.61\))] TJ ET 0.267 0.267 0.267 rg 321.281 668.272 119.626 0.750 re f 321.281 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 658.417 Td /F1 9.8 Tf [(2.05 \(1.56, 2.70\))] TJ ET 0.267 0.267 0.267 rg 440.157 668.272 140.718 0.750 re f 440.157 652.390 0.750 16.631 re f 580.125 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 658.417 Td /F1 9.8 Tf [(2.21 \(1.60, 3.07\))] TJ ET 0.267 0.267 0.267 rg 102.211 652.390 97.757 0.750 re f 102.211 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 642.535 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 652.390 122.814 0.750 re f 199.218 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 642.535 Td /F1 9.8 Tf [(1.90 \(1.26,2.86\))] TJ ET 0.267 0.267 0.267 rg 321.281 652.390 119.626 0.750 re f 321.281 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 642.535 Td /F1 9.8 Tf [(2.18 \(1.24, 3.84\))] TJ ET 0.267 0.267 0.267 rg 440.157 652.390 140.718 0.750 re f 440.157 636.509 0.750 16.631 re f 580.125 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 642.535 Td /F1 9.8 Tf [(1.61 \(0.89, 2.92\))] TJ ET 0.267 0.267 0.267 rg 26.625 636.509 76.336 0.750 re f 26.625 621.003 0.750 16.256 re f 26.625 605.122 0.750 15.881 re f 26.625 588.865 0.750 16.256 re f 0.271 0.267 0.267 rg BT 31.875 626.654 Td /F1 9.8 Tf [(15-84 months)] TJ ET 0.267 0.267 0.267 rg 102.211 636.509 97.757 0.750 re f 102.211 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 626.654 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 636.509 122.814 0.750 re f 199.218 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 626.654 Td /F1 9.8 Tf [(1.90 \(1.49,2.44\))] TJ ET 0.267 0.267 0.267 rg 321.281 636.509 119.626 0.750 re f 321.281 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 626.654 Td /F1 9.8 Tf [(2.02 \(1.47, 2.77\))] TJ ET 0.267 0.267 0.267 rg 440.157 636.509 140.718 0.750 re f 440.157 620.628 0.750 16.631 re f 580.125 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 626.654 Td /F1 9.8 Tf [(1.74 \(1.17, 2.59\))] TJ ET 0.267 0.267 0.267 rg 102.211 620.628 97.757 0.750 re f 102.211 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 610.773 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 620.628 122.814 0.750 re f 199.218 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 610.773 Td /F1 9.8 Tf [(1.20 \(1.03,1.39\))] TJ ET 0.267 0.267 0.267 rg 321.281 620.628 119.626 0.750 re f 321.281 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 610.773 Td /F1 9.8 Tf [(1.28 \(1.06, 1.56\))] TJ ET 0.267 0.267 0.267 rg 440.157 620.628 140.718 0.750 re f 440.157 604.747 0.750 16.631 re f 580.125 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 610.773 Td /F1 9.8 Tf [(1.06 \(0.83, 1.36\))] TJ ET 0.267 0.267 0.267 rg 102.211 604.747 97.757 0.750 re f 102.211 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 594.892 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 604.747 122.814 0.750 re f 199.218 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 594.892 Td /F1 9.8 Tf [(1.59 \(1.28,1.98\))] TJ ET 0.267 0.267 0.267 rg 321.281 604.747 119.626 0.750 re f 321.281 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 594.892 Td /F1 9.8 Tf [(1.57 \(1.19, 2.08\))] TJ ET 0.267 0.267 0.267 rg 440.157 604.747 140.718 0.750 re f 440.157 588.865 0.750 16.631 re f 580.125 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 594.892 Td /F1 9.8 Tf [(1.64 \(1.16, 2.32\))] TJ ET 0.267 0.267 0.267 rg 26.625 588.865 76.336 0.750 re f 26.625 541.222 76.336 0.750 re f 26.625 573.359 0.750 16.256 re f 26.625 557.478 0.750 15.881 re f 26.625 541.222 0.750 16.256 re f 0.271 0.267 0.267 rg BT 31.875 579.010 Td /F1 9.8 Tf [(85-120 months)] TJ ET 0.267 0.267 0.267 rg 102.211 588.865 97.757 0.750 re f 102.211 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 579.010 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 588.865 122.814 0.750 re f 199.218 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 579.010 Td /F1 9.8 Tf [(1.20 \(0.92,1.56\))] TJ ET 0.267 0.267 0.267 rg 321.281 588.865 119.626 0.750 re f 321.281 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 579.010 Td /F1 9.8 Tf [(1.36 \(0.93,1.99\))] TJ ET 0.267 0.267 0.267 rg 440.157 588.865 140.718 0.750 re f 440.157 572.984 0.750 16.631 re f 580.125 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 579.010 Td /F1 9.8 Tf [(1.03 \(0.71, 1.51\))] TJ ET 0.267 0.267 0.267 rg 102.211 572.984 97.757 0.750 re f 102.211 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 563.129 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 572.984 122.814 0.750 re f 199.218 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 563.129 Td /F1 9.8 Tf [(1.17 \(0.97,1.42\))] TJ ET 0.267 0.267 0.267 rg 321.281 572.984 119.626 0.750 re f 321.281 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 563.129 Td /F1 9.8 Tf [(1.21 \(0.92,1.58\))] TJ ET 0.267 0.267 0.267 rg 440.157 572.984 140.718 0.750 re f 440.157 557.103 0.750 16.631 re f 580.125 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 563.129 Td /F1 9.8 Tf [(1.14 \(0.86, 1.51\))] TJ ET 0.267 0.267 0.267 rg 102.211 557.103 97.757 0.750 re f 102.211 541.222 97.757 0.750 re f 102.211 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 547.248 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 557.103 122.814 0.750 re f 199.218 541.222 122.814 0.750 re f 199.218 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 547.248 Td /F1 9.8 Tf [(1.02 \(0.82,1.27\))] TJ ET 0.267 0.267 0.267 rg 321.281 557.103 119.626 0.750 re f 321.281 541.222 119.626 0.750 re f 321.281 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 547.248 Td /F1 9.8 Tf [(1.13 \(0.82,1.55\))] TJ ET 0.267 0.267 0.267 rg 440.157 557.103 140.718 0.750 re f 440.157 541.222 140.718 0.750 re f 440.157 541.222 0.750 16.631 re f 580.125 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 547.248 Td /F1 9.8 Tf [(0.91 \(0.67,1.23\))] TJ ET BT 26.250 486.323 Td /F1 9.8 Tf [(Figure 3 shows the estimated incidence of new physician-diagnosed OAD by quarter for each of the exposure groups. The )] TJ ET BT 26.250 474.418 Td /F1 9.8 Tf [(incidence rates for the low exposure group correspond to the values of a baseline hazard function in a Cox regression model. )] TJ ET BT 26.250 462.513 Td /F1 9.8 Tf [(The incidence graphs show the large exposure effects early after 9/11/2001, and continued elevated incidence in the high and )] TJ ET BT 26.250 450.609 Td /F1 9.8 Tf [(moderate exposure groups through month 84 compared to the low exposure group. Seasonal effects are clearly apparent, with )] TJ ET BT 26.250 438.704 Td /F1 9.8 Tf [(higher incidence in winter months. The increase in physician-diagnosed OAD after the WTC medication program took effect in )] TJ ET BT 26.250 426.799 Td /F1 9.8 Tf [(2007 \(year six\) is seen in all exposure groups. Retirement status was weakly associated with OAD diagnosis, with retired )] TJ ET BT 26.250 414.894 Td /F1 9.8 Tf [(persons having non-significantly lower rates of OAD \(incidence rate ratio 0.89, 95% CI [0.79-1.00]\). Surprisingly, smoking was )] TJ ET BT 26.250 402.990 Td /F1 9.8 Tf [(not associated with OAD diagnoses \(incidence rate ratio 1.03 for ever smokers vs. never smokers, 95% CI [0.94-1.12]\).)] TJ ET 0.965 0.965 0.965 rg 26.250 61.799 555.000 331.310 re f 0.267 0.267 0.267 rg 26.250 393.109 m 581.250 393.109 l 581.250 392.359 l 26.250 392.359 l f 26.250 61.799 m 581.250 61.799 l 581.250 62.549 l 26.250 62.549 l f q 450.000 0 0 274.500 35.250 108.859 cm /I23 Do Q q 35.250 73.049 537.000 29.810 re W n 0.271 0.267 0.267 rg BT 35.250 93.335 Td /F4 9.8 Tf [(Fig. 3: Incidence of physician-diagnosed OAD in WTC firefighters exposed to the WTC rescue/recovery effort since )] TJ ET BT 35.250 81.430 Td /F4 9.8 Tf [(9/11/2001 and by exposure intensity.)] TJ ET Q Q q 15.000 34.894 577.500 742.106 re W n q 26.250 749.527 555.000 27.473 re W n 0.271 0.267 0.267 rg BT 26.250 766.011 Td /F1 9.8 Tf [(Table 2. Incidence rate ratios \(hazard ratios\) for incidence of physician-diagnosed obstructive airway disease \(OAD\) as a )] TJ ET BT 26.250 752.275 Td /F1 9.8 Tf [(function of exposure intensity for the three periods identified as the times of rate ratio change that best fit the data.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 709.462 555.000 32.565 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 742.027 m 581.250 742.027 l 580.500 741.277 l 27.000 741.277 l f 581.250 742.027 m 581.250 709.462 l 580.500 709.462 l 580.500 741.277 l f 26.250 742.027 m 26.250 709.462 l 27.000 709.462 l 27.000 741.277 l f 0.271 0.267 0.267 rg BT 33.000 727.951 Td /F1 9.0 Tf [(The analysis controls for age on 9/11, retirement status \(time dependent\), smoking status \(ever vs. never\), and implicitly for seasonality )] TJ ET BT 33.000 718.794 Td /F1 9.0 Tf [(\(by quarter\).)] TJ ET 1.000 1.000 1.000 rg 26.250 540.847 555.000 168.616 re f 0.965 0.965 0.965 rg 27.000 684.528 75.586 24.185 re f 0.267 0.267 0.267 rg 26.625 708.337 75.961 0.750 re f 26.625 684.153 0.750 24.935 re f 0.271 0.267 0.267 rg BT 31.500 699.189 Td /F4 9.8 Tf [(Period)] TJ ET 0.965 0.965 0.965 rg 102.586 684.528 97.007 24.185 re f 0.267 0.267 0.267 rg 102.586 708.337 97.007 0.750 re f 0.271 0.267 0.267 rg BT 107.086 699.189 Td /F4 9.8 Tf [(Exposure Contrast)] TJ ET 0.965 0.965 0.965 rg 199.593 684.528 122.064 24.185 re f 0.267 0.267 0.267 rg 199.593 708.337 122.064 0.750 re f 0.271 0.267 0.267 rg BT 204.093 699.189 Td /F4 9.8 Tf [(Any OAD Rate Ratio )] TJ ET BT 204.093 687.284 Td /F4 9.8 Tf [(\(95% CI\))] TJ ET 0.965 0.965 0.965 rg 321.656 684.528 118.876 24.185 re f 0.267 0.267 0.267 rg 321.656 708.337 118.876 0.750 re f 0.271 0.267 0.267 rg BT 326.156 699.189 Td /F4 9.8 Tf [(Asthma Rate Ratio )] TJ ET BT 326.156 687.284 Td /F4 9.8 Tf [(\(95% CI\))] TJ ET 0.965 0.965 0.965 rg 440.532 684.528 139.968 24.185 re f 0.267 0.267 0.267 rg 440.532 708.337 140.343 0.750 re f 580.125 684.153 0.750 24.935 re f 0.271 0.267 0.267 rg BT 445.032 699.189 Td /F4 9.8 Tf [(Non-Asthma OAD Rate )] TJ ET BT 445.032 687.284 Td /F4 9.8 Tf [(Ratio \(95% CI\))] TJ ET 0.267 0.267 0.267 rg 26.625 684.153 76.336 0.750 re f 26.625 668.647 0.750 16.256 re f 26.625 652.765 0.750 15.881 re f 26.625 636.509 0.750 16.256 re f 102.211 684.153 97.757 0.750 re f 102.211 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 674.298 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 684.153 122.814 0.750 re f 199.218 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 674.298 Td /F1 9.8 Tf [(4.02 \(2.62,6.16\))] TJ ET 0.267 0.267 0.267 rg 321.281 684.153 119.626 0.750 re f 321.281 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 674.298 Td /F1 9.8 Tf [(4.47 \(2.48, 8.06\))] TJ ET 0.267 0.267 0.267 rg 440.157 684.153 140.718 0.750 re f 440.157 668.272 0.750 16.631 re f 580.125 668.272 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 674.298 Td /F1 9.8 Tf [(3.56 \(1.91, 6.66\))] TJ ET 0.267 0.267 0.267 rg 102.211 668.272 97.757 0.750 re f 102.211 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 658.417 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 668.272 122.814 0.750 re f 199.218 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 658.417 Td /F1 9.8 Tf [(2.11 \(1.71,2.61\))] TJ ET 0.267 0.267 0.267 rg 321.281 668.272 119.626 0.750 re f 321.281 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 658.417 Td /F1 9.8 Tf [(2.05 \(1.56, 2.70\))] TJ ET 0.267 0.267 0.267 rg 440.157 668.272 140.718 0.750 re f 440.157 652.390 0.750 16.631 re f 580.125 652.390 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 658.417 Td /F1 9.8 Tf [(2.21 \(1.60, 3.07\))] TJ ET 0.267 0.267 0.267 rg 102.211 652.390 97.757 0.750 re f 102.211 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 642.535 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 652.390 122.814 0.750 re f 199.218 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 642.535 Td /F1 9.8 Tf [(1.90 \(1.26,2.86\))] TJ ET 0.267 0.267 0.267 rg 321.281 652.390 119.626 0.750 re f 321.281 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 642.535 Td /F1 9.8 Tf [(2.18 \(1.24, 3.84\))] TJ ET 0.267 0.267 0.267 rg 440.157 652.390 140.718 0.750 re f 440.157 636.509 0.750 16.631 re f 580.125 636.509 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 642.535 Td /F1 9.8 Tf [(1.61 \(0.89, 2.92\))] TJ ET 0.267 0.267 0.267 rg 26.625 636.509 76.336 0.750 re f 26.625 621.003 0.750 16.256 re f 26.625 605.122 0.750 15.881 re f 26.625 588.865 0.750 16.256 re f 0.271 0.267 0.267 rg BT 31.875 626.654 Td /F1 9.8 Tf [(15-84 months)] TJ ET 0.267 0.267 0.267 rg 102.211 636.509 97.757 0.750 re f 102.211 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 626.654 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 636.509 122.814 0.750 re f 199.218 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 626.654 Td /F1 9.8 Tf [(1.90 \(1.49,2.44\))] TJ ET 0.267 0.267 0.267 rg 321.281 636.509 119.626 0.750 re f 321.281 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 626.654 Td /F1 9.8 Tf [(2.02 \(1.47, 2.77\))] TJ ET 0.267 0.267 0.267 rg 440.157 636.509 140.718 0.750 re f 440.157 620.628 0.750 16.631 re f 580.125 620.628 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 626.654 Td /F1 9.8 Tf [(1.74 \(1.17, 2.59\))] TJ ET 0.267 0.267 0.267 rg 102.211 620.628 97.757 0.750 re f 102.211 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 610.773 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 620.628 122.814 0.750 re f 199.218 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 610.773 Td /F1 9.8 Tf [(1.20 \(1.03,1.39\))] TJ ET 0.267 0.267 0.267 rg 321.281 620.628 119.626 0.750 re f 321.281 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 610.773 Td /F1 9.8 Tf [(1.28 \(1.06, 1.56\))] TJ ET 0.267 0.267 0.267 rg 440.157 620.628 140.718 0.750 re f 440.157 604.747 0.750 16.631 re f 580.125 604.747 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 610.773 Td /F1 9.8 Tf [(1.06 \(0.83, 1.36\))] TJ ET 0.267 0.267 0.267 rg 102.211 604.747 97.757 0.750 re f 102.211 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 594.892 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 604.747 122.814 0.750 re f 199.218 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 594.892 Td /F1 9.8 Tf [(1.59 \(1.28,1.98\))] TJ ET 0.267 0.267 0.267 rg 321.281 604.747 119.626 0.750 re f 321.281 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 594.892 Td /F1 9.8 Tf [(1.57 \(1.19, 2.08\))] TJ ET 0.267 0.267 0.267 rg 440.157 604.747 140.718 0.750 re f 440.157 588.865 0.750 16.631 re f 580.125 588.865 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 594.892 Td /F1 9.8 Tf [(1.64 \(1.16, 2.32\))] TJ ET 0.267 0.267 0.267 rg 26.625 588.865 76.336 0.750 re f 26.625 541.222 76.336 0.750 re f 26.625 573.359 0.750 16.256 re f 26.625 557.478 0.750 15.881 re f 26.625 541.222 0.750 16.256 re f 0.271 0.267 0.267 rg BT 31.875 579.010 Td /F1 9.8 Tf [(85-120 months)] TJ ET 0.267 0.267 0.267 rg 102.211 588.865 97.757 0.750 re f 102.211 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 579.010 Td /F1 9.8 Tf [(High vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 588.865 122.814 0.750 re f 199.218 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 579.010 Td /F1 9.8 Tf [(1.20 \(0.92,1.56\))] TJ ET 0.267 0.267 0.267 rg 321.281 588.865 119.626 0.750 re f 321.281 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 579.010 Td /F1 9.8 Tf [(1.36 \(0.93,1.99\))] TJ ET 0.267 0.267 0.267 rg 440.157 588.865 140.718 0.750 re f 440.157 572.984 0.750 16.631 re f 580.125 572.984 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 579.010 Td /F1 9.8 Tf [(1.03 \(0.71, 1.51\))] TJ ET 0.267 0.267 0.267 rg 102.211 572.984 97.757 0.750 re f 102.211 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 563.129 Td /F1 9.8 Tf [(High vs. Moderate)] TJ ET 0.267 0.267 0.267 rg 199.218 572.984 122.814 0.750 re f 199.218 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 563.129 Td /F1 9.8 Tf [(1.17 \(0.97,1.42\))] TJ ET 0.267 0.267 0.267 rg 321.281 572.984 119.626 0.750 re f 321.281 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 563.129 Td /F1 9.8 Tf [(1.21 \(0.92,1.58\))] TJ ET 0.267 0.267 0.267 rg 440.157 572.984 140.718 0.750 re f 440.157 557.103 0.750 16.631 re f 580.125 557.103 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 563.129 Td /F1 9.8 Tf [(1.14 \(0.86, 1.51\))] TJ ET 0.267 0.267 0.267 rg 102.211 557.103 97.757 0.750 re f 102.211 541.222 97.757 0.750 re f 102.211 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 107.461 547.248 Td /F1 9.8 Tf [(Moderate vs. Low)] TJ ET 0.267 0.267 0.267 rg 199.218 557.103 122.814 0.750 re f 199.218 541.222 122.814 0.750 re f 199.218 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 204.468 547.248 Td /F1 9.8 Tf [(1.02 \(0.82,1.27\))] TJ ET 0.267 0.267 0.267 rg 321.281 557.103 119.626 0.750 re f 321.281 541.222 119.626 0.750 re f 321.281 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 326.531 547.248 Td /F1 9.8 Tf [(1.13 \(0.82,1.55\))] TJ ET 0.267 0.267 0.267 rg 440.157 557.103 140.718 0.750 re f 440.157 541.222 140.718 0.750 re f 440.157 541.222 0.750 16.631 re f 580.125 541.222 0.750 16.631 re f 0.271 0.267 0.267 rg BT 445.407 547.248 Td /F1 9.8 Tf [(0.91 \(0.67,1.23\))] TJ ET BT 26.250 486.323 Td /F1 9.8 Tf [(Figure 3 shows the estimated incidence of new physician-diagnosed OAD by quarter for each of the exposure groups. The )] TJ ET BT 26.250 474.418 Td /F1 9.8 Tf [(incidence rates for the low exposure group correspond to the values of a baseline hazard function in a Cox regression model. )] TJ ET BT 26.250 462.513 Td /F1 9.8 Tf [(The incidence graphs show the large exposure effects early after 9/11/2001, and continued elevated incidence in the high and )] TJ ET BT 26.250 450.609 Td /F1 9.8 Tf [(moderate exposure groups through month 84 compared to the low exposure group. Seasonal effects are clearly apparent, with )] TJ ET BT 26.250 438.704 Td /F1 9.8 Tf [(higher incidence in winter months. The increase in physician-diagnosed OAD after the WTC medication program took effect in )] TJ ET BT 26.250 426.799 Td /F1 9.8 Tf [(2007 \(year six\) is seen in all exposure groups. Retirement status was weakly associated with OAD diagnosis, with retired )] TJ ET BT 26.250 414.894 Td /F1 9.8 Tf [(persons having non-significantly lower rates of OAD \(incidence rate ratio 0.89, 95% CI [0.79-1.00]\). Surprisingly, smoking was )] TJ ET BT 26.250 402.990 Td /F1 9.8 Tf [(not associated with OAD diagnoses \(incidence rate ratio 1.03 for ever smokers vs. never smokers, 95% CI [0.94-1.12]\).)] TJ ET 0.965 0.965 0.965 rg 26.250 61.799 555.000 331.310 re f 0.267 0.267 0.267 rg 26.250 393.109 m 581.250 393.109 l 581.250 392.359 l 26.250 392.359 l f 26.250 61.799 m 581.250 61.799 l 581.250 62.549 l 26.250 62.549 l f q 450.000 0 0 274.500 35.250 108.859 cm /I23 Do Q q 35.250 73.049 537.000 29.810 re W n 0.271 0.267 0.267 rg BT 35.250 93.335 Td /F4 9.8 Tf [(Fig. 3: Incidence of physician-diagnosed OAD in WTC firefighters exposed to the WTC rescue/recovery effort since )] TJ ET BT 35.250 81.430 Td /F4 9.8 Tf [(9/11/2001 and by exposure intensity.)] TJ ET Q Q q 450.000 0 0 274.500 35.250 108.859 cm /I23 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(7)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 311 0 obj << /Type /Annot /Subtype /Link /A 312 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 108.8587 485.2500 383.3587 ] >> endobj 312 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/03/Figure-3_new-ch2.jpeg) >> endobj 313 0 obj << /Type /XObject /Subtype /Image /Width 600 /Height 366 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 30137>> stream JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   nX" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?QE-b\tQKhJ)hJ)hJ)hJ)hJ3KE&hZZ(3Fih=h-4Pf4fLњZ(3֌@ 3KE&hZZ(3Fih▊LњZ8(3Fih(3Fix4f(3FixLњZ(3FixLњ^(PIK()EQF(~4bP~4bPz(QF(Q1@bPEQF(Q1@%.)(Z\PQE-%Q@ZJ(֗QK@ EzE.)( (%RQEQF(Q1@bPEQF(Q1@bPEQF(QF(Q@ ho|/⎝ M ͢Ec0HCG /js@K6YZJ "`OҀ8x :|;ww&}6Y'yRW$I$o¶ ' i ZAZe]%2@ks#B?[xG]5▀9VWDt?M#BK[xG]4#B1K[xG]4¶WDt?Mtµ ' hktOCI7 ?*.U?]]&(9VWDt?M|#B(9VWDt?M|#B9µ ' hktOCIµ ' hktOCI7 ?*.U?]]&)1@+_Ы&VWEt?Mtxs|#B?ZG]5P9 ?*.U?]](s|#B?ZG]5bµ / hktOCGfYMZrj٦TQo4 9G ?*.U]G<_A]`4OMtµ ' hkt_CsD4G<_A]|#B?ZG]4}?M7%oD4@+_Ы&VWDt?M`4OMt}?M7% ?*.U?]G<_A]`4OMtµ ' hkt_CoD4G<_A]|#B?ZG]4}?M7%oD4@+_Ы&VWDt?M`4OMt}?M7% ?*.U?]G<_AU`OMT¶ ' i?[xG]4`wOMT}?M7%P ?*.U?]G<_AU`OMT¶ ' hmtOCoD4G<]AU'+oЫ&U?]L,Siz}7VW*R[4OMks#B?[xG]5P9 ?*.mtOCI1@+oЫ&VWDt?Mtx¶ ' hmtOCG1@xgLvwg& W,bI#p2X.A 9#D-Mtx4Q(sFhQ1F(k$¿ +]%s G[ *Dt.+ j{,,H.'qG@MZTYƜwn?/}Q--5RXP2;RBGP$3EyH<#*F_*|9AIs'kD?>MgJSj-+(b<:PEPE@Q@QQEQEfh4bP(4fъ1@hW7;² t5Hns% `T&RȱK6@اt ךNи8){#g??n]G=*->tῒ_'g??nKk"LRu%H$~4,U%.ƣ׫OFWC3kwQ-i-2쑡rw87oF.2Ԡ.6^cēF5UiЋ+^ $*ˑ'p *^Y\r4JBrJ P@L3!<ޥ.ct˻IX0 ʲm1[vqR k A"yu R$; A ኿7 OaifI0\ n:aTYs6,sR\Ұ,Ll;%0ĒoZئ0$F|Z F< V{{eiل'EɌ-,kqsRg7";Nc #y5 e9bm/tVZLkWӉ6c.?v>G t;Iފ`.h Jh&hb 撊3KLQ@+Pu(g].i3E&hf4P\b>$A5ω /kPAAkmn}p[srXw'p Gl{e^}}J~ m⿇פD$UĸG܃D7肿,.h&hhq ;fZ(J? ( (GG ( (J? ( ( ( ( ( U!VO!wHno~[5 D|*hY3ݷFğƺJ׵*XA,@="4WAW5"rQ?R@[?R@[['X/?G&: :YR9.nx-wa2<4d@1I?"Wo#Kn.je'ItiԄkFOtKXaVK<G# AW%رKc\,9.JqOnvT?(-4¾\>c=ʹ96m1^k~~?muxx,"I_22 ;NrϩeuafRt򁛔A 0Hd^0@*j(^x-m$Tw+J2s; ;t Zzdhw&dX$p:\h42蚼OjffCvMtJg7?.{F=! N ɥo\0HdmCmr +>B hk>4gWlaB폸$ٔt!fwyk`k$Q$FC #&PH:aoj bY{]H#G"by2(::UosmaIͥγu(H+cqh$Dž|J/<7>/SA\>OʅpэYF9e6xtPh (PO– 3IEsQ?j:κL7%CV(h4RQ@ )? Z(%|H _)]&k"K Z( O—4~x7!u@fwYn$"rDʀp=fKè[qas_ Pj]+Z͌S3]6+jxWV%ksˍz'&[E}{OjօoiEŭvG<:Ŧ]lw-m*|ͳSqjgl=NȒCy8r3\WƔŎ57uhȬ=]{xPqK~.z)~QK)3Fzևb4fb4PRfRQ\QJ3@ 1I(qF)3E.(&hbRQ@ 1IE.+P+'WGh:g` WNԡO5#eT|aB}hCbV[E|_M#B1F+m_ ?+h/bV[E|?M#B.- IJ$A5cڹ(-Mtyǵ4PEvo *Dt5u_蔮f)k6CRolؐDX /SY $6DR_9uLN8#4^ m5 %^]ʈkluQT4VQ3Fhњ(4f (3Fhњ(4f (&hh4fLњZ)3Fhh4fLњZ)3Fhh4fLњZ)3Fhh-QEQEQEQEQEQEQEQEQEs?B_I\ďA5PEPsA\g~%[JM^mCqS%㎞»1Ƞ;[Z̈́RW;hBm+i/F끒kS5ŌGdHK` |dƭ oXY[y4ź?JGF5q&h0PfP|scB::1>s\7W_ejqej>sysaGv֕eM6w94f+C3ER@ E-R@ E-R@ E-fLњZ(3E-4Pf@ Fih4R@ 3KE&h-fLњZ(3E--уK(0h4fisFh0h4уK3@ 4isFh0h4fZ3@Ā_G\ă^R&LsE.h {ox^{_E:@ҨÑ#,N`!r \#<}y4(X&ea{fsJB Pc8`Fp:+pVw$R݈M$(QRI9$[RJJ\QSk$¿ +]%s WV%kEƻ6?4 2!^+y4Ü-}ڃ(gSdvu2"_´8(&)hQEb(1KEb(UZ\ R7Y#}"ѕaLk4QK@ *ڎ>k-~߾clp{q9Ϩ]pᶯvMP&~du>v`i/O;Qڊ 4Ҁ4f/z3I=(.h=(.i=h%/IF(RTRQ?*(%PKRbPKIF(PTbZOʌQ@PQ1@bPڊ1F(Q(F(Q1@bPڊ1F(Q#ȅה sPZyK@bu+{2e;mG^E+w(H\ȷ & Clw'+|yr1 SK{WbWXl?xzǾ_=Z=RBn(R{He1##lRLo *Dt5s^?kVO€ ()? Z״h5h՛%o][ǷGVQEQEQފ(J(QEQGQGz(=(;EPEPE((4QE%.(? (PE4QGEboG:yK+"^R&O€ (<u xr_KGxDS? VH Jߕ9{z^AQZk uXV5Y"_,嘴kW>o8̏)E d?JK`KIҊ)|5?n+`_φN+`OZJ4W'_iYfh$I\*xJkJJ\f$5˪C#x.QGC%4>=wY+񷁵JJ!,2}" ^NGu;n?B֎VQGQEր8Y9s#Np2V{qvYl!ޛ-NPhZxh=V`Ğ35ccW $5Yױ2Ǵ[}3 fh4oGL5M63 '$Nqpã# ΢ʗm#֥8TޒmG?KX~_]`.g&>2W$¶D2pt-ւG ;w>RfI3@ ۽4RfQ۽&hϵ-4zRfE&}-4&Ox0ںX 4h =^$#wu8ԴϯL=AS uhwZ&uGLYW=g*=+ɨbrҧ*'Z|_5V$e*ǮF"F?—\>yWu*++ SG֙ug0qU+x"~ l~]C3t+ۜ=M~/ѥ3{|?f5?~)y#[1#^9פf2g=j>II>RQEg9|G _)]|H _)]Q(-+.gݼŷcb&cd(@Sq8_4j:o+iX4eڍwR[ x埇\N{*SU3!bRs!P0:rwV `IgUv 3Ƭ@.v`'$H^n5|MR!Xju!w1=Ro/w_%M>1Xi}Yi:LJVx{ @Eբ#>A^^{%QOMvդܓe&}]yX\`9H«յgWZ]OX?z/4:JkE5t;ACXEvS.bxdSXGkEK|6\{-V䞾|9\Ѻq\O~_sҗjο[Sԭt}:tg8TEb}?[OK˒L'+6#%N T`NPuRV*Q@R< %mbETVm36\O<%¾$yA?˛/L}m]'bI59[]G|AXLkYeY|=  Mk}o>-w&ծR+iIC~Nn?%K_ykNtOhMFsyJEX :=zҸKO }^⸄BK?<Sm1~Oi?Z֊(N PGPގQ@z=(Z;EEzQEwPޏJ(֎Q@jmzէ?f޹ ö7t$A%Ya"Llx#^I!e)?^Ǘ-rpXRXMϞA5 Jn?eVwT)Iq$>ĸr~H:E.}v5 N[B>[Om=9!-ǽw=42LL:fFpjWRq_NJeo5GiR&kk:p7$ɪۘpKfXԎ o!,fHCFA?٦Rij 놞Xu>Y3"pw1&\zW’t7Rx~!S>l{cϬl;UTaRwvt5c*V/Ε^t/O9_^}- ՊKh2kkrC^E7A2 sZ  Ymhcѭᇱ n&&oN/#LͥZ۽ʁMkH0ThiU{lk-.u'YЍ*ݯezrSL޼"߂K|Ey x` 0>S=1N&𽎡g͞eY|l?zGk|5}gq*qZ}~'|OgzA{G{\oꦶ<7AOimkG]C OU텄z{~U6,H7Q-c8^O9BcΈO:s*9h 2NtO{j[+K_}sGPrďA5oGZyK((>)?[+Cmqk(GM LPH^2WԅyxVO&}E$6y~J+ E_,ҽ}NGqIlEhRv9IυkRJ:mJGUҬ )mk9L"a!e;]>}j'+O!sOPhO.>~֛Mϕ\ ]CW~%tc۰& 'Rǖhܞ/M6·NuE;w[ɞgOz~3 z[]Y[cL`bf^n*8&xwY}z^O]@[=7P2Y2C#npxj^V{b0eWO\ x:z$7 &c ^mNJMtVQy]/ݟu(kZt2WIc I mڤeٰ'6ϮhK-GƷƒ 4V(<8D(bz[SM)N[ t(RwMݯE| :_ NCxZi2i@?޷Ó׌iá ӊ 4"1 o*WrhWU[&WgKCo*iv,S1U'S.BJPt? R6ZG=Hu{-͑Y`U`B Y7kul㤯+)qtG}i5˾)Qu=Ԍׁ|0mpqJL2)ks\-qֱiAYiigJ*ʤ{z/'V9ω!k/k\A5_\:jxb{kBƗRZ@>N]z^}S`/41]Ol,x9XF;֗JK@U_i>0,tC' Ukr$hnVmFl..L u#db_ xWV%kgvm3"N@>Jdk(<$_"#<)ݙ/|^y%PWī5g?qpZ\z`G^ޟdϧMbeC 8mG"-XcDeyKnux^K:?3X$MJGV#`?ϳ[kTʹ."U` gq-ɗ袊+5.o:}=."2&B>'נxi/ jg648iHǻ1UWxq>|?iܷKkm"K'KǷOUw?ZP^1µ~θgBs/u~o^47}6i''&WTܜ l8iJ5{kp<"q30dWCSхeRs޲o>U!7?nX/B~w1ٮ:s?OO 7 E[y,x#Jᛏ|=״"Ojc#lj!|So 5ݎ]n#ۥk0Vb:)+ޅ :j|JİOeaAŦQE((((}m^^Om,R4Qf'\g/1 c̴?|J']E7Ǚx;^r}=۪(Y7&ڏC0NgU6}ZmyKzoZL1On$2B2vqk/xVhrX+\+Z·1ʞFA$U/oj k3ϗ"ObAM M>YJtOM[tKNhQW Vu9ռDfQAnF.. 5º[U˽Bug2Iq>g<e:t6at>0]#ȁmT*;y˧n6u-,bmF(J= GΕuPê.{}幐c>Xu{F+K^m>7w8k-i(]C#STA`kwh{Wsms 7HA* #UԌpA#t`C+ ;^Yx'ǟ-`𦵧@QD6[8X⻁ȣ$e(֦%%+=u'&ƛ}3T*9WF  AW^%<-A_Nn&+lWQP3Ɏ@pѕi[q&KeAsFiX\^DZ% )?vxoN~>ۋI8#taʺ "+jMY}hVm UuU^vkeľ;>ͪ\ )1ͱٯI[0Sy0-]C,K-R#Ga4U lF(礴TrK啿& x$Wc/!x;CƷIHϖ +:IcXmXbF?\x/>(oiD0j'O+@F_+tc79Uމo7 x>6i4ylovgg^hv!&jvDːq2RRp|_˿nV"CnZ_+O]ς>iGT2]dנIE+ҕ5J QIFh5֒x='qyag 8^U\̱zqy+xxĒ[wmTCgD#j֦R*S$^w=.+hn eT!ʲAMq?.$oe4f]*GcfOk}κYSsGZyK8o?ZyKEJ(M%))i(k$¿ +]%s WV%k8.*LPF7G$S$mT={.ƭXJ[]N׊WaOCUP{iYHʞ3{ s:NGkk7n64Փs GQ>efkC[KJOSbSu ̋]}yQ^~&8U`B[ue:[S(9W}Z_mFO{3D1XgeJcPϲt}SFX|>)5 {d1/usvF '\VڛWvhx9:8* y=4K}c%ndD 2G ב]po)N>.Lsw{o|~O8&c͓~ ݣjm.6R؃&[\L !QG %^.ڷk+Jѭѭt^ _tPax<3)+,g]YOyφ5?^!=2/.$+ nj TOLNc xAmU.z@2?|}\j)ݧ=R},.?Lc!5eo3ėV>@g x3M-<[fzzyO6n(ai\𑢂NC;IV𷌾5i7swڏ4wKl 7)Cy,g*~J/v ~cD9b#h+Goݾ mYY AˉȀ矛]RuKu,bOV 8,qA\\xZ_z8"Z)aQK@ QGqEqG|BՒRl=̬#m&U٥8:P&Zi_r4M[k]rlАp]9"DGL>l ;Wi<1$3F"xeX#5zퟅuj4JywgG˧ǝ؜DHatኃT5_Uv]kʄ]|TOe]N^CK1]ʇ任¼6c`8z0ǷM#_v[NUIKz9HYYbH/tsoCZ2b't*Lisʠpko mb=ndCݘ(¨ B?V'?];F*ƫP;V] \w'"N$y 糗%^UG9K__3̫*%'f~AG7Y.Uյ0p1|كq+xMT:)U"/ 坾i51N9aCF  A.>gLRx`/g ӹs?V  6W\q]y0sQGvb@"Y㛌S O_>-xb i^m[R6k{C4lG"1Go+fshoM5UK@1(p>NOvf#:zUч8x_H+&EZ0N2 A@cj']okx _ )# f4p֛*{>힜kA^Rio.mw魚M*Vޥenh>xsGȎZDFD0x]sAXBpfX1Q[V^[TV$I,řYXVr7P/UCoW`y=V?l.74']̐K%N2F88'a-HU4UT`(+N\~/O-J^6{_KEvQ@EPEQE~tQ@Q@EPEP7#D-Mts?B_I@Q@)(>;\VhV5<+1 SRҪ~zh59AZY{VJ "`*G@ᯄČ'EU S$ }2kJ9? +]'@ %/E%cxB3̶ѺZ\2E2#$w*e8l? x|G`$ e[?{c)AaR m)0n/7_), '=șI!Mӭ>%5(ע)tx[fO:3$Ʒ qm 1n֯e~~Z)(Zs,_lWOKEoycu7NHkylݱuqT_EycH[4H~hbV#q0@52 xGS__Ӎ)x}YF0Ue(Lmp$F*Yq|ص?+=ݬ}~֍ܧKݭWT?4qǯ<-!Y#ѭч~gڞd**PpWy,BeQI?zR~vuӷ|gqZGτzMz=1cJw tR밈NdVi_RꚃOw6]h **"P;x$"GTP0\n&+ĬMR#oz4/iQKKko>:)i(EQKG@ E/G~QQKQK߭'@~4R4w@ E-%s?B_G\ď_GE-( ))hk$¿ )]%s xWV%kZ(QE^xuK#\Эo\Kwok o^r\0Bnx9'Ƨ_JP7ORᎁsyl^Fu>!>cP N8S*tR f_Z/~{R[T"fWo4DΣd.v39WB)ޔTF ۊNm)_0%Y4z@hw4fր fҊxIAn#1S\`{pA@;I|v֚9j(yyc"s6`JzszǁmR[u9DK$u8܃c9ϵ#Z*R?h{A}K Ǿ}FsޣO~?O'|Jwkz-a0lz=5h|1dֺeZd}-#fc̀9$iU 0z- 7ϼ_Ed&h/Gnt 3KE&h-&h/4Pf4zPf(((((((((("^R&J$ȅה ( (=)(h_.xkognG0TI& ~tosVӮ5-K)ղeXYccqx@_ WV%ks? J-v[)RPE~TRR撎 3G'-%-Q@h@h=(h?( (h??(ƀ (?(Ɗ((h?( (h4Q@ E&h4 ZJ3@ IE%PI(&h9#D-Mtu|G _)]hsE%Oʊ\P=OYm* jce E2kI浥@u i+u;]"[ۈmbye8U Xe4-[r ~PQiPO%Z ?*Nֿ$GEsj'k_hT;Z?]UНISkXMttP9 VBv&J<ȝI?*Mֿ$ VBn&Lњ*Mֿ$ VBn&LmGQ,./on#y*F2YkI浥@e i*%Z {پ4ihL؂vlJ#*M$ VBn&Lњ*M$ VBn&Lњ*Mֿ$ VBn&Lњ*Mֿ$ ^Bv&L7 VBv&J?c5~4~4UНIgo5kgFK&K!#F>]wYޗy`h\YY\:yg J?c4UНIoOoXMj'kkhhS;Z?G%z ??*N$ VBv&OƏƀ9J?c4UНIoOoXMj'kkiU,N=խ{ok-&K!#F>V*N$ jZ>%ͽŧ!v`TJ]Kgk~4UНIOoXMtsj'khS;[?]'G@%Z ?*Nֿ$I7 ^Bv&J?c5~4@%Z ?*?Nֿ$GEsj'k_jo5 o#=g2،>lxu9hw:%ݭ4Z`eؼ;4SSkXMj'k_k9JOc4UНI?*?N$ VBv&:(T;Z?G%Z sSkXMj'kk9JOc4UНIITY|!4S yai 'E%Z v ƚf\/#<jv b#tC@Gu-c>t|'A- <{[m8j袀J(MOZZ(Iڀ1]ZLs_ rKYɷBbw%I88d%-RPIK@PIE-b붗5zmAx F$(G<y'Ddwgy3,Ř9$3ۤRQ@ E%QJZ))h( S{eqn%͍al:dcrpGQ\OEˡKnWW4h4. ߌ㞼tUQEQHh-^L6k$q3IR*MIr=4*^jme0ISS_$[Tm՝`YԹU Xp{o_Q@)|w_NY &7KsM慆 1 Q 6vn<8(((((}(# /oqK# F2 6XUWkQ(J(ʀ (QQGF(KO",*!Tc@mAGo+'م*]"۰NJI~TQF(}(hE%@ h(4(G%PQKފJ9KF(9NhPQ.(Z1@ -QKJ(4|J4-{IE.m+vҧp{WC5jvi> endobj 315 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/03/Figure-3_new-ch2.jpeg) >> endobj 316 0 obj << /Type /Annot /Subtype /Link /A 317 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 108.8587 485.2500 383.3587 ] >> endobj 317 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2015/03/Figure-3_new-ch2.jpeg) >> endobj 318 0 obj << /Type /Page /Parent 3 0 R /Contents 319 0 R >> endobj 319 0 obj << /Length 32158 >> stream 0.271 0.267 0.267 rg q 15.000 24.352 577.500 752.648 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(The relationship between symptoms and diagnoses)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(We examined how lower respiratory symptoms were associated with OAD diagnoses within individuals. Table 3 shows the )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(relationship of physician diagnoses of OAD to prior self-reported OAD symptoms of cough, wheeze, and shortness of breath. )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Most persons who developed OAD reported symptoms prior to physician diagnosis, and this was true throughout the follow-up )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(period. However, the majority of persons who never received an OAD diagnosis also reported OAD symptoms. Of the 2,286 )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(persons who received an OAD diagnosis during the follow-up period, 1,934 \(84.6%\) took a medical monitoring questionnaire )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(and completed the question on self-reported lower respiratory symptoms during the first 15 months. Of those, 1,559 reported at )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(least one lower respiratory symptom during the first 15 months, for an overall sensitivity of 80.6%.)] TJ ET q 26.250 653.026 555.000 13.736 re W n 0.271 0.267 0.267 rg BT 26.250 655.773 Td /F1 9.8 Tf [(Table 3. Fraction of persons reporting OAD symptoms on medical monitoring questionnaires by month of OAD diagnosis.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 622.118 555.000 23.407 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 645.526 m 581.250 645.526 l 580.500 644.776 l 27.000 644.776 l f 581.250 645.526 m 581.250 622.118 l 580.500 622.118 l 580.500 644.776 l f 26.250 645.526 m 26.250 622.118 l 27.000 622.118 l 27.000 644.776 l f 0.271 0.267 0.267 rg BT 33.000 631.450 Td /F1 9.0 Tf [(*1,471 persons did not complete a medical monitoring questionnaire during the first 15 months and are excluded from this column.)] TJ ET 1.000 1.000 1.000 rg 26.250 501.146 555.000 120.972 re f 0.965 0.965 0.965 rg 27.000 597.184 125.850 24.185 re f 0.267 0.267 0.267 rg 26.625 620.993 126.225 0.750 re f 26.625 596.809 0.750 24.935 re f 0.271 0.267 0.267 rg BT 31.500 611.844 Td /F4 9.8 Tf [(Month of OAD diagnosis)] TJ ET 0.965 0.965 0.965 rg 152.850 597.184 218.859 24.185 re f 0.267 0.267 0.267 rg 152.850 620.993 218.859 0.750 re f 0.271 0.267 0.267 rg BT 157.350 611.844 Td /F4 9.8 Tf [(#/N \(%\) self-reporting OAD symptoms in first )] TJ ET BT 157.350 599.940 Td /F4 9.8 Tf [(15 months*)] TJ ET 0.965 0.965 0.965 rg 371.709 597.184 208.791 24.185 re f 0.267 0.267 0.267 rg 371.709 620.993 209.166 0.750 re f 580.125 596.809 0.750 24.935 re f 0.271 0.267 0.267 rg BT 376.209 611.844 Td /F4 9.8 Tf [(#/N self-reporting OAD symptoms in any )] TJ ET BT 376.209 599.940 Td /F4 9.8 Tf [(prior period)] TJ ET 0.267 0.267 0.267 rg 26.625 596.809 126.600 0.750 re f 26.625 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 586.954 Td /F1 9.8 Tf [(1-15)] TJ ET 0.267 0.267 0.267 rg 152.475 596.809 219.609 0.750 re f 152.475 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 586.954 Td /F1 9.8 Tf [(321/351 \(91.5%\))] TJ ET 0.267 0.267 0.267 rg 371.334 596.809 209.541 0.750 re f 371.334 580.927 0.750 16.631 re f 580.125 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 586.954 Td /F1 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg 26.625 580.927 126.600 0.750 re f 26.625 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 571.072 Td /F1 9.8 Tf [(16-60)] TJ ET 0.267 0.267 0.267 rg 152.475 580.927 219.609 0.750 re f 152.475 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 571.072 Td /F1 9.8 Tf [(477/585 \(81.5%\))] TJ ET 0.267 0.267 0.267 rg 371.334 580.927 209.541 0.750 re f 371.334 565.046 0.750 16.631 re f 580.125 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 571.072 Td /F1 9.8 Tf [(477/685 \(69.6%\))] TJ ET 0.267 0.267 0.267 rg 26.625 565.046 126.600 0.750 re f 26.625 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 555.191 Td /F1 9.8 Tf [(61-84)] TJ ET 0.267 0.267 0.267 rg 152.475 565.046 219.609 0.750 re f 152.475 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 555.191 Td /F1 9.8 Tf [(288/369 \(78.1%\))] TJ ET 0.267 0.267 0.267 rg 371.334 565.046 209.541 0.750 re f 371.334 549.165 0.750 16.631 re f 580.125 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 555.191 Td /F1 9.8 Tf [(319/432 \(73.8%\))] TJ ET 0.267 0.267 0.267 rg 26.625 549.165 126.600 0.750 re f 26.625 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 539.310 Td /F1 9.8 Tf [(85-120)] TJ ET 0.267 0.267 0.267 rg 152.475 549.165 219.609 0.750 re f 152.475 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 539.310 Td /F1 9.8 Tf [(473/629 \(75.2%\))] TJ ET 0.267 0.267 0.267 rg 371.334 549.165 209.541 0.750 re f 371.334 533.284 0.750 16.631 re f 580.125 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 539.310 Td /F1 9.8 Tf [(554/745 \(74.4%\))] TJ ET 0.267 0.267 0.267 rg 26.625 533.284 126.600 0.750 re f 26.625 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 523.429 Td /F1 9.8 Tf [(Never)] TJ ET 0.267 0.267 0.267 rg 152.475 533.284 219.609 0.750 re f 152.475 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 523.429 Td /F1 9.8 Tf [(4,088/6,373 \(64.2%\))] TJ ET 0.267 0.267 0.267 rg 371.334 533.284 209.541 0.750 re f 371.334 517.402 0.750 16.631 re f 580.125 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 523.429 Td /F1 9.8 Tf [(4,682/7,492 \(62.5%\))] TJ ET 0.267 0.267 0.267 rg 26.625 517.402 126.600 0.750 re f 26.625 501.521 126.600 0.750 re f 26.625 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 507.547 Td /F1 9.8 Tf [(Entire cohort)] TJ ET 0.267 0.267 0.267 rg 152.475 517.402 219.609 0.750 re f 152.475 501.521 219.609 0.750 re f 152.475 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 507.547 Td /F1 9.8 Tf [(5,647/8,307 \(68.0%\))] TJ ET 0.267 0.267 0.267 rg 371.334 517.402 209.541 0.750 re f 371.334 501.521 209.541 0.750 re f 371.334 501.521 0.750 16.631 re f 580.125 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 507.547 Td /F1 9.8 Tf [(9,778)] TJ ET BT 26.250 446.622 Td /F1 9.8 Tf [(Persons whose first physician diagnosis of OAD was long after 9/11/2001 were very likely to have reported lower respiratory )] TJ ET BT 26.250 434.718 Td /F1 9.8 Tf [(symptoms shortly after 9/11. 6,373 persons did not receive a diagnosis during the follow-up period and responded to the )] TJ ET BT 26.250 422.813 Td /F1 9.8 Tf [(medical monitoring questionnaire item for lower respiratory symptoms; of those, 4,088 reported at least one lower respiratory )] TJ ET BT 26.250 410.908 Td /F1 9.8 Tf [(symptom, for a specificity of 35.9%. Only 189 of 954 individuals \(19.8%\) who were diagnosed with OAD between months 16 )] TJ ET BT 26.250 399.003 Td /F1 9.8 Tf [(and 84 and who completed the questionnaire during the first 15 months did not report any lower respiratory symptoms at that )] TJ ET BT 26.250 387.099 Td /F1 9.8 Tf [(time.)] TJ ET BT 26.250 367.694 Td /F1 9.8 Tf [(The majority of those who reported lower respiratory symptoms shortly after 9/11/2001 did not receive an OAD diagnosis during )] TJ ET BT 26.250 355.789 Td /F1 9.8 Tf [(the study period. 1,559 of 5,647 individuals reporting a lower respiratory symptom during the first 15 months received a )] TJ ET BT 26.250 343.884 Td /F1 9.8 Tf [(physician diagnosis of OAD during follow-up, for a positive predictive value of 27.6%.)] TJ ET BT 26.250 307.282 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 287.328 Td /F1 9.8 Tf [(We found that for the first seven years after 9/11/2001, earlier arrival time at the WTC site was associated with higher rates of )] TJ ET BT 26.250 275.423 Td /F1 9.8 Tf [(physician diagnoses of incident OAD. This finding is consistent with crude analyses and also with other modeling approaches )] TJ ET BT 26.250 263.518 Td /F1 9.8 Tf [(not reported here. These results support recognizing OAD among rescue workers as WTC-related even if diagnosed long after )] TJ ET BT 26.250 251.613 Td /F1 9.8 Tf [(the exposure.)] TJ ET BT 26.250 232.209 Td /F1 9.8 Tf [(We cannot determine, however, how much of the apparent lag in WTC-associated diagnoses represents the progressive )] TJ ET BT 26.250 220.304 Td /F1 9.8 Tf [(development of disease compared with the possibility of delayed diagnoses of OAD for two main reasons. First, in 2007, free )] TJ ET BT 26.250 208.399 Td /F1 9.8 Tf [(medications for the treatment of OAD began to be provided to FDNY WTC-exposed firefighters. This program change required )] TJ ET BT 26.250 196.494 Td /F1 9.8 Tf [(that diagnoses be given by FDNY physicians, and was followed by large increases in new incident physician diagnoses of OAD )] TJ ET BT 26.250 184.590 Td /F1 9.8 Tf [(for the next two years in all three exposure groups. Nonetheless, the effect of WTC exposure remained, even as the number of )] TJ ET BT 26.250 172.685 Td /F1 9.8 Tf [(incident physician diagnoses increased.)] TJ ET BT 26.250 153.280 Td /F1 9.8 Tf [(Second, most persons receiving an OAD diagnosis reported lower respiratory symptoms early in the follow-up period even )] TJ ET BT 26.250 141.375 Td /F1 9.8 Tf [(when the diagnosis was made years later. For some, it may have taken time for symptoms to become sufficiently severe and )] TJ ET BT 26.250 129.471 Td /F1 9.8 Tf [(chronic to warrant a diagnosis. Indeed 19.8% of those responding to questionnaire items on lower respiratory symptoms during )] TJ ET BT 26.250 117.566 Td /F1 9.8 Tf [(the first 15 months post-9/11 who received an OAD diagnosis between month 16 and month 84 failed to report any symptoms )] TJ ET BT 26.250 105.661 Td /F1 9.8 Tf [(on that early questionnaire.)] TJ ET BT 26.250 86.256 Td /F1 9.8 Tf [(But it is also likely that some cases could have been diagnosed earlier. We believe that this is particularly likely to be true for )] TJ ET BT 26.250 74.352 Td /F1 9.8 Tf [(cases diagnosed after year five, as the program change resulted in higher incidence rates starting in the sixth year when free )] TJ ET BT 26.250 62.447 Td /F1 9.8 Tf [(OAD medications became available to those diagnosed by FDNY-BHS physicians. In addition, it is likely that symptoms )] TJ ET BT 26.250 50.542 Td /F1 9.8 Tf [(reported on confidential medical monitoring questionnaires preceded the FDNY-BHS physician diagnosis for some FDNY )] TJ ET BT 26.250 38.637 Td /F1 9.8 Tf [(members who may have felt their symptoms to be of insufficient severity to warrant further testing, medications, or disability )] TJ ET Q q 15.000 24.352 577.500 752.648 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(The relationship between symptoms and diagnoses)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(We examined how lower respiratory symptoms were associated with OAD diagnoses within individuals. Table 3 shows the )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(relationship of physician diagnoses of OAD to prior self-reported OAD symptoms of cough, wheeze, and shortness of breath. )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Most persons who developed OAD reported symptoms prior to physician diagnosis, and this was true throughout the follow-up )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(period. However, the majority of persons who never received an OAD diagnosis also reported OAD symptoms. Of the 2,286 )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(persons who received an OAD diagnosis during the follow-up period, 1,934 \(84.6%\) took a medical monitoring questionnaire )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(and completed the question on self-reported lower respiratory symptoms during the first 15 months. Of those, 1,559 reported at )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(least one lower respiratory symptom during the first 15 months, for an overall sensitivity of 80.6%.)] TJ ET q 26.250 653.026 555.000 13.736 re W n 0.271 0.267 0.267 rg BT 26.250 655.773 Td /F1 9.8 Tf [(Table 3. Fraction of persons reporting OAD symptoms on medical monitoring questionnaires by month of OAD diagnosis.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 622.118 555.000 23.407 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 645.526 m 581.250 645.526 l 580.500 644.776 l 27.000 644.776 l f 581.250 645.526 m 581.250 622.118 l 580.500 622.118 l 580.500 644.776 l f 26.250 645.526 m 26.250 622.118 l 27.000 622.118 l 27.000 644.776 l f 0.271 0.267 0.267 rg BT 33.000 631.450 Td /F1 9.0 Tf [(*1,471 persons did not complete a medical monitoring questionnaire during the first 15 months and are excluded from this column.)] TJ ET 1.000 1.000 1.000 rg 26.250 501.146 555.000 120.972 re f 0.965 0.965 0.965 rg 27.000 597.184 125.850 24.185 re f 0.267 0.267 0.267 rg 26.625 620.993 126.225 0.750 re f 26.625 596.809 0.750 24.935 re f 0.271 0.267 0.267 rg BT 31.500 611.844 Td /F4 9.8 Tf [(Month of OAD diagnosis)] TJ ET 0.965 0.965 0.965 rg 152.850 597.184 218.859 24.185 re f 0.267 0.267 0.267 rg 152.850 620.993 218.859 0.750 re f 0.271 0.267 0.267 rg BT 157.350 611.844 Td /F4 9.8 Tf [(#/N \(%\) self-reporting OAD symptoms in first )] TJ ET BT 157.350 599.940 Td /F4 9.8 Tf [(15 months*)] TJ ET 0.965 0.965 0.965 rg 371.709 597.184 208.791 24.185 re f 0.267 0.267 0.267 rg 371.709 620.993 209.166 0.750 re f 580.125 596.809 0.750 24.935 re f 0.271 0.267 0.267 rg BT 376.209 611.844 Td /F4 9.8 Tf [(#/N self-reporting OAD symptoms in any )] TJ ET BT 376.209 599.940 Td /F4 9.8 Tf [(prior period)] TJ ET 0.267 0.267 0.267 rg 26.625 596.809 126.600 0.750 re f 26.625 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 586.954 Td /F1 9.8 Tf [(1-15)] TJ ET 0.267 0.267 0.267 rg 152.475 596.809 219.609 0.750 re f 152.475 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 586.954 Td /F1 9.8 Tf [(321/351 \(91.5%\))] TJ ET 0.267 0.267 0.267 rg 371.334 596.809 209.541 0.750 re f 371.334 580.927 0.750 16.631 re f 580.125 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 586.954 Td /F1 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg 26.625 580.927 126.600 0.750 re f 26.625 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 571.072 Td /F1 9.8 Tf [(16-60)] TJ ET 0.267 0.267 0.267 rg 152.475 580.927 219.609 0.750 re f 152.475 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 571.072 Td /F1 9.8 Tf [(477/585 \(81.5%\))] TJ ET 0.267 0.267 0.267 rg 371.334 580.927 209.541 0.750 re f 371.334 565.046 0.750 16.631 re f 580.125 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 571.072 Td /F1 9.8 Tf [(477/685 \(69.6%\))] TJ ET 0.267 0.267 0.267 rg 26.625 565.046 126.600 0.750 re f 26.625 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 555.191 Td /F1 9.8 Tf [(61-84)] TJ ET 0.267 0.267 0.267 rg 152.475 565.046 219.609 0.750 re f 152.475 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 555.191 Td /F1 9.8 Tf [(288/369 \(78.1%\))] TJ ET 0.267 0.267 0.267 rg 371.334 565.046 209.541 0.750 re f 371.334 549.165 0.750 16.631 re f 580.125 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 555.191 Td /F1 9.8 Tf [(319/432 \(73.8%\))] TJ ET 0.267 0.267 0.267 rg 26.625 549.165 126.600 0.750 re f 26.625 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 539.310 Td /F1 9.8 Tf [(85-120)] TJ ET 0.267 0.267 0.267 rg 152.475 549.165 219.609 0.750 re f 152.475 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 539.310 Td /F1 9.8 Tf [(473/629 \(75.2%\))] TJ ET 0.267 0.267 0.267 rg 371.334 549.165 209.541 0.750 re f 371.334 533.284 0.750 16.631 re f 580.125 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 539.310 Td /F1 9.8 Tf [(554/745 \(74.4%\))] TJ ET 0.267 0.267 0.267 rg 26.625 533.284 126.600 0.750 re f 26.625 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 523.429 Td /F1 9.8 Tf [(Never)] TJ ET 0.267 0.267 0.267 rg 152.475 533.284 219.609 0.750 re f 152.475 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 523.429 Td /F1 9.8 Tf [(4,088/6,373 \(64.2%\))] TJ ET 0.267 0.267 0.267 rg 371.334 533.284 209.541 0.750 re f 371.334 517.402 0.750 16.631 re f 580.125 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 523.429 Td /F1 9.8 Tf [(4,682/7,492 \(62.5%\))] TJ ET 0.267 0.267 0.267 rg 26.625 517.402 126.600 0.750 re f 26.625 501.521 126.600 0.750 re f 26.625 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 507.547 Td /F1 9.8 Tf [(Entire cohort)] TJ ET 0.267 0.267 0.267 rg 152.475 517.402 219.609 0.750 re f 152.475 501.521 219.609 0.750 re f 152.475 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 507.547 Td /F1 9.8 Tf [(5,647/8,307 \(68.0%\))] TJ ET 0.267 0.267 0.267 rg 371.334 517.402 209.541 0.750 re f 371.334 501.521 209.541 0.750 re f 371.334 501.521 0.750 16.631 re f 580.125 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 507.547 Td /F1 9.8 Tf [(9,778)] TJ ET BT 26.250 446.622 Td /F1 9.8 Tf [(Persons whose first physician diagnosis of OAD was long after 9/11/2001 were very likely to have reported lower respiratory )] TJ ET BT 26.250 434.718 Td /F1 9.8 Tf [(symptoms shortly after 9/11. 6,373 persons did not receive a diagnosis during the follow-up period and responded to the )] TJ ET BT 26.250 422.813 Td /F1 9.8 Tf [(medical monitoring questionnaire item for lower respiratory symptoms; of those, 4,088 reported at least one lower respiratory )] TJ ET BT 26.250 410.908 Td /F1 9.8 Tf [(symptom, for a specificity of 35.9%. Only 189 of 954 individuals \(19.8%\) who were diagnosed with OAD between months 16 )] TJ ET BT 26.250 399.003 Td /F1 9.8 Tf [(and 84 and who completed the questionnaire during the first 15 months did not report any lower respiratory symptoms at that )] TJ ET BT 26.250 387.099 Td /F1 9.8 Tf [(time.)] TJ ET BT 26.250 367.694 Td /F1 9.8 Tf [(The majority of those who reported lower respiratory symptoms shortly after 9/11/2001 did not receive an OAD diagnosis during )] TJ ET BT 26.250 355.789 Td /F1 9.8 Tf [(the study period. 1,559 of 5,647 individuals reporting a lower respiratory symptom during the first 15 months received a )] TJ ET BT 26.250 343.884 Td /F1 9.8 Tf [(physician diagnosis of OAD during follow-up, for a positive predictive value of 27.6%.)] TJ ET BT 26.250 307.282 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 287.328 Td /F1 9.8 Tf [(We found that for the first seven years after 9/11/2001, earlier arrival time at the WTC site was associated with higher rates of )] TJ ET BT 26.250 275.423 Td /F1 9.8 Tf [(physician diagnoses of incident OAD. This finding is consistent with crude analyses and also with other modeling approaches )] TJ ET BT 26.250 263.518 Td /F1 9.8 Tf [(not reported here. These results support recognizing OAD among rescue workers as WTC-related even if diagnosed long after )] TJ ET BT 26.250 251.613 Td /F1 9.8 Tf [(the exposure.)] TJ ET BT 26.250 232.209 Td /F1 9.8 Tf [(We cannot determine, however, how much of the apparent lag in WTC-associated diagnoses represents the progressive )] TJ ET BT 26.250 220.304 Td /F1 9.8 Tf [(development of disease compared with the possibility of delayed diagnoses of OAD for two main reasons. First, in 2007, free )] TJ ET BT 26.250 208.399 Td /F1 9.8 Tf [(medications for the treatment of OAD began to be provided to FDNY WTC-exposed firefighters. This program change required )] TJ ET BT 26.250 196.494 Td /F1 9.8 Tf [(that diagnoses be given by FDNY physicians, and was followed by large increases in new incident physician diagnoses of OAD )] TJ ET BT 26.250 184.590 Td /F1 9.8 Tf [(for the next two years in all three exposure groups. Nonetheless, the effect of WTC exposure remained, even as the number of )] TJ ET BT 26.250 172.685 Td /F1 9.8 Tf [(incident physician diagnoses increased.)] TJ ET BT 26.250 153.280 Td /F1 9.8 Tf [(Second, most persons receiving an OAD diagnosis reported lower respiratory symptoms early in the follow-up period even )] TJ ET BT 26.250 141.375 Td /F1 9.8 Tf [(when the diagnosis was made years later. For some, it may have taken time for symptoms to become sufficiently severe and )] TJ ET BT 26.250 129.471 Td /F1 9.8 Tf [(chronic to warrant a diagnosis. Indeed 19.8% of those responding to questionnaire items on lower respiratory symptoms during )] TJ ET BT 26.250 117.566 Td /F1 9.8 Tf [(the first 15 months post-9/11 who received an OAD diagnosis between month 16 and month 84 failed to report any symptoms )] TJ ET BT 26.250 105.661 Td /F1 9.8 Tf [(on that early questionnaire.)] TJ ET BT 26.250 86.256 Td /F1 9.8 Tf [(But it is also likely that some cases could have been diagnosed earlier. We believe that this is particularly likely to be true for )] TJ ET BT 26.250 74.352 Td /F1 9.8 Tf [(cases diagnosed after year five, as the program change resulted in higher incidence rates starting in the sixth year when free )] TJ ET BT 26.250 62.447 Td /F1 9.8 Tf [(OAD medications became available to those diagnosed by FDNY-BHS physicians. In addition, it is likely that symptoms )] TJ ET BT 26.250 50.542 Td /F1 9.8 Tf [(reported on confidential medical monitoring questionnaires preceded the FDNY-BHS physician diagnosis for some FDNY )] TJ ET BT 26.250 38.637 Td /F1 9.8 Tf [(members who may have felt their symptoms to be of insufficient severity to warrant further testing, medications, or disability )] TJ ET Q q 15.000 24.352 577.500 752.648 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(The relationship between symptoms and diagnoses)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(We examined how lower respiratory symptoms were associated with OAD diagnoses within individuals. Table 3 shows the )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(relationship of physician diagnoses of OAD to prior self-reported OAD symptoms of cough, wheeze, and shortness of breath. )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Most persons who developed OAD reported symptoms prior to physician diagnosis, and this was true throughout the follow-up )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(period. However, the majority of persons who never received an OAD diagnosis also reported OAD symptoms. Of the 2,286 )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(persons who received an OAD diagnosis during the follow-up period, 1,934 \(84.6%\) took a medical monitoring questionnaire )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(and completed the question on self-reported lower respiratory symptoms during the first 15 months. Of those, 1,559 reported at )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(least one lower respiratory symptom during the first 15 months, for an overall sensitivity of 80.6%.)] TJ ET q 26.250 653.026 555.000 13.736 re W n 0.271 0.267 0.267 rg BT 26.250 655.773 Td /F1 9.8 Tf [(Table 3. Fraction of persons reporting OAD symptoms on medical monitoring questionnaires by month of OAD diagnosis.)] TJ ET Q 0.965 0.965 0.965 rg 26.250 622.118 555.000 23.407 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 645.526 m 581.250 645.526 l 580.500 644.776 l 27.000 644.776 l f 581.250 645.526 m 581.250 622.118 l 580.500 622.118 l 580.500 644.776 l f 26.250 645.526 m 26.250 622.118 l 27.000 622.118 l 27.000 644.776 l f 0.271 0.267 0.267 rg BT 33.000 631.450 Td /F1 9.0 Tf [(*1,471 persons did not complete a medical monitoring questionnaire during the first 15 months and are excluded from this column.)] TJ ET 1.000 1.000 1.000 rg 26.250 501.146 555.000 120.972 re f 0.965 0.965 0.965 rg 27.000 597.184 125.850 24.185 re f 0.267 0.267 0.267 rg 26.625 620.993 126.225 0.750 re f 26.625 596.809 0.750 24.935 re f 0.271 0.267 0.267 rg BT 31.500 611.844 Td /F4 9.8 Tf [(Month of OAD diagnosis)] TJ ET 0.965 0.965 0.965 rg 152.850 597.184 218.859 24.185 re f 0.267 0.267 0.267 rg 152.850 620.993 218.859 0.750 re f 0.271 0.267 0.267 rg BT 157.350 611.844 Td /F4 9.8 Tf [(#/N \(%\) self-reporting OAD symptoms in first )] TJ ET BT 157.350 599.940 Td /F4 9.8 Tf [(15 months*)] TJ ET 0.965 0.965 0.965 rg 371.709 597.184 208.791 24.185 re f 0.267 0.267 0.267 rg 371.709 620.993 209.166 0.750 re f 580.125 596.809 0.750 24.935 re f 0.271 0.267 0.267 rg BT 376.209 611.844 Td /F4 9.8 Tf [(#/N self-reporting OAD symptoms in any )] TJ ET BT 376.209 599.940 Td /F4 9.8 Tf [(prior period)] TJ ET 0.267 0.267 0.267 rg 26.625 596.809 126.600 0.750 re f 26.625 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 586.954 Td /F1 9.8 Tf [(1-15)] TJ ET 0.267 0.267 0.267 rg 152.475 596.809 219.609 0.750 re f 152.475 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 586.954 Td /F1 9.8 Tf [(321/351 \(91.5%\))] TJ ET 0.267 0.267 0.267 rg 371.334 596.809 209.541 0.750 re f 371.334 580.927 0.750 16.631 re f 580.125 580.927 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 586.954 Td /F1 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg 26.625 580.927 126.600 0.750 re f 26.625 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 571.072 Td /F1 9.8 Tf [(16-60)] TJ ET 0.267 0.267 0.267 rg 152.475 580.927 219.609 0.750 re f 152.475 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 571.072 Td /F1 9.8 Tf [(477/585 \(81.5%\))] TJ ET 0.267 0.267 0.267 rg 371.334 580.927 209.541 0.750 re f 371.334 565.046 0.750 16.631 re f 580.125 565.046 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 571.072 Td /F1 9.8 Tf [(477/685 \(69.6%\))] TJ ET 0.267 0.267 0.267 rg 26.625 565.046 126.600 0.750 re f 26.625 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 555.191 Td /F1 9.8 Tf [(61-84)] TJ ET 0.267 0.267 0.267 rg 152.475 565.046 219.609 0.750 re f 152.475 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 555.191 Td /F1 9.8 Tf [(288/369 \(78.1%\))] TJ ET 0.267 0.267 0.267 rg 371.334 565.046 209.541 0.750 re f 371.334 549.165 0.750 16.631 re f 580.125 549.165 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 555.191 Td /F1 9.8 Tf [(319/432 \(73.8%\))] TJ ET 0.267 0.267 0.267 rg 26.625 549.165 126.600 0.750 re f 26.625 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 539.310 Td /F1 9.8 Tf [(85-120)] TJ ET 0.267 0.267 0.267 rg 152.475 549.165 219.609 0.750 re f 152.475 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 539.310 Td /F1 9.8 Tf [(473/629 \(75.2%\))] TJ ET 0.267 0.267 0.267 rg 371.334 549.165 209.541 0.750 re f 371.334 533.284 0.750 16.631 re f 580.125 533.284 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 539.310 Td /F1 9.8 Tf [(554/745 \(74.4%\))] TJ ET 0.267 0.267 0.267 rg 26.625 533.284 126.600 0.750 re f 26.625 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 523.429 Td /F1 9.8 Tf [(Never)] TJ ET 0.267 0.267 0.267 rg 152.475 533.284 219.609 0.750 re f 152.475 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 523.429 Td /F1 9.8 Tf [(4,088/6,373 \(64.2%\))] TJ ET 0.267 0.267 0.267 rg 371.334 533.284 209.541 0.750 re f 371.334 517.402 0.750 16.631 re f 580.125 517.402 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 523.429 Td /F1 9.8 Tf [(4,682/7,492 \(62.5%\))] TJ ET 0.267 0.267 0.267 rg 26.625 517.402 126.600 0.750 re f 26.625 501.521 126.600 0.750 re f 26.625 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 31.875 507.547 Td /F1 9.8 Tf [(Entire cohort)] TJ ET 0.267 0.267 0.267 rg 152.475 517.402 219.609 0.750 re f 152.475 501.521 219.609 0.750 re f 152.475 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 157.725 507.547 Td /F1 9.8 Tf [(5,647/8,307 \(68.0%\))] TJ ET 0.267 0.267 0.267 rg 371.334 517.402 209.541 0.750 re f 371.334 501.521 209.541 0.750 re f 371.334 501.521 0.750 16.631 re f 580.125 501.521 0.750 16.631 re f 0.271 0.267 0.267 rg BT 376.584 507.547 Td /F1 9.8 Tf [(9,778)] TJ ET BT 26.250 446.622 Td /F1 9.8 Tf [(Persons whose first physician diagnosis of OAD was long after 9/11/2001 were very likely to have reported lower respiratory )] TJ ET BT 26.250 434.718 Td /F1 9.8 Tf [(symptoms shortly after 9/11. 6,373 persons did not receive a diagnosis during the follow-up period and responded to the )] TJ ET BT 26.250 422.813 Td /F1 9.8 Tf [(medical monitoring questionnaire item for lower respiratory symptoms; of those, 4,088 reported at least one lower respiratory )] TJ ET BT 26.250 410.908 Td /F1 9.8 Tf [(symptom, for a specificity of 35.9%. Only 189 of 954 individuals \(19.8%\) who were diagnosed with OAD between months 16 )] TJ ET BT 26.250 399.003 Td /F1 9.8 Tf [(and 84 and who completed the questionnaire during the first 15 months did not report any lower respiratory symptoms at that )] TJ ET BT 26.250 387.099 Td /F1 9.8 Tf [(time.)] TJ ET BT 26.250 367.694 Td /F1 9.8 Tf [(The majority of those who reported lower respiratory symptoms shortly after 9/11/2001 did not receive an OAD diagnosis during )] TJ ET BT 26.250 355.789 Td /F1 9.8 Tf [(the study period. 1,559 of 5,647 individuals reporting a lower respiratory symptom during the first 15 months received a )] TJ ET BT 26.250 343.884 Td /F1 9.8 Tf [(physician diagnosis of OAD during follow-up, for a positive predictive value of 27.6%.)] TJ ET BT 26.250 307.282 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 287.328 Td /F1 9.8 Tf [(We found that for the first seven years after 9/11/2001, earlier arrival time at the WTC site was associated with higher rates of )] TJ ET BT 26.250 275.423 Td /F1 9.8 Tf [(physician diagnoses of incident OAD. This finding is consistent with crude analyses and also with other modeling approaches )] TJ ET BT 26.250 263.518 Td /F1 9.8 Tf [(not reported here. These results support recognizing OAD among rescue workers as WTC-related even if diagnosed long after )] TJ ET BT 26.250 251.613 Td /F1 9.8 Tf [(the exposure.)] TJ ET BT 26.250 232.209 Td /F1 9.8 Tf [(We cannot determine, however, how much of the apparent lag in WTC-associated diagnoses represents the progressive )] TJ ET BT 26.250 220.304 Td /F1 9.8 Tf [(development of disease compared with the possibility of delayed diagnoses of OAD for two main reasons. First, in 2007, free )] TJ ET BT 26.250 208.399 Td /F1 9.8 Tf [(medications for the treatment of OAD began to be provided to FDNY WTC-exposed firefighters. This program change required )] TJ ET BT 26.250 196.494 Td /F1 9.8 Tf [(that diagnoses be given by FDNY physicians, and was followed by large increases in new incident physician diagnoses of OAD )] TJ ET BT 26.250 184.590 Td /F1 9.8 Tf [(for the next two years in all three exposure groups. Nonetheless, the effect of WTC exposure remained, even as the number of )] TJ ET BT 26.250 172.685 Td /F1 9.8 Tf [(incident physician diagnoses increased.)] TJ ET BT 26.250 153.280 Td /F1 9.8 Tf [(Second, most persons receiving an OAD diagnosis reported lower respiratory symptoms early in the follow-up period even )] TJ ET BT 26.250 141.375 Td /F1 9.8 Tf [(when the diagnosis was made years later. For some, it may have taken time for symptoms to become sufficiently severe and )] TJ ET BT 26.250 129.471 Td /F1 9.8 Tf [(chronic to warrant a diagnosis. Indeed 19.8% of those responding to questionnaire items on lower respiratory symptoms during )] TJ ET BT 26.250 117.566 Td /F1 9.8 Tf [(the first 15 months post-9/11 who received an OAD diagnosis between month 16 and month 84 failed to report any symptoms )] TJ ET BT 26.250 105.661 Td /F1 9.8 Tf [(on that early questionnaire.)] TJ ET BT 26.250 86.256 Td /F1 9.8 Tf [(But it is also likely that some cases could have been diagnosed earlier. We believe that this is particularly likely to be true for )] TJ ET BT 26.250 74.352 Td /F1 9.8 Tf [(cases diagnosed after year five, as the program change resulted in higher incidence rates starting in the sixth year when free )] TJ ET BT 26.250 62.447 Td /F1 9.8 Tf [(OAD medications became available to those diagnosed by FDNY-BHS physicians. In addition, it is likely that symptoms )] TJ ET BT 26.250 50.542 Td /F1 9.8 Tf [(reported on confidential medical monitoring questionnaires preceded the FDNY-BHS physician diagnosis for some FDNY )] TJ ET BT 26.250 38.637 Td /F1 9.8 Tf [(members who may have felt their symptoms to be of insufficient severity to warrant further testing, medications, or disability )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(8)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 320 0 obj << /Type /Page /Parent 3 0 R /Annots [ 322 0 R 324 0 R 326 0 R ] /Contents 321 0 R >> endobj 321 0 obj << /Length 21409 >> stream 0.271 0.267 0.267 rg 0.267 0.267 0.267 RG q 15.000 30.673 577.500 746.327 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(retirement. Similarly, some diagnoses may have been made by outside physicians at some time prior to diagnosis by FDNY-)] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(BHS physicians.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Thus we believe that the length of time between WTC exposure and OAD diagnoses must be interpreted as a combination of )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(disease natural history and the characteristics of the health system that produce those diagnoses. Biologically, the natural )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(history of this cohort suggests that a brief exposure to irritants predisposes a subgroup of susceptible individuals to non-)] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(resolving pulmonary inflammation producing the signs and symptoms supporting the diagnosis of OAD years after the exposure. )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(Trained immunity involving epigenetic reprogramming of myeloid cells is one mechanism whereby a brief challenge can produce )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(prolonged increased inflammation upon re-challenge.)] TJ ET 0.267 0.267 0.267 rg BT 256.019 678.150 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 26.250 657.238 Td /F1 9.8 Tf [(A study limitation is that we did not have access to a demographically similar cohort of non-WTC exposed individuals. )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(Therefore, we can neither support nor rule out an association of WTC exposure with OAD that is not intensity-related. Nor can )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(we assess the possible duration of such an association; we cannot rule out the possibility that WTC-exposed individuals in )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(general remain at higher risk for incident OAD beyond the study period. An additional limitation is that we did not have access to )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(the records of private physicians who might have given diagnoses of OAD that were unknown to FDNY-BHS, or were unknown )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(prior to the 2007 change in medication coverage. However, we believe that it is likely that some of the early symptoms )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(represented acute irritation that did not progress to OAD which is, by definition, a chronic disease. Further research is needed to )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(understand why individuals with similar exposures experience vastly different disease progression; i.e., why some with acute )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(symptoms progress to chronic disease while others appear to fully recover. Exposures to the FDNY firefighter responders, even )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(for those in what is defined as the low exposure group in this study, are likely to have been more intense than exposures of )] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(other rescue/recovery workers so the results here may not be generalizable to other rescue/recovery cohorts. Nevertheless, the )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(study has many strengths, including low rates of loss to follow-up, consistent diagnostic criteria applied throughout the follow-up )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(period, and an exposure measure that has been validated in other studies.)] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(Our results support recognizing OAD among WTC rescue workers as WTC-related even if diagnosed long after the exposure. )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(Hopefully, the lessons learned from the study of the health effects of the WTC-responders can contribute to greater protections )] TJ ET BT 26.250 471.167 Td /F1 9.8 Tf [(and better care for the survivors and responders in future disasters.)] TJ ET BT 26.250 434.564 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(This research was supported by National Institute of Occupational Safety and Health Cooperative Agreement # U01 OH010412 )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(\(PI: Charles B. Hall\).)] TJ ET BT 26.250 383.301 Td /F1 9.8 Tf [(Additional support came from National Institute of Occupational Safety and Health Contracts 200-2011-39378 \(PI: David J. )] TJ ET BT 26.250 371.396 Td /F1 9.8 Tf [(Prezant\), 200-2001-39383 \(PI: Kerry J. Kelly\); Cooperative Agreements U10-OH008242 \(PI: David J. Prezant\) and U10-)] TJ ET BT 26.250 359.491 Td /F1 9.8 Tf [(OH008243 \(PI: Kerry J. Kelly\).)] TJ ET BT 26.250 340.086 Td /F1 9.8 Tf [(Dr. Hall, Ms. Liu, Ms. Weakley, Ms. Schwartz, and Dr. Webber receive additional salary support from National Institute of )] TJ ET BT 26.250 328.182 Td /F1 9.8 Tf [(Occupational Safety and Health Cooperative Agreement U01 OH010711.)] TJ ET BT 26.250 308.777 Td /F1 9.8 Tf [(Drs. Weiden and Nolan receive salary support from National Institute of Occupational Safety and Health Cooperative )] TJ ET BT 26.250 296.872 Td /F1 9.8 Tf [(Agreement U01 OH010726 \(PI: Michael P. Weiden\).)] TJ ET BT 26.250 277.467 Td /F1 9.8 Tf [(Dr. Nolan receives salary support from National Center for Advancing Translational Sciences grant UL1 TR000038 \(PI: Bruce N. )] TJ ET BT 26.250 265.563 Td /F1 9.8 Tf [(Cronstein\).)] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(Dr. Aldrich and Dr. Hall received salary support from National Institute of Occupational Safety and Health Cooperative )] TJ ET BT 26.250 234.253 Td /F1 9.8 Tf [(Agreement U01 OH010411 \(PI: Thomas K. Aldrich\).)] TJ ET BT 26.250 214.848 Td /F1 9.8 Tf [(The authors have no additional competing interests to declare.)] TJ ET BT 26.250 178.246 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 150.792 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 150.792 Td /F1 9.8 Tf [(Prezant DJ, Levin S, Kelly KJ, Aldrich TK. Upper and lower respiratory diseases after occupational and environmental )] TJ ET BT 26.250 138.887 Td /F1 9.8 Tf [(disasters. Mt Sinai J Med. 2008 Mar-Apr;75\(2\):89-100. PubMed PMID:18500710.)] TJ ET BT 26.250 119.482 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 119.482 Td /F1 9.8 Tf [(Thurston GD, Bates DV. Air pollution as an underappreciated cause of asthma symptoms. JAMA. 2003 Oct 8;290\(14\):1915-)] TJ ET BT 26.250 107.577 Td /F1 9.8 Tf [(7. PubMed PMID:14532321.)] TJ ET BT 26.250 88.173 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 88.173 Td /F1 9.8 Tf [(De Leon SF, Thurston GD, Ito K. Contribution of respiratory disease to nonrespiratory mortality associations with air pollution. )] TJ ET BT 26.250 76.268 Td /F1 9.8 Tf [(Am J Respir Crit Care Med. 2003 Apr 15;167\(8\):1117-23. PubMed PMID:12684250.)] TJ ET BT 26.250 56.863 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 56.863 Td /F1 9.8 Tf [(Chatkin JM, Tarlo SM, Liss G, Banks D, Broder I. The outcome of asthma related to workplace irritant exposures: a )] TJ ET BT 26.250 44.958 Td /F1 9.8 Tf [(comparison of irritant-induced asthma and irritant aggravation of asthma. Chest. 1999 Dec;116\(6\):1780-5. PubMed )] TJ ET Q q 15.000 30.673 577.500 746.327 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(retirement. Similarly, some diagnoses may have been made by outside physicians at some time prior to diagnosis by FDNY-)] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(BHS physicians.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Thus we believe that the length of time between WTC exposure and OAD diagnoses must be interpreted as a combination of )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(disease natural history and the characteristics of the health system that produce those diagnoses. Biologically, the natural )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(history of this cohort suggests that a brief exposure to irritants predisposes a subgroup of susceptible individuals to non-)] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(resolving pulmonary inflammation producing the signs and symptoms supporting the diagnosis of OAD years after the exposure. )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(Trained immunity involving epigenetic reprogramming of myeloid cells is one mechanism whereby a brief challenge can produce )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(prolonged increased inflammation upon re-challenge.)] TJ ET 0.267 0.267 0.267 rg BT 256.019 678.150 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 26.250 657.238 Td /F1 9.8 Tf [(A study limitation is that we did not have access to a demographically similar cohort of non-WTC exposed individuals. )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(Therefore, we can neither support nor rule out an association of WTC exposure with OAD that is not intensity-related. Nor can )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(we assess the possible duration of such an association; we cannot rule out the possibility that WTC-exposed individuals in )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(general remain at higher risk for incident OAD beyond the study period. An additional limitation is that we did not have access to )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(the records of private physicians who might have given diagnoses of OAD that were unknown to FDNY-BHS, or were unknown )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(prior to the 2007 change in medication coverage. However, we believe that it is likely that some of the early symptoms )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(represented acute irritation that did not progress to OAD which is, by definition, a chronic disease. Further research is needed to )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(understand why individuals with similar exposures experience vastly different disease progression; i.e., why some with acute )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(symptoms progress to chronic disease while others appear to fully recover. Exposures to the FDNY firefighter responders, even )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(for those in what is defined as the low exposure group in this study, are likely to have been more intense than exposures of )] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(other rescue/recovery workers so the results here may not be generalizable to other rescue/recovery cohorts. Nevertheless, the )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(study has many strengths, including low rates of loss to follow-up, consistent diagnostic criteria applied throughout the follow-up )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(period, and an exposure measure that has been validated in other studies.)] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(Our results support recognizing OAD among WTC rescue workers as WTC-related even if diagnosed long after the exposure. )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(Hopefully, the lessons learned from the study of the health effects of the WTC-responders can contribute to greater protections )] TJ ET BT 26.250 471.167 Td /F1 9.8 Tf [(and better care for the survivors and responders in future disasters.)] TJ ET BT 26.250 434.564 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(This research was supported by National Institute of Occupational Safety and Health Cooperative Agreement # U01 OH010412 )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(\(PI: Charles B. Hall\).)] TJ ET BT 26.250 383.301 Td /F1 9.8 Tf [(Additional support came from National Institute of Occupational Safety and Health Contracts 200-2011-39378 \(PI: David J. )] TJ ET BT 26.250 371.396 Td /F1 9.8 Tf [(Prezant\), 200-2001-39383 \(PI: Kerry J. Kelly\); Cooperative Agreements U10-OH008242 \(PI: David J. Prezant\) and U10-)] TJ ET BT 26.250 359.491 Td /F1 9.8 Tf [(OH008243 \(PI: Kerry J. Kelly\).)] TJ ET BT 26.250 340.086 Td /F1 9.8 Tf [(Dr. Hall, Ms. Liu, Ms. Weakley, Ms. Schwartz, and Dr. Webber receive additional salary support from National Institute of )] TJ ET BT 26.250 328.182 Td /F1 9.8 Tf [(Occupational Safety and Health Cooperative Agreement U01 OH010711.)] TJ ET BT 26.250 308.777 Td /F1 9.8 Tf [(Drs. Weiden and Nolan receive salary support from National Institute of Occupational Safety and Health Cooperative )] TJ ET BT 26.250 296.872 Td /F1 9.8 Tf [(Agreement U01 OH010726 \(PI: Michael P. Weiden\).)] TJ ET BT 26.250 277.467 Td /F1 9.8 Tf [(Dr. Nolan receives salary support from National Center for Advancing Translational Sciences grant UL1 TR000038 \(PI: Bruce N. )] TJ ET BT 26.250 265.563 Td /F1 9.8 Tf [(Cronstein\).)] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(Dr. Aldrich and Dr. Hall received salary support from National Institute of Occupational Safety and Health Cooperative )] TJ ET BT 26.250 234.253 Td /F1 9.8 Tf [(Agreement U01 OH010411 \(PI: Thomas K. Aldrich\).)] TJ ET BT 26.250 214.848 Td /F1 9.8 Tf [(The authors have no additional competing interests to declare.)] TJ ET BT 26.250 178.246 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 150.792 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 150.792 Td /F1 9.8 Tf [(Prezant DJ, Levin S, Kelly KJ, Aldrich TK. Upper and lower respiratory diseases after occupational and environmental )] TJ ET BT 26.250 138.887 Td /F1 9.8 Tf [(disasters. Mt Sinai J Med. 2008 Mar-Apr;75\(2\):89-100. PubMed PMID:18500710.)] TJ ET BT 26.250 119.482 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 119.482 Td /F1 9.8 Tf [(Thurston GD, Bates DV. Air pollution as an underappreciated cause of asthma symptoms. JAMA. 2003 Oct 8;290\(14\):1915-)] TJ ET BT 26.250 107.577 Td /F1 9.8 Tf [(7. PubMed PMID:14532321.)] TJ ET BT 26.250 88.173 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 88.173 Td /F1 9.8 Tf [(De Leon SF, Thurston GD, Ito K. Contribution of respiratory disease to nonrespiratory mortality associations with air pollution. )] TJ ET BT 26.250 76.268 Td /F1 9.8 Tf [(Am J Respir Crit Care Med. 2003 Apr 15;167\(8\):1117-23. PubMed PMID:12684250.)] TJ ET BT 26.250 56.863 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 56.863 Td /F1 9.8 Tf [(Chatkin JM, Tarlo SM, Liss G, Banks D, Broder I. The outcome of asthma related to workplace irritant exposures: a )] TJ ET BT 26.250 44.958 Td /F1 9.8 Tf [(comparison of irritant-induced asthma and irritant aggravation of asthma. Chest. 1999 Dec;116\(6\):1780-5. PubMed )] TJ ET Q q 15.000 30.673 577.500 746.327 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(retirement. Similarly, some diagnoses may have been made by outside physicians at some time prior to diagnosis by FDNY-)] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(BHS physicians.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Thus we believe that the length of time between WTC exposure and OAD diagnoses must be interpreted as a combination of )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(disease natural history and the characteristics of the health system that produce those diagnoses. Biologically, the natural )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(history of this cohort suggests that a brief exposure to irritants predisposes a subgroup of susceptible individuals to non-)] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(resolving pulmonary inflammation producing the signs and symptoms supporting the diagnosis of OAD years after the exposure. )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(Trained immunity involving epigenetic reprogramming of myeloid cells is one mechanism whereby a brief challenge can produce )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(prolonged increased inflammation upon re-challenge.)] TJ ET 0.267 0.267 0.267 rg BT 256.019 678.150 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 26.250 657.238 Td /F1 9.8 Tf [(A study limitation is that we did not have access to a demographically similar cohort of non-WTC exposed individuals. )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(Therefore, we can neither support nor rule out an association of WTC exposure with OAD that is not intensity-related. Nor can )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(we assess the possible duration of such an association; we cannot rule out the possibility that WTC-exposed individuals in )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(general remain at higher risk for incident OAD beyond the study period. An additional limitation is that we did not have access to )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(the records of private physicians who might have given diagnoses of OAD that were unknown to FDNY-BHS, or were unknown )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(prior to the 2007 change in medication coverage. However, we believe that it is likely that some of the early symptoms )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(represented acute irritation that did not progress to OAD which is, by definition, a chronic disease. Further research is needed to )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(understand why individuals with similar exposures experience vastly different disease progression; i.e., why some with acute )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(symptoms progress to chronic disease while others appear to fully recover. Exposures to the FDNY firefighter responders, even )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(for those in what is defined as the low exposure group in this study, are likely to have been more intense than exposures of )] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(other rescue/recovery workers so the results here may not be generalizable to other rescue/recovery cohorts. Nevertheless, the )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(study has many strengths, including low rates of loss to follow-up, consistent diagnostic criteria applied throughout the follow-up )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(period, and an exposure measure that has been validated in other studies.)] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(Our results support recognizing OAD among WTC rescue workers as WTC-related even if diagnosed long after the exposure. )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(Hopefully, the lessons learned from the study of the health effects of the WTC-responders can contribute to greater protections )] TJ ET BT 26.250 471.167 Td /F1 9.8 Tf [(and better care for the survivors and responders in future disasters.)] TJ ET BT 26.250 434.564 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(This research was supported by National Institute of Occupational Safety and Health Cooperative Agreement # U01 OH010412 )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(\(PI: Charles B. Hall\).)] TJ ET BT 26.250 383.301 Td /F1 9.8 Tf [(Additional support came from National Institute of Occupational Safety and Health Contracts 200-2011-39378 \(PI: David J. )] TJ ET BT 26.250 371.396 Td /F1 9.8 Tf [(Prezant\), 200-2001-39383 \(PI: Kerry J. Kelly\); Cooperative Agreements U10-OH008242 \(PI: David J. Prezant\) and U10-)] TJ ET BT 26.250 359.491 Td /F1 9.8 Tf [(OH008243 \(PI: Kerry J. Kelly\).)] TJ ET BT 26.250 340.086 Td /F1 9.8 Tf [(Dr. Hall, Ms. Liu, Ms. Weakley, Ms. Schwartz, and Dr. Webber receive additional salary support from National Institute of )] TJ ET BT 26.250 328.182 Td /F1 9.8 Tf [(Occupational Safety and Health Cooperative Agreement U01 OH010711.)] TJ ET BT 26.250 308.777 Td /F1 9.8 Tf [(Drs. Weiden and Nolan receive salary support from National Institute of Occupational Safety and Health Cooperative )] TJ ET BT 26.250 296.872 Td /F1 9.8 Tf [(Agreement U01 OH010726 \(PI: Michael P. Weiden\).)] TJ ET BT 26.250 277.467 Td /F1 9.8 Tf [(Dr. Nolan receives salary support from National Center for Advancing Translational Sciences grant UL1 TR000038 \(PI: Bruce N. )] TJ ET BT 26.250 265.563 Td /F1 9.8 Tf [(Cronstein\).)] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(Dr. Aldrich and Dr. Hall received salary support from National Institute of Occupational Safety and Health Cooperative )] TJ ET BT 26.250 234.253 Td /F1 9.8 Tf [(Agreement U01 OH010411 \(PI: Thomas K. Aldrich\).)] TJ ET BT 26.250 214.848 Td /F1 9.8 Tf [(The authors have no additional competing interests to declare.)] TJ ET BT 26.250 178.246 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 150.792 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 150.792 Td /F1 9.8 Tf [(Prezant DJ, Levin S, Kelly KJ, Aldrich TK. Upper and lower respiratory diseases after occupational and environmental )] TJ ET BT 26.250 138.887 Td /F1 9.8 Tf [(disasters. Mt Sinai J Med. 2008 Mar-Apr;75\(2\):89-100. PubMed PMID:18500710.)] TJ ET BT 26.250 119.482 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 119.482 Td /F1 9.8 Tf [(Thurston GD, Bates DV. Air pollution as an underappreciated cause of asthma symptoms. JAMA. 2003 Oct 8;290\(14\):1915-)] TJ ET BT 26.250 107.577 Td /F1 9.8 Tf [(7. PubMed PMID:14532321.)] TJ ET BT 26.250 88.173 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 88.173 Td /F1 9.8 Tf [(De Leon SF, Thurston GD, Ito K. Contribution of respiratory disease to nonrespiratory mortality associations with air pollution. )] TJ ET BT 26.250 76.268 Td /F1 9.8 Tf [(Am J Respir Crit Care Med. 2003 Apr 15;167\(8\):1117-23. PubMed PMID:12684250.)] TJ ET BT 26.250 56.863 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 56.863 Td /F1 9.8 Tf [(Chatkin JM, Tarlo SM, Liss G, Banks D, Broder I. The outcome of asthma related to workplace irritant exposures: a )] TJ ET BT 26.250 44.958 Td /F1 9.8 Tf [(comparison of irritant-induced asthma and irritant aggravation of asthma. Chest. 1999 Dec;116\(6\):1780-5. PubMed )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(9)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 322 0 obj << /Type /Annot /Subtype /Link /A 323 0 R /Border [0 0 0] /H /I /Rect [ 256.0185 677.3484 265.6558 686.1667 ] >> endobj 323 0 obj << /Type /Action >> endobj 324 0 obj << /Type /Annot /Subtype /Link /A 325 0 R /Border [0 0 0] /H /I /Rect [ 256.0185 677.3484 265.6558 686.1667 ] >> endobj 325 0 obj << /Type /Action >> endobj 326 0 obj << /Type /Annot /Subtype /Link /A 327 0 R /Border [0 0 0] /H /I /Rect [ 256.0185 677.3484 265.6558 686.1667 ] >> endobj 327 0 obj << /Type /Action >> endobj 328 0 obj << /Type /Page /Parent 3 0 R /Contents 329 0 R >> endobj 329 0 obj << /Length 23771 >> stream 0.271 0.267 0.267 rg q 15.000 39.263 577.500 737.737 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(PMID:10593805.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 748.071 Td /F1 9.8 Tf [(Kogevinas M, Zock JP, Jarvis D, Kromhout H, Lillienberg L, Plana E, Radon K, Torn K, Alliksoo A, Benke G, Blanc PD, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Dahlman-Hoglund A, D'Errico A, Hry M, Kennedy S, Kunzli N, Leynaert B, Mirabelli MC, Muniozguren N, Norbck D, Olivieri )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(M, Payo F, Villani S, van Sprundel M, Urrutia I, Wieslander G, Sunyer J, Ant JM. Exposure to substances in the workplace and )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(new-onset asthma: an international prospective population-based study \(ECRHS-II\). Lancet. 2007 Jul 28;370\(9584\):336-41. )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(PubMed PMID:17662882.)] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 681.048 Td /F1 9.8 Tf [(Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(associated with time to diagnostic steps. Chest. 2007 Jun;131\(6\):1768-75. PubMed PMID:17505048.)] TJ ET BT 26.250 649.738 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 649.738 Td /F1 9.8 Tf [(Petran M, Cocrl? A, B?iescu M. Association between bronchial hyper-reactivity and exposure to silicon carbide. Occup Med )] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(\(Lond\). 2000 Feb;50\(2\):103-6. PubMed PMID:10829429.)] TJ ET BT 26.250 618.429 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 618.429 Td /F1 9.8 Tf [(Malo JL, L'archevque J, Castellanos L, Lavoie K, Ghezzo H, Maghni K. Long-term outcomes of acute irritant-induced )] TJ ET BT 26.250 606.524 Td /F1 9.8 Tf [(asthma. Am J Respir Crit Care Med. 2009 May 15;179\(10\):923-8. PubMed PMID:19234102.)] TJ ET BT 26.250 587.119 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 587.119 Td /F1 9.8 Tf [(Tarlo SM, Broder I. Irritant-induced occupational asthma. Chest. 1989 Aug;96\(2\):297-300. PubMed PMID:2666043.)] TJ ET BT 26.250 567.714 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 567.714 Td /F1 9.8 Tf [(Malo JL, Chan-Yeung M, Bernstein DI. Asthma in the Workplace. 4th ed. Boca Raton, FL: CRC Press; 2013. DOI: )] TJ ET BT 26.250 555.810 Td /F1 9.8 Tf [(10.3109/9781841849256)] TJ ET BT 26.250 536.405 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 536.405 Td /F1 9.8 Tf [(Malo JL, Ghezzo H, D'Aquino C, L'Archevque J, Cartier A, Chan-Yeung M. Natural history of occupational asthma: )] TJ ET BT 26.250 524.500 Td /F1 9.8 Tf [(relevance of type of agent and other factors in the rate of development of symptoms in affected subjects. J Allergy Clin )] TJ ET BT 26.250 512.595 Td /F1 9.8 Tf [(Immunol. 1992 Dec;90\(6 Pt 1\):937-44. PubMed PMID:1460199.)] TJ ET BT 26.250 493.191 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 493.191 Td /F1 9.8 Tf [(Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete )] TJ ET BT 26.250 481.286 Td /F1 9.8 Tf [(C, Yang I, Stiles R, Chee G, Johnson W, Porcja R, Alimokhtari S, Hale RC, Weschler C, Chen LC. Characterization of the )] TJ ET BT 26.250 469.381 Td /F1 9.8 Tf [(dust/smoke aerosol that settled east of the World Trade Center \(WTC\) in lower Manhattan after the collapse of the WTC 11 )] TJ ET BT 26.250 457.476 Td /F1 9.8 Tf [(September 2001. Environ Health Perspect. 2002 Jul;110\(7\):703-14. PubMed PMID:12117648.)] TJ ET BT 26.250 438.072 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 438.072 Td /F1 9.8 Tf [(Banauch GI, Dhala A, Prezant DJ. Pulmonary disease in rescue workers at the World Trade Center site. Curr Opin Pulm )] TJ ET BT 26.250 426.167 Td /F1 9.8 Tf [(Med. 2005 Mar;11\(2\):160-8. PubMed PMID:15699790.)] TJ ET BT 26.250 406.762 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 406.762 Td /F1 9.8 Tf [(Farfel M, DiGrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson )] TJ ET BT 26.250 394.857 Td /F1 9.8 Tf [(D, Frieden TR, Thorpe L. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade )] TJ ET BT 26.250 382.953 Td /F1 9.8 Tf [(Center Health Registry enrollees. J Urban Health. 2008 Nov;85\(6\):880-909. PubMed PMID:18785012.)] TJ ET BT 26.250 363.548 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 363.548 Td /F1 9.8 Tf [(Ekenga CC, Friedman-Jimnez G. Epidemiology of respiratory health outcomes among World Trade Center disaster )] TJ ET BT 26.250 351.643 Td /F1 9.8 Tf [(workers: review of the literature 10 years after the September 11, 2001 terrorist attacks. Disaster Med Public Health Prep. 2011 )] TJ ET BT 26.250 339.738 Td /F1 9.8 Tf [(Sep;5 Suppl 2:S189-96. PubMed PMID:21908698.)] TJ ET BT 26.250 320.334 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 320.334 Td /F1 9.8 Tf [(Kim H, Herbert R, Landrigan P, Markowitz SB, Moline JM, Savitz DA, Todd AC, Udasin IG, Wisnivesky JP. Increased rates )] TJ ET BT 26.250 308.429 Td /F1 9.8 Tf [(of asthma among World Trade Center disaster responders. Am J Ind Med. 2012 Jan;55\(1\):44-53. PubMed PMID:22068920.)] TJ ET BT 26.250 289.024 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 289.024 Td /F1 9.8 Tf [(Weakley J, Webber MP, Ye F, Zeig-Owens R, Cohen HW, Hall CB, Kelly K, Prezant DJ. Agreement between obstructive )] TJ ET BT 26.250 277.119 Td /F1 9.8 Tf [(airways disease diagnoses from self-report questionnaires and medical records. Prev Med. 2013 Jul;57\(1\):38-42. PubMed )] TJ ET BT 26.250 265.215 Td /F1 9.8 Tf [(PMID:23597657.)] TJ ET BT 26.250 245.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 245.810 Td /F1 9.8 Tf [(Webber MP, Glaser MS, Weakley J, Soo J, Ye F, Zeig-Owens R, Weiden MD, Nolan A, Aldrich TK, Kelly K, Prezant D. )] TJ ET BT 26.250 233.905 Td /F1 9.8 Tf [(Physician-diagnosed respiratory conditions and mental health symptoms 7-9 years following the World Trade Center disaster. )] TJ ET BT 26.250 222.000 Td /F1 9.8 Tf [(Am J Ind Med. 2011 Sep;54\(9\):661-71. PubMed PMID:21966080.)] TJ ET BT 26.250 202.596 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 202.596 Td /F1 9.8 Tf [(Weakley J, Webber MP, Gustave J, Kelly K, Cohen HW, Hall CB, Prezant DJ. Trends in respiratory diagnoses and )] TJ ET BT 26.250 190.691 Td /F1 9.8 Tf [(symptoms of firefighters exposed to the World Trade Center disaster: 2005-2010. Prev Med. 2011 Dec;53\(6\):364-9. PubMed )] TJ ET BT 26.250 178.786 Td /F1 9.8 Tf [(PMID:21930151.)] TJ ET BT 26.250 159.381 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 159.381 Td /F1 9.8 Tf [(Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors )] TJ ET BT 26.250 147.477 Td /F1 9.8 Tf [(associated with time to diagnostic steps. Chest. 2007 Jun;131\(6\):1768-75. PubMed PMID:17505048.)] TJ ET BT 26.250 128.072 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 128.072 Td /F1 9.8 Tf [(Glaser MS, Webber MP, Zeig-Owens R, Weakley J, Liu X, Ye F, Cohen HW, Aldrich TK, Kelly KJ, Nolan A, Weiden MD, )] TJ ET BT 26.250 116.167 Td /F1 9.8 Tf [(Prezant DJ, Hall CB. Estimating the time interval between exposure to the World Trade Center disaster and incident diagnoses )] TJ ET BT 26.250 104.262 Td /F1 9.8 Tf [(of obstructive airway disease. Am J Epidemiol. 2014 Aug 1;180\(3\):272-9. PubMed PMID:24980522.)] TJ ET BT 26.250 84.858 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 84.858 Td /F1 9.8 Tf [(Hall CB, Lipton RB, Sliwinski M, Stewart WF. A change point model for estimating the onset of cognitive decline in )] TJ ET BT 26.250 72.953 Td /F1 9.8 Tf [(preclinical Alzheimer's disease. Stat Med. 2000 Jun 15-30;19\(11-12\):1555-66. PubMed PMID:10844718.)] TJ ET BT 26.250 53.548 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 53.548 Td /F1 9.8 Tf [(Hall CB, Ying J, Kuo L, Lipton RB. Bayesian and profile likelihood change point methods for modeling cognitive function )] TJ ET Q q 15.000 39.263 577.500 737.737 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(PMID:10593805.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 748.071 Td /F1 9.8 Tf [(Kogevinas M, Zock JP, Jarvis D, Kromhout H, Lillienberg L, Plana E, Radon K, Torn K, Alliksoo A, Benke G, Blanc PD, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Dahlman-Hoglund A, D'Errico A, Hry M, Kennedy S, Kunzli N, Leynaert B, Mirabelli MC, Muniozguren N, Norbck D, Olivieri )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(M, Payo F, Villani S, van Sprundel M, Urrutia I, Wieslander G, Sunyer J, Ant JM. Exposure to substances in the workplace and )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(new-onset asthma: an international prospective population-based study \(ECRHS-II\). Lancet. 2007 Jul 28;370\(9584\):336-41. )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(PubMed PMID:17662882.)] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 681.048 Td /F1 9.8 Tf [(Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(associated with time to diagnostic steps. Chest. 2007 Jun;131\(6\):1768-75. PubMed PMID:17505048.)] TJ ET BT 26.250 649.738 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 649.738 Td /F1 9.8 Tf [(Petran M, Cocrl? A, B?iescu M. Association between bronchial hyper-reactivity and exposure to silicon carbide. Occup Med )] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(\(Lond\). 2000 Feb;50\(2\):103-6. PubMed PMID:10829429.)] TJ ET BT 26.250 618.429 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 618.429 Td /F1 9.8 Tf [(Malo JL, L'archevque J, Castellanos L, Lavoie K, Ghezzo H, Maghni K. Long-term outcomes of acute irritant-induced )] TJ ET BT 26.250 606.524 Td /F1 9.8 Tf [(asthma. Am J Respir Crit Care Med. 2009 May 15;179\(10\):923-8. PubMed PMID:19234102.)] TJ ET BT 26.250 587.119 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 587.119 Td /F1 9.8 Tf [(Tarlo SM, Broder I. Irritant-induced occupational asthma. Chest. 1989 Aug;96\(2\):297-300. PubMed PMID:2666043.)] TJ ET BT 26.250 567.714 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 567.714 Td /F1 9.8 Tf [(Malo JL, Chan-Yeung M, Bernstein DI. Asthma in the Workplace. 4th ed. Boca Raton, FL: CRC Press; 2013. DOI: )] TJ ET BT 26.250 555.810 Td /F1 9.8 Tf [(10.3109/9781841849256)] TJ ET BT 26.250 536.405 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 536.405 Td /F1 9.8 Tf [(Malo JL, Ghezzo H, D'Aquino C, L'Archevque J, Cartier A, Chan-Yeung M. Natural history of occupational asthma: )] TJ ET BT 26.250 524.500 Td /F1 9.8 Tf [(relevance of type of agent and other factors in the rate of development of symptoms in affected subjects. J Allergy Clin )] TJ ET BT 26.250 512.595 Td /F1 9.8 Tf [(Immunol. 1992 Dec;90\(6 Pt 1\):937-44. PubMed PMID:1460199.)] TJ ET BT 26.250 493.191 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 493.191 Td /F1 9.8 Tf [(Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete )] TJ ET BT 26.250 481.286 Td /F1 9.8 Tf [(C, Yang I, Stiles R, Chee G, Johnson W, Porcja R, Alimokhtari S, Hale RC, Weschler C, Chen LC. Characterization of the )] TJ ET BT 26.250 469.381 Td /F1 9.8 Tf [(dust/smoke aerosol that settled east of the World Trade Center \(WTC\) in lower Manhattan after the collapse of the WTC 11 )] TJ ET BT 26.250 457.476 Td /F1 9.8 Tf [(September 2001. Environ Health Perspect. 2002 Jul;110\(7\):703-14. PubMed PMID:12117648.)] TJ ET BT 26.250 438.072 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 438.072 Td /F1 9.8 Tf [(Banauch GI, Dhala A, Prezant DJ. Pulmonary disease in rescue workers at the World Trade Center site. Curr Opin Pulm )] TJ ET BT 26.250 426.167 Td /F1 9.8 Tf [(Med. 2005 Mar;11\(2\):160-8. PubMed PMID:15699790.)] TJ ET BT 26.250 406.762 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 406.762 Td /F1 9.8 Tf [(Farfel M, DiGrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson )] TJ ET BT 26.250 394.857 Td /F1 9.8 Tf [(D, Frieden TR, Thorpe L. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade )] TJ ET BT 26.250 382.953 Td /F1 9.8 Tf [(Center Health Registry enrollees. J Urban Health. 2008 Nov;85\(6\):880-909. PubMed PMID:18785012.)] TJ ET BT 26.250 363.548 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 363.548 Td /F1 9.8 Tf [(Ekenga CC, Friedman-Jimnez G. Epidemiology of respiratory health outcomes among World Trade Center disaster )] TJ ET BT 26.250 351.643 Td /F1 9.8 Tf [(workers: review of the literature 10 years after the September 11, 2001 terrorist attacks. Disaster Med Public Health Prep. 2011 )] TJ ET BT 26.250 339.738 Td /F1 9.8 Tf [(Sep;5 Suppl 2:S189-96. PubMed PMID:21908698.)] TJ ET BT 26.250 320.334 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 320.334 Td /F1 9.8 Tf [(Kim H, Herbert R, Landrigan P, Markowitz SB, Moline JM, Savitz DA, Todd AC, Udasin IG, Wisnivesky JP. Increased rates )] TJ ET BT 26.250 308.429 Td /F1 9.8 Tf [(of asthma among World Trade Center disaster responders. Am J Ind Med. 2012 Jan;55\(1\):44-53. PubMed PMID:22068920.)] TJ ET BT 26.250 289.024 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 289.024 Td /F1 9.8 Tf [(Weakley J, Webber MP, Ye F, Zeig-Owens R, Cohen HW, Hall CB, Kelly K, Prezant DJ. Agreement between obstructive )] TJ ET BT 26.250 277.119 Td /F1 9.8 Tf [(airways disease diagnoses from self-report questionnaires and medical records. Prev Med. 2013 Jul;57\(1\):38-42. PubMed )] TJ ET BT 26.250 265.215 Td /F1 9.8 Tf [(PMID:23597657.)] TJ ET BT 26.250 245.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 245.810 Td /F1 9.8 Tf [(Webber MP, Glaser MS, Weakley J, Soo J, Ye F, Zeig-Owens R, Weiden MD, Nolan A, Aldrich TK, Kelly K, Prezant D. )] TJ ET BT 26.250 233.905 Td /F1 9.8 Tf [(Physician-diagnosed respiratory conditions and mental health symptoms 7-9 years following the World Trade Center disaster. )] TJ ET BT 26.250 222.000 Td /F1 9.8 Tf [(Am J Ind Med. 2011 Sep;54\(9\):661-71. PubMed PMID:21966080.)] TJ ET BT 26.250 202.596 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 202.596 Td /F1 9.8 Tf [(Weakley J, Webber MP, Gustave J, Kelly K, Cohen HW, Hall CB, Prezant DJ. Trends in respiratory diagnoses and )] TJ ET BT 26.250 190.691 Td /F1 9.8 Tf [(symptoms of firefighters exposed to the World Trade Center disaster: 2005-2010. Prev Med. 2011 Dec;53\(6\):364-9. PubMed )] TJ ET BT 26.250 178.786 Td /F1 9.8 Tf [(PMID:21930151.)] TJ ET BT 26.250 159.381 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 159.381 Td /F1 9.8 Tf [(Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors )] TJ ET BT 26.250 147.477 Td /F1 9.8 Tf [(associated with time to diagnostic steps. Chest. 2007 Jun;131\(6\):1768-75. PubMed PMID:17505048.)] TJ ET BT 26.250 128.072 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 128.072 Td /F1 9.8 Tf [(Glaser MS, Webber MP, Zeig-Owens R, Weakley J, Liu X, Ye F, Cohen HW, Aldrich TK, Kelly KJ, Nolan A, Weiden MD, )] TJ ET BT 26.250 116.167 Td /F1 9.8 Tf [(Prezant DJ, Hall CB. Estimating the time interval between exposure to the World Trade Center disaster and incident diagnoses )] TJ ET BT 26.250 104.262 Td /F1 9.8 Tf [(of obstructive airway disease. Am J Epidemiol. 2014 Aug 1;180\(3\):272-9. PubMed PMID:24980522.)] TJ ET BT 26.250 84.858 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 84.858 Td /F1 9.8 Tf [(Hall CB, Lipton RB, Sliwinski M, Stewart WF. A change point model for estimating the onset of cognitive decline in )] TJ ET BT 26.250 72.953 Td /F1 9.8 Tf [(preclinical Alzheimer's disease. Stat Med. 2000 Jun 15-30;19\(11-12\):1555-66. PubMed PMID:10844718.)] TJ ET BT 26.250 53.548 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 53.548 Td /F1 9.8 Tf [(Hall CB, Ying J, Kuo L, Lipton RB. Bayesian and profile likelihood change point methods for modeling cognitive function )] TJ ET Q q 15.000 39.263 577.500 737.737 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(PMID:10593805.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 748.071 Td /F1 9.8 Tf [(Kogevinas M, Zock JP, Jarvis D, Kromhout H, Lillienberg L, Plana E, Radon K, Torn K, Alliksoo A, Benke G, Blanc PD, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Dahlman-Hoglund A, D'Errico A, Hry M, Kennedy S, Kunzli N, Leynaert B, Mirabelli MC, Muniozguren N, Norbck D, Olivieri )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(M, Payo F, Villani S, van Sprundel M, Urrutia I, Wieslander G, Sunyer J, Ant JM. Exposure to substances in the workplace and )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(new-onset asthma: an international prospective population-based study \(ECRHS-II\). Lancet. 2007 Jul 28;370\(9584\):336-41. )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(PubMed PMID:17662882.)] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 681.048 Td /F1 9.8 Tf [(Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(associated with time to diagnostic steps. Chest. 2007 Jun;131\(6\):1768-75. PubMed PMID:17505048.)] TJ ET BT 26.250 649.738 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 649.738 Td /F1 9.8 Tf [(Petran M, Cocrl? A, B?iescu M. Association between bronchial hyper-reactivity and exposure to silicon carbide. Occup Med )] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(\(Lond\). 2000 Feb;50\(2\):103-6. PubMed PMID:10829429.)] TJ ET BT 26.250 618.429 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 618.429 Td /F1 9.8 Tf [(Malo JL, L'archevque J, Castellanos L, Lavoie K, Ghezzo H, Maghni K. Long-term outcomes of acute irritant-induced )] TJ ET BT 26.250 606.524 Td /F1 9.8 Tf [(asthma. Am J Respir Crit Care Med. 2009 May 15;179\(10\):923-8. PubMed PMID:19234102.)] TJ ET BT 26.250 587.119 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 587.119 Td /F1 9.8 Tf [(Tarlo SM, Broder I. Irritant-induced occupational asthma. Chest. 1989 Aug;96\(2\):297-300. PubMed PMID:2666043.)] TJ ET BT 26.250 567.714 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 567.714 Td /F1 9.8 Tf [(Malo JL, Chan-Yeung M, Bernstein DI. Asthma in the Workplace. 4th ed. Boca Raton, FL: CRC Press; 2013. DOI: )] TJ ET BT 26.250 555.810 Td /F1 9.8 Tf [(10.3109/9781841849256)] TJ ET BT 26.250 536.405 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 536.405 Td /F1 9.8 Tf [(Malo JL, Ghezzo H, D'Aquino C, L'Archevque J, Cartier A, Chan-Yeung M. Natural history of occupational asthma: )] TJ ET BT 26.250 524.500 Td /F1 9.8 Tf [(relevance of type of agent and other factors in the rate of development of symptoms in affected subjects. J Allergy Clin )] TJ ET BT 26.250 512.595 Td /F1 9.8 Tf [(Immunol. 1992 Dec;90\(6 Pt 1\):937-44. PubMed PMID:1460199.)] TJ ET BT 26.250 493.191 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 493.191 Td /F1 9.8 Tf [(Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete )] TJ ET BT 26.250 481.286 Td /F1 9.8 Tf [(C, Yang I, Stiles R, Chee G, Johnson W, Porcja R, Alimokhtari S, Hale RC, Weschler C, Chen LC. Characterization of the )] TJ ET BT 26.250 469.381 Td /F1 9.8 Tf [(dust/smoke aerosol that settled east of the World Trade Center \(WTC\) in lower Manhattan after the collapse of the WTC 11 )] TJ ET BT 26.250 457.476 Td /F1 9.8 Tf [(September 2001. Environ Health Perspect. 2002 Jul;110\(7\):703-14. PubMed PMID:12117648.)] TJ ET BT 26.250 438.072 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 438.072 Td /F1 9.8 Tf [(Banauch GI, Dhala A, Prezant DJ. Pulmonary disease in rescue workers at the World Trade Center site. Curr Opin Pulm )] TJ ET BT 26.250 426.167 Td /F1 9.8 Tf [(Med. 2005 Mar;11\(2\):160-8. PubMed PMID:15699790.)] TJ ET BT 26.250 406.762 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 406.762 Td /F1 9.8 Tf [(Farfel M, DiGrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson )] TJ ET BT 26.250 394.857 Td /F1 9.8 Tf [(D, Frieden TR, Thorpe L. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade )] TJ ET BT 26.250 382.953 Td /F1 9.8 Tf [(Center Health Registry enrollees. J Urban Health. 2008 Nov;85\(6\):880-909. PubMed PMID:18785012.)] TJ ET BT 26.250 363.548 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 363.548 Td /F1 9.8 Tf [(Ekenga CC, Friedman-Jimnez G. Epidemiology of respiratory health outcomes among World Trade Center disaster )] TJ ET BT 26.250 351.643 Td /F1 9.8 Tf [(workers: review of the literature 10 years after the September 11, 2001 terrorist attacks. Disaster Med Public Health Prep. 2011 )] TJ ET BT 26.250 339.738 Td /F1 9.8 Tf [(Sep;5 Suppl 2:S189-96. PubMed PMID:21908698.)] TJ ET BT 26.250 320.334 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 320.334 Td /F1 9.8 Tf [(Kim H, Herbert R, Landrigan P, Markowitz SB, Moline JM, Savitz DA, Todd AC, Udasin IG, Wisnivesky JP. Increased rates )] TJ ET BT 26.250 308.429 Td /F1 9.8 Tf [(of asthma among World Trade Center disaster responders. Am J Ind Med. 2012 Jan;55\(1\):44-53. PubMed PMID:22068920.)] TJ ET BT 26.250 289.024 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 289.024 Td /F1 9.8 Tf [(Weakley J, Webber MP, Ye F, Zeig-Owens R, Cohen HW, Hall CB, Kelly K, Prezant DJ. Agreement between obstructive )] TJ ET BT 26.250 277.119 Td /F1 9.8 Tf [(airways disease diagnoses from self-report questionnaires and medical records. Prev Med. 2013 Jul;57\(1\):38-42. PubMed )] TJ ET BT 26.250 265.215 Td /F1 9.8 Tf [(PMID:23597657.)] TJ ET BT 26.250 245.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 245.810 Td /F1 9.8 Tf [(Webber MP, Glaser MS, Weakley J, Soo J, Ye F, Zeig-Owens R, Weiden MD, Nolan A, Aldrich TK, Kelly K, Prezant D. )] TJ ET BT 26.250 233.905 Td /F1 9.8 Tf [(Physician-diagnosed respiratory conditions and mental health symptoms 7-9 years following the World Trade Center disaster. )] TJ ET BT 26.250 222.000 Td /F1 9.8 Tf [(Am J Ind Med. 2011 Sep;54\(9\):661-71. PubMed PMID:21966080.)] TJ ET BT 26.250 202.596 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 202.596 Td /F1 9.8 Tf [(Weakley J, Webber MP, Gustave J, Kelly K, Cohen HW, Hall CB, Prezant DJ. Trends in respiratory diagnoses and )] TJ ET BT 26.250 190.691 Td /F1 9.8 Tf [(symptoms of firefighters exposed to the World Trade Center disaster: 2005-2010. Prev Med. 2011 Dec;53\(6\):364-9. PubMed )] TJ ET BT 26.250 178.786 Td /F1 9.8 Tf [(PMID:21930151.)] TJ ET BT 26.250 159.381 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 159.381 Td /F1 9.8 Tf [(Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors )] TJ ET BT 26.250 147.477 Td /F1 9.8 Tf [(associated with time to diagnostic steps. Chest. 2007 Jun;131\(6\):1768-75. PubMed PMID:17505048.)] TJ ET BT 26.250 128.072 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 128.072 Td /F1 9.8 Tf [(Glaser MS, Webber MP, Zeig-Owens R, Weakley J, Liu X, Ye F, Cohen HW, Aldrich TK, Kelly KJ, Nolan A, Weiden MD, )] TJ ET BT 26.250 116.167 Td /F1 9.8 Tf [(Prezant DJ, Hall CB. Estimating the time interval between exposure to the World Trade Center disaster and incident diagnoses )] TJ ET BT 26.250 104.262 Td /F1 9.8 Tf [(of obstructive airway disease. Am J Epidemiol. 2014 Aug 1;180\(3\):272-9. PubMed PMID:24980522.)] TJ ET BT 26.250 84.858 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 84.858 Td /F1 9.8 Tf [(Hall CB, Lipton RB, Sliwinski M, Stewart WF. A change point model for estimating the onset of cognitive decline in )] TJ ET BT 26.250 72.953 Td /F1 9.8 Tf [(preclinical Alzheimer's disease. Stat Med. 2000 Jun 15-30;19\(11-12\):1555-66. PubMed PMID:10844718.)] TJ ET BT 26.250 53.548 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 53.548 Td /F1 9.8 Tf [(Hall CB, Ying J, Kuo L, Lipton RB. Bayesian and profile likelihood change point methods for modeling cognitive function )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(10)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 330 0 obj << /Type /Page /Parent 3 0 R /Contents 331 0 R >> endobj 331 0 obj << /Length 3077 >> stream 0.271 0.267 0.267 rg q 15.000 683.072 577.500 93.929 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(over time. Computational Statistics & Data Analysis. 2003 February; 42\(1-2\):91-109. DOI: 10.1016/S0167-9473\(02\)00148-2)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 748.071 Td /F1 9.8 Tf [(Cheng SC, Quintin J, Cramer RA, Shepardson KM, Saeed S, Kumar V, Giamarellos-Bourboulis EJ, Martens JH, Rao NA, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Aghajanirefah A, Manjeri GR, Li Y, Ifrim DC, Arts RJ, van der Veer BM, Deen PM, Logie C, O'Neill LA, Willems P, van de )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Veerdonk FL, van der Meer JW, Ng A, Joosten LA, Wijmenga C, Stunnenberg HG, Xavier RJ, Netea MG. mTOR- and HIF-1?-)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(mediated aerobic glycolysis as metabolic basis for trained immunity. Science. 2014 Sep 26;345\(6204\):1250684. PubMed )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(PMID:25258083.)] TJ ET Q q 15.000 683.072 577.500 93.929 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(over time. Computational Statistics & Data Analysis. 2003 February; 42\(1-2\):91-109. DOI: 10.1016/S0167-9473\(02\)00148-2)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 748.071 Td /F1 9.8 Tf [(Cheng SC, Quintin J, Cramer RA, Shepardson KM, Saeed S, Kumar V, Giamarellos-Bourboulis EJ, Martens JH, Rao NA, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Aghajanirefah A, Manjeri GR, Li Y, Ifrim DC, Arts RJ, van der Veer BM, Deen PM, Logie C, O'Neill LA, Willems P, van de )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Veerdonk FL, van der Meer JW, Ng A, Joosten LA, Wijmenga C, Stunnenberg HG, Xavier RJ, Netea MG. mTOR- and HIF-1?-)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(mediated aerobic glycolysis as metabolic basis for trained immunity. Science. 2014 Sep 26;345\(6204\):1250684. PubMed )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(PMID:25258083.)] TJ ET Q q 15.000 683.072 577.500 93.929 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(over time. Computational Statistics & Data Analysis. 2003 February; 42\(1-2\):91-109. DOI: 10.1016/S0167-9473\(02\)00148-2)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 748.071 Td /F1 9.8 Tf [(Cheng SC, Quintin J, Cramer RA, Shepardson KM, Saeed S, Kumar V, Giamarellos-Bourboulis EJ, Martens JH, Rao NA, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Aghajanirefah A, Manjeri GR, Li Y, Ifrim DC, Arts RJ, van der Veer BM, Deen PM, Logie C, O'Neill LA, Willems P, van de )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Veerdonk FL, van der Meer JW, Ng A, Joosten LA, Wijmenga C, Stunnenberg HG, Xavier RJ, Netea MG. mTOR- and HIF-1?-)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(mediated aerobic glycolysis as metabolic basis for trained immunity. Science. 2014 Sep 26;345\(6204\):1250684. PubMed )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(PMID:25258083.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(11)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj xref 0 332 0000000000 65535 f 0000000008 00000 n 0000000073 00000 n 0000000119 00000 n 0000000702 00000 n 0000000739 00000 n 0000001030 00000 n 0000001758 00000 n 0000027736 00000 n 0000027843 00000 n 0000027951 00000 n 0000028062 00000 n 0000028175 00000 n 0000028563 00000 n 0000032448 00000 n 0000032575 00000 n 0000032811 00000 n 0000032938 00000 n 0000033174 00000 n 0000033301 00000 n 0000033537 00000 n 0000033664 00000 n 0000033785 00000 n 0000033911 00000 n 0000034017 00000 n 0000034144 00000 n 0000034262 00000 n 0000034390 00000 n 0000034514 00000 n 0000034642 00000 n 0000034762 00000 n 0000034890 00000 n 0000035007 00000 n 0000035135 00000 n 0000035244 00000 n 0000035372 00000 n 0000035495 00000 n 0000035621 00000 n 0000035743 00000 n 0000035870 00000 n 0000035989 00000 n 0000036117 00000 n 0000036240 00000 n 0000036368 00000 n 0000036486 00000 n 0000036614 00000 n 0000036717 00000 n 0000036845 00000 n 0000036963 00000 n 0000037091 00000 n 0000037211 00000 n 0000037339 00000 n 0000037375 00000 n 0000037501 00000 n 0000037537 00000 n 0000037663 00000 n 0000037699 00000 n 0000037825 00000 n 0000037861 00000 n 0000037987 00000 n 0000038023 00000 n 0000038150 00000 n 0000038186 00000 n 0000038314 00000 n 0000038350 00000 n 0000038478 00000 n 0000038514 00000 n 0000038642 00000 n 0000038678 00000 n 0000038806 00000 n 0000038842 00000 n 0000038970 00000 n 0000039006 00000 n 0000039133 00000 n 0000039369 00000 n 0000039496 00000 n 0000039732 00000 n 0000039859 00000 n 0000040095 00000 n 0000040222 00000 n 0000040343 00000 n 0000040469 00000 n 0000040575 00000 n 0000040702 00000 n 0000040820 00000 n 0000040948 00000 n 0000041072 00000 n 0000041200 00000 n 0000041320 00000 n 0000041448 00000 n 0000041565 00000 n 0000041693 00000 n 0000041802 00000 n 0000041930 00000 n 0000042053 00000 n 0000042179 00000 n 0000042301 00000 n 0000042428 00000 n 0000042547 00000 n 0000042675 00000 n 0000042798 00000 n 0000042928 00000 n 0000043047 00000 n 0000043177 00000 n 0000043281 00000 n 0000043411 00000 n 0000043530 00000 n 0000043660 00000 n 0000043781 00000 n 0000043911 00000 n 0000043948 00000 n 0000044076 00000 n 0000044113 00000 n 0000044241 00000 n 0000044278 00000 n 0000044406 00000 n 0000044443 00000 n 0000044571 00000 n 0000044608 00000 n 0000044737 00000 n 0000044774 00000 n 0000044904 00000 n 0000044941 00000 n 0000045071 00000 n 0000045108 00000 n 0000045238 00000 n 0000045275 00000 n 0000045405 00000 n 0000045442 00000 n 0000045572 00000 n 0000045609 00000 n 0000045738 00000 n 0000045975 00000 n 0000046104 00000 n 0000046341 00000 n 0000046470 00000 n 0000046707 00000 n 0000046836 00000 n 0000046958 00000 n 0000047086 00000 n 0000047193 00000 n 0000047322 00000 n 0000047441 00000 n 0000047571 00000 n 0000047696 00000 n 0000047826 00000 n 0000047947 00000 n 0000048077 00000 n 0000048195 00000 n 0000048325 00000 n 0000048435 00000 n 0000048565 00000 n 0000048689 00000 n 0000048817 00000 n 0000048940 00000 n 0000049069 00000 n 0000049189 00000 n 0000049319 00000 n 0000049443 00000 n 0000049573 00000 n 0000049692 00000 n 0000049822 00000 n 0000049926 00000 n 0000050056 00000 n 0000050175 00000 n 0000050305 00000 n 0000050426 00000 n 0000050556 00000 n 0000050593 00000 n 0000050721 00000 n 0000050758 00000 n 0000050886 00000 n 0000050923 00000 n 0000051051 00000 n 0000051088 00000 n 0000051216 00000 n 0000051253 00000 n 0000051382 00000 n 0000051419 00000 n 0000051549 00000 n 0000051586 00000 n 0000051716 00000 n 0000051753 00000 n 0000051883 00000 n 0000051920 00000 n 0000052050 00000 n 0000052087 00000 n 0000052217 00000 n 0000052254 00000 n 0000052573 00000 n 0000067965 00000 n 0000068095 00000 n 0000068132 00000 n 0000068262 00000 n 0000068299 00000 n 0000068429 00000 n 0000068466 00000 n 0000068596 00000 n 0000068633 00000 n 0000068763 00000 n 0000068800 00000 n 0000068930 00000 n 0000068967 00000 n 0000069097 00000 n 0000069134 00000 n 0000069264 00000 n 0000069301 00000 n 0000069431 00000 n 0000069468 00000 n 0000069598 00000 n 0000069740 00000 n 0000129654 00000 n 0000129784 00000 n 0000129821 00000 n 0000129951 00000 n 0000129988 00000 n 0000130118 00000 n 0000130155 00000 n 0000130285 00000 n 0000130322 00000 n 0000130452 00000 n 0000130489 00000 n 0000130619 00000 n 0000130656 00000 n 0000130786 00000 n 0000130823 00000 n 0000130953 00000 n 0000130990 00000 n 0000131120 00000 n 0000131157 00000 n 0000131287 00000 n 0000131429 00000 n 0000131559 00000 n 0000131596 00000 n 0000131726 00000 n 0000131763 00000 n 0000131893 00000 n 0000131930 00000 n 0000132060 00000 n 0000132097 00000 n 0000132227 00000 n 0000132264 00000 n 0000132394 00000 n 0000132431 00000 n 0000132561 00000 n 0000132598 00000 n 0000132728 00000 n 0000132765 00000 n 0000132895 00000 n 0000132932 00000 n 0000133062 00000 n 0000133204 00000 n 0000133379 00000 n 0000165874 00000 n 0000165991 00000 n 0000166121 00000 n 0000166158 00000 n 0000166288 00000 n 0000166325 00000 n 0000166455 00000 n 0000166492 00000 n 0000166622 00000 n 0000166659 00000 n 0000169868 00000 n 0000170180 00000 n 0000170310 00000 n 0000170347 00000 n 0000170477 00000 n 0000170514 00000 n 0000170644 00000 n 0000170681 00000 n 0000170811 00000 n 0000170848 00000 n 0000174057 00000 n 0000174369 00000 n 0000174499 00000 n 0000174536 00000 n 0000174666 00000 n 0000174703 00000 n 0000174833 00000 n 0000174870 00000 n 0000175000 00000 n 0000175037 00000 n 0000178246 00000 n 0000178558 00000 n 0000178625 00000 n 0000197527 00000 n 0000201080 00000 n 0000201399 00000 n 0000203719 00000 n 0000204025 00000 n 0000207578 00000 n 0000207897 00000 n 0000210217 00000 n 0000210523 00000 n 0000214076 00000 n 0000214395 00000 n 0000216715 00000 n 0000217021 00000 n 0000217088 00000 n 0000264058 00000 n 0000264161 00000 n 0000271314 00000 n 0000271443 00000 n 0000271566 00000 n 0000305035 00000 n 0000305164 00000 n 0000305287 00000 n 0000305416 00000 n 0000305539 00000 n 0000305642 00000 n 0000340408 00000 n 0000340537 00000 n 0000340660 00000 n 0000370967 00000 n 0000371096 00000 n 0000371219 00000 n 0000371348 00000 n 0000371471 00000 n 0000371538 00000 n 0000403751 00000 n 0000403854 00000 n 0000425318 00000 n 0000425448 00000 n 0000425485 00000 n 0000425615 00000 n 0000425652 00000 n 0000425782 00000 n 0000425819 00000 n 0000425886 00000 n 0000449712 00000 n 0000449779 00000 n trailer << /Size 332 /Root 1 0 R /Info 5 0 R >> startxref 452910 %%EOF