Search

Coronavirus disease 2019 (COVID-19) poses a significant occupational risk factor to health care workers (HCWs). As in previous events, this occupational risk amplifies and compounds the adverse impact of the pandemic. We conducted a narrative review summarizing risk factors associated with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) transmission in HCWs. We searched for original observational studies (including case-control, cross-sectional, prospective and retrospective cohorts) using PubMed, Scopus, and Google Scholar. A total of 22 articles were reviewed, including eligible English articles published between April 2020 and May 2022. Job category, work environment, personal protective equipment (PPE) noncompliance, lack of PPE awareness and training, unvaccinated status, and competing community and household exposures were identified as risk factors for SARS-CoV-2 transmission among HCWs. Effective measures to protect HCWs from SARS-CoV-2 need to account for the identified occupational risk factors. Identifying and understanding COVID-19 risk factors among HCWs must be considered a public health priority for policy makers to mitigate occupational and community transmission in current and future epidemics.

We present new intensity and polarisation maps obtained with the QUIJOTE experiment towards the Galactic regions W49, W51 and IC443, covering the frequency range from 10 to 20 GHz at $\sim$ 1 deg angular resolution, with a sensitivity in the range 35-79 ${\mu}$K/beam for total intensity and 13-23 ${\mu}$K/beam for polarisation. For each region, we combine QUIJOTE maps with ancillary data at frequencies ranging from 0.4 to 3000 GHz, reconstruct the spectral energy distribution and model it with a combination of known foregrounds. We detect anomalous microwave emission (AME) in total intensity towards W49 at 4.7${\sigma}$ and W51 at 4.0${\sigma}$ with peak frequencies ${\nu}_{AME}$ = (20.0 $\pm$ 1.4) GHz and ${\nu}_{AME}$ = (17.7 $\pm$ 3.6) GHz respectively; this is the first detection of AME towards W51. The contamination from ultra-compact HII regions to the residual AME flux density is estimated at 10% in W49 and 5% in W51, and does not rule out the AME detection. The polarised SEDs reveal a synchrotron contribution with spectral indices ${\alpha}_s$ = -0.67 $\pm$ 0.10 in W49 and ${\alpha}_s$ = -0.51 $\pm$ 0.07 in W51, ascribed to the diffuse Galactic emission and to the local supernova remnant respectively. Towards IC443 in total intensity we measure a broken power-law synchrotron spectrum with cut-off frequency ${\nu}_{0,s}$ = (114 $\pm$ 73) GHz, in agreement with previous studies; our analysis, however, rules out any AME contribution which had been previously claimed towards IC443. No evidence of polarised AME emission is detected in this study., Comment: 29 pages, 11 figures. Accepted for publication in MNRAS

Many World Trade Center disaster (WTC) rescue and recovery workers (WTC RRWV) were exposed to toxic inhalable particles. The impact of WTC exposures on lung cancer risk is unclear.Data from the WTC Health Program General Responders Cohort (WTCGRC) were linked to health information from a large New York City health system to identify incident lung cancer cases. Incidence rates for lung cancer were then calculated. As a comparison group, we created a microsimulation model that generated expected lung cancer incidence rates for a WTC- and occupationally-unexposed cohort with similar characteristics. We also fitted a Poisson regression model to determine specific lung cancer risk factors for WTC RRWV.The incidence of lung cancer for WTC RRWV was 39.5 (95% confidence interval [CI]: 30.7-49.9) per 100,000 person-years. When compared to the simulated unexposed cohort, no significant elevation in incidence was found among WTC RRWV (incidence rate ratio [IRR] 1.34; 95% CI: 0.92-1.96). Predictors of lung cancer incidence included age, smoking intensity, and years since quitting for former smokers. In adjusted models evaluating airway obstruction and individual pre-WTC occupational exposures, only mineral dust work was associated with lung cancer risk (IRR: 2.03; 95% CI: 1.07-3.86).In a sample from a large, prospective cohort of WTC RRWV we found a lung cancer incidence rate that was similar to that expected of a WTC- and occupationally-unexposed cohort with similar individual risk profiles. Guideline-concordant lung cancer surveillance and periodic evaluations of population-level lung cancer risk should continue in this group.

We present the catalogue of Q-U-I JOint TEnerife (QUIJOTE) Wide Survey radio sources extracted from the maps of the Multi-Frequency Instrument compiled between 2012 and 2018. The catalogue contains 786 sources observed in intensity and polarization, and is divided into two separate sub-catalogues: one containing 47 bright sources previously studied by the \emph{Planck} collaboration and an extended catalogue of 739 sources either selected from the \emph{Planck} Second Catalogue of Compact Sources or found through a blind search carried out with a Mexican Hat 2 wavelet. A significant fraction of the sources in our catalogue (38.7 per cent) are within the $|b| \leq 20^\circ$ region of the Galactic plane. We determine statistical properties for those sources that are likely to be extragalactic. We find that these statistical properties are compatible with currently available models, with a $\sim$1.8 Jy completeness limit at 11 GHz. We provide the polarimetric properties of (38, 33, 31, 23) sources with P detected above the $99.99\%$ significance level at (11, 13, 17, 19) GHz, respectively. Median polarization fractions are in the $2.8$-$4.7$\% range in the 11-19 GHz frequency interval. We do not distinguish between Galactic and extragalactic sources here. The results presented here are consistent with those reported in the literature for flat- and steep-spectrum radio sources., 21 pages, 13 figures, 7 tables

The Haze is an excess of microwave intensity emission surrounding the Galactic centre. It is spatially correlated with the $\gamma$-ray Fermi bubbles, and with the S-PASS radio polarization plumes, suggesting a possible common provenance. The models proposed to explain the origin of the Haze, including energetic events at the Galactic centre and dark matter decay in the Galactic halo, do not yet provide a clear physical interpretation. In this paper we present a re-analysis of the Haze including new observations from the Multi-Frequency Instrument (MFI) of the Q-U-I JOint TEnerife (QUIJOTE) experiment, at 11 and 13 GHz. We analyze the Haze in intensity and polarization, characterizing its spectrum. We detect an excess of diffuse intensity signal ascribed to the Haze. The spectrum at frequencies 11$\,\leq\nu\leq\,$70 GHz is a power-law with spectral index $\beta^{\rm H}=-2.79\pm0.08$, which is flatter than the Galactic synchrotron in the same region ($\beta^{\rm S}=-2.98\pm0.04$), but steeper than that obtained from previous works ($\beta^{\rm H}\sim-2.5$ at 23$\,\leq\,\nu\leq\,$70 GHz). We also observe an excess of polarized signal in the QUIJOTE-MFI maps in the Haze area. This is a first hint detection of polarized Haze, or a consequence of curvature of the synchrotron spectrum in that area. Finally, we show that the spectrum of polarized structures associated with Galactic centre activity is steep at low frequencies ($\beta \sim -3.2$ at 2.3 $\leq\nu\leq$ 23 GHz), and becomes flatter above 11 GHz., Comment: 31 pages. Accepted for publication in MNRAS

We present QUIJOTE intensity and polarization maps in four frequency bands centred around 11, 13, 17 and 19GHz, and covering approximately 29000 deg$^2$, including most of the Northern sky region. These maps result from 9000 h of observations taken between May 2013 and June 2018 with the first QUIJOTE instrument (MFI), and have angular resolutions of around $1^\circ$, and sensitivities in polarization within the range 35-40 $\mu$K per 1-degree beam, being a factor $\sim 2$-$4$ worse in intensity. We discuss the data processing pipeline employed, and the basic characteristics of the maps in terms of real space statistics and angular power spectra. A number of validation tests have been applied to characterise the accuracy of the calibration and the residual level of systematic effects, finding a conservative overall calibration uncertainty of 5%. We also discuss flux densities for four bright celestial sources (Tau A, Cas A, Cyg A and 3C274) which are often used as calibrators at microwave frequencies. The polarization signal in our maps is dominated by synchrotron emission. The distribution of spectral index values between the 11GHz and WMAP 23GHz map peaks at $\beta=-3.09$ with a standard deviation of 0.14. The measured BB/EE ratio at scales of $\ell=80$ is $0.26\pm 0.07$ for a Galactic cut $|b|>10^\circ$. We find a positive TE correlation for 11GHz at large angular scales ($\ell \lesssim 50$), while the EB and TB signals are consistent with zero in the multipole range $30 \lesssim \ell \lesssim 150$. The maps discussed in this paper are publicly available., Comment: 60 pages. Accepted for publication in MNRAS. Maps and derived data products available at https://research.iac.es/proyecto/quijote/

The QUIJOTE-MFI Northern Hemisphere Wide-Survey has provided maps of the sky above declinations $-30^\circ$ at 11, 13, 17 and 19$\,$GHz. These data are combined with ancillary data to produce Spectral Energy Distributions in intensity in the frequency range 0.4--3\,000$\,$GHz on a sample of 52 candidate compact sources harbouring anomalous microwave emission (AME). We apply a component separation analysis at 1$^\circ$ scale on the full sample from which we identify 44 sources with high AME significance. We explore correlations between different fitted parameters on this last sample. QUIJOTE-MFI data contribute to notably improve the characterisation of the AME spectrum, and its separation from the other components. In particular, ignoring the 10--20\,GHz data produces on average an underestimation of the AME amplitude, and an overestimation of the free-free component. We find an average AME peak frequency of 23.6 $\pm$ 3.6$\,$GHz, about 4$\,$GHz lower than the value reported in previous studies. The strongest correlation is found between the peak flux density of the thermal dust and of the AME component. A mild correlation is found between the AME emissivity ($A_{\rm AME}/\tau_{250}$) and the interstellar radiation field. On the other hand no correlation is found between the AME emissivity and the free-free radiation Emission Measure. Our statistical results suggest that the interstellar radiation field could still be the main driver of the intensity of the AME as regards spinning dust excitation mechanisms. On the other hand, it is not clear whether spinning dust would be most likely associated with cold phases of the interstellar medium rather than with hot phases dominated by free-free radiation., Comment: 36 pages. Accepted for publication in MNRAS. Maps and derived data products available at https://research.iac.es/proyecto/quijote/

World Trade Center exposures may have the potential to cause or aggravate chronic obstructive pulmonary disease (COPD). The WTC Health Program covers the entire range of clinical services for COPD, following the 2021 diagnostic and treatment guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

Chronic Obstructive Pulmonary Disease (COPD) is a clinical syndrome defined as non- or incompletely reversible airflow obstruction associated with persistent lower respiratory symptoms such as dyspnea, cough, and excessive sputum production. The present definition probably includes more than one disease. Despite being largely preventable, COPD is often a disabling disease with accelerated longitudinal lung function loss and systemic comorbidities and is presently the third leading cause of death and one of the most important health care expenditures worldwide. While most cases are unquestionably related to tobacco smoking, it has long been suspected and is also now fairly well established that occupational and environmental exposures, as well as a variety of other factors, contribute to its causation. Most recent estimates place the fraction of COPD causation by occupational exposures at ~15% and ~30% overall and among nonsmokers, respectively. The disease occurs in workers exposed to vapors, gases, dust, and fumes at their longestheld job, and in several occupations that include miners, agricultural, cotton/textile, and construction workers, food, drink, and tobacco processors, and bus drivers, among others. There is evidence of an additive effect of occupational exposures and cigarette smoking. There is presently no evidence that treatments differ from those in widely accepted guidelines, except for the occupational interventions for primary, secondary, and tertiary prevention discussed throughout this book. This is in large part due to treatment trials having required a fairly heavy smoking history and disregarded patients’ occupations. Improved appraisal of the etiological contribution of occupational exposures should lead to progress towards disease elimination.

Occupational disease is an important public health problem of the 21st century. Occupational disease still accounts for many preventable illnesses and injuries in the workplace. It is important to incorporate modern knowledge of disease epidemiology and cutting-edge diagnostic methods and treatment with the most recent developments in the management and prevention methods to better control work-related diseases and injuries. This book covers a selection of the common occupational diseases and injuries. It offers accurate, current information on the history, causes, diagnosis, management and prevention of several occupational diseases. Key features: - 14 chapters contributed by more than 30 experts in occupational and preventive medicine - Comprehensive treatment of the history, causes, diagnosis, management and prevention of many important occupational diseases (including asbestosis, silicosis, work-related asthma, occupational cancer, mesothelioma, arsenic, and other diseases.). - Each chapter highlights the latest research findings and cutting-edge technologies - References for further reading Modern Occupational Diseases: Diagnosis, Epidemiology, Management and Prevention serves as a useful guide for all readers interested in occupational diseases. The suggested readership includes trainees in occupational medicine, general practitioners, medical students, graduate students in public health programs, occupational health nurses, and professionals involved in occupational health and safety roles at public and private levels.

Background Occupational exposures at the WTC site after 11 September 2001 have been associated with presumably inflammatory chronic lower airway diseases. Aims In this study, we describe the trajectories of expiratory air flow decline, identify subgroups with adverse progression, and investigate the association of those trajectories with quantitative computed tomography (QCT) imaging measurement of increased and decreased lung density. Methods We examined the trajectories of expiratory air flow decline in a group of 1,321 former WTC workers and volunteers with at least three periodic spirometries, and using QCT‐measured low (LAV%, −950 HU) and high (HAV%, from −600 to −250 HU) attenuation volume percent. We calculated the individual regression line slopes for first‐second forced expiratory volume (FEV1slope), identified subjects with rapidly declining (“accelerated decliners”) and increasing (“improved”), and compared them to subjects with “intermediate” (0 to −66.5 mL/year) FEV1slope. We then used multinomial logistic regression to model those three trajectories, and the two lung attenuation metrics. Results The mean longitudinal FEV1 slopes for the entire study population, and its intermediate, decliner, and improved subgroups were, respectively, −40.4, −34.3, −106.5, and 37.6 mL/year. In unadjusted and adjusted analyses, LAV% and HAV% were both associated with “accelerated decliner” status (ORadj, 95% CI 2.37, 1.41–3.97, and 1.77, 1.08–2.89, respectively), compared to the intermediate decline. Conclusions Longitudinal FEV1 decline in this cohort, known to be associated with QCT proximal airway inflammation metric, is also associated with QCT indicators of increased and decreased lung density. The improved FEV1 trajectory did not seem to be associated with lung density metrics.

BACKGROUND: The most common abnormal spirometric pattern reported in WTC worker and volunteer cohorts has consistently been that of a nonobstructive reduced forced vital capacity (low FVC). Low FVC is associated with obesity, which is highly prevalent in these cohorts. We used quantitative CT (QCT) to investigate proximal and distal airway inflammation and emphysema in participants with stable low FVC pattern. METHODS: We selected study participants with at least two available longitudinal surveillance spirometries, and a chest CT with QCT measurements of proximal airway inflammation (wall area percent, WAP), end-expiratory air trapping, suggestive of distal airway obstruction (expiratory to inspiratory mean lung attenuation ratio, MLA(EI)), and emphysema (percentage of lung volume with attenuation below −950 HU, LAV%). The comparison groups in multinomial logistic regression models were participants with consistently normal spirometries, and participants with stable fixed obstruction (COPD). RESULTS: Compared to normal spirometry participants, and after adjusting for age, sex, race/ethnicity, BMI, smoking, and early arrival at the WTC disaster site, low FVC participants had higher WAP (OR(adj) 1.24, 95% CI 1.06, 1.45, per 5% unit), suggestive of proximal airway inflammation, but did not differ in MLA(EI), or LAV%. COPD participants did not differ in WAP with the low FVC ones and were more likely to have higher MLA(EI) or LAV% than the other two subgroups. DISCUSSION: WTC workers with spirometric low FVC have higher QCT-measured WAP compared to those with normal spirometries, but did not differ in distal airway and emphysema measurements, independently of obesity, smoking, and other covariates.

et al., Feedhorn- and orthomode transducer- (OMT) coupled transition edge sensor (TES) bolometers have been designed and micro-fabricated to meet the optical specifications of the LiteBIRD high frequency telescope (HFT) focal plane. We discuss the design and optical characterization of two LiteBIRD HFT detector types: dual-polarization, dual-frequency-band pixels with 195/280 GHz and 235/337 GHz band centers. Results show well-matched passbands between orthogonal polarization channels and frequency centers within 3% of the design values. The optical efficiency of each frequency channel is conservatively reported to be within the range 0.64−0.72, determined from the response to a cryogenic, temperature-controlled thermal source. These values are in good agreement with expectations and either exceed or are within 10% of the values used in the LiteBIRD sensitivity forecast. Lastly, we report a measurement of loss in Nb/SiNx/Nb microstrip at 100 mK and over the frequency range 200–350 GHz, which is comparable to values previously reported in the literature., This work is supported by NASA under grant no. 80NSSC18K0132.

Introduction: Reports and associations of COPD and ACO with WTC occupational exposures have been inconsistent. Using spirometric case definitions, we examined that association in the largest WTC occupational surveillance cohort. Methods: We tested for association between ACO and COPD and early arrival (within 48 hr, when dust and fumes exposures were more intense) at the 2001 WTC disaster site in workers with at least two spirometries between 2002 and 2018. Case definitions of COPD required fixed obstruction, and, for ACO pre-bronchodilator obstruction with >400 ml FEV1 response to bronchodilator. We used a nested 1:4 case-control design matching on sex and height (within 5 cm) using density sampling. We imputed missing data. Results: The study population consisted of 17,996 former WTC workers, predominantly (85.4%) male and overweight or obese (85.6%), of whom 586 (3.3%) and 258 (1.4%) cases met the COPD and ACO case definition, respectively. In adjusted analyses, COPD and ACO were associated with early arrival at the WTC site, with adjusted odds ratio, and 95% confidence interval of 1.3, 1.03-1.64, and 1.66, 1.1-2.49, respectively, independently from covariates such as smoking, age, cohort entry period, metabolic syndrome indicators, and high peripheral eosinophil count, among others. Discussion: In this cohort of WTC workers, spirometrically defined COPD and ACO were both associated with WTC exposure intensity. With substantially lower prevalence and effect sizes, we confirmed the findings from another cohort where the case definitions were based on self-reported physician diagnoses (PMID 32930623).

OBJECTIVE: To investigate whether health care workers' (HCWs) return to work (RTW) after coronavirus disease 2019 (COVID-19) was associated with time to a negative viral detection test. METHODS: To evaluate the association of return to work (RTW) with an undetectable RT-PCR adjusting for different factors. RESULTS: 375 HCWs who required medical leave for COVID-19 at a hospital in Madrid. Multivariable analyses confirmed the association of delayed RTW with interval to negative PCR (ORadj 1.12, 95% CI 1.08, 1.17) as well as age, sex, and nursing staff and clinical support services compared to physicians. A predictive model based on those variables is proposed, which had an area under the receiver operating curve of 0.82. CONCLUSIONS: Delayed RTW was associated with longer interval to a negative RT-PCR after symptom onset, adjusting for occupational category, age, and sex.

Background Many respiratory conditions have been attributed to toxic dust and fume exposure in World Trade Center (WTC) rescue and recovery workers, who frequently report symptoms of OSA. We examined the prevalence of new-onset OSA and tested if the prevalence and severity of OSA are related to the presence of chronic rhinosinusitis (CRS). Methods A total of 601 subjects (83% men; age, 33-87 years; BMI, 29.9 ± 5.5 kg/m2) enrolled in the WTC Health Program, excluding those with significant pre-September 11, 2001, snoring or prior CRS, underwent two nights of home sleep testing. OSA was defined as Apnea Hypopnea Index 4% ≥ 5 events/h or respiratory disturbance index of ≥ 15 events/h. CRS was assessed using nasal symptom questionnaires. Results The prevalence of OSA was 75% (25% no OSA, 46% mild OSA, 19% moderate OSA, and 10% severe OSA), and the prevalence of CRS was 43.5%. Compared with no CRS, new and worsening CRS was a significant risk factor for OSA with an OR of 1.80 (95% CI, 1.18-2.73; P = .006) unadjusted and 1.76 (95% CI, 1.08-2.88; P = .02) after adjustment for age, BMI, sex, gastroesophageal reflux disorder, and alcohol use. Conclusions The high prevalence of OSA in WTC responders was not explained fully by obesity and sex. Possible mechanisms for the elevated risk of OSA in subjects with CRS include increased upper airway inflammation and/or elevated nasal/upper airway resistance, but these need confirmation.

The impact of coronavirus disease 2019 (COVID‐19) caused by the severe acute respiratory syndrome coronavirus 2 permeates all aspects of society worldwide. Initial medical reports and media coverage have increased awareness of the risk imposed on healthcare workers in particular, during this pandemic. However, the health implications of COVID‐19 for the global workforce are multifaceted and complex, warranting careful reflection and consideration to mitigate the adverse effects on workers worldwide. Accordingly, our review offers a framework for considering this topic, highlighting key issues, with the aim to prompt and inform action, including research, to minimize the occupational hazards imposed by this ongoing challenge. We address respiratory disease as a primary concern, while recognizing the multisystem spectrum of COVID‐19‐related disease and how clinical aspects are interwoven with broader socioeconomic forces.

The health care domain is a culmination and emergence of many other economic sectors that give different services from patient treatment to healing, protective, rehabilitation, and palliative care. The GDP consumes to facilitate health in terms of smart device development, clinical examinations, outsourcing, and tele-medication facilities. The Asian countries and less developed countries with a high population rate are facing health care services related issues. One of these countries is India. India has two types of health care services systems: (i) public service system and (ii) private system. The public health system, i.e., the government, provides facilities to patients as primary health centers (PHCs) through limited secondary and tertiary health institutions like hospitals in rural areas while the private service is owned by local practitioners and institutions. Both of these service providers are facing bed occupancy issues for patients due to a highly populated country. To overcome this issue, we propose a machine learning solution for patient admission scheduling autonomously. The proposed framework helps hospitals to enhance the decision process for bed occupancy for patients concerning their departments and their diseases. We have deployed our framework in real time environment and find that it facilitates the overall performance of bed allocation in the prescribed hospitals.

Rationale: Continuous positive airway pressure (CPAP) adherence is often poor in obstructive sleep apnea (OSA) and may be influenced by nasal resistance. CPAP with a reduction of expiratory pressure (CPAPflex) may reduce discomfort in those with high nasal resistance and improve adherence in this subgroup. Objectives: To evaluate the association of positive airway pressure (PAP) treatment adherence to nasal resistance and examine if CPAPflex improves adherence over CPAP in subjects with high nasal resistance. Methods: A randomized double-blind crossover trial of 4 weeks each of CPAPflex versus CPAP in subjects exposed to World Trade Center dust with OSA stratified by nasal resistance, measured by 4-Phase Rhinomanometry. Results: Three hundred seventeen subjects with OSA (mean, apnea–hypopnea index with 4% O(2) desaturation for hypopnea = 17 ± 14/h) were randomized. Overall, PAP adherence was poor, but adherence to CPAP (n = 239; mean hours per night [95% confidence interval (CI)]), 1.97 h (1.68 to 2.26) was greater than adherence to CPAPflex (n = 249; 1.65 h [1.39 to 1.91]; difference of 0.31 h [0.03; 0.6]; P

INTRODUCTION: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a newly redefined form of chronic airway disease and has not been well studied among 9/11-exposed populations with increased prevalence of asthma. We assessed the prevalence and risk factors associated with ACO in an exposure cohort of World Trade Center Health Registry (WTCHR) enrollees. METHODS: This is a longitudinal study, including enrollees with complete data on 9/11/01 exposure at enrollment (2003–2004, Wave 1), asthma and COPD diagnoses and at least 25 years of age at the time of the 2015–2016 (Wave 4) WTCHR survey. Probable ACO was defined as self-reported post-9/11 physician-diagnosed asthma and either emphysema, chronic bronchitis, or COPD. We evaluated whether probable ACO was associated with World Trade Center (WTC)-related exposures, using multivariable logistic regression. RESULTS: Of 36,864 Wave 4 participants, 29,911 were eligible for this analysis, and 1,495 (5.0%) had self-reported post-9/11 probable ACO. After adjusting for demographics and smoking status, we found 38% increased odds of having ACO in enrollees with exposure to the dust cloud, and up to 3.39 times the odds in those with ≥3 injuries sustained on 9/11. Among rescue/recovery workers, ever working on the pile, on the pile on 9/11 or 9/12/01, or working on the WTC site for >7 days showed increased odds ratios of having ACO. CONCLUSION: Probable ACO is associated with WTC exposures. Further study of ACO is needed to understand the development of this and other environmentally or occupationally-related airway diseases, and how to prevent these in disasters like 9/11.

Introduction: Although overweight or obesity have been linked to reduced lung function, no study has estimated the effects of lung function on weight in adults. Aim: We investigated the relation between expiratory flow and body size, and vice versa, in a cohort of adults. Methods: Prospective study in 1,329 former World Trade Center (WTC) workers who were included in the WTC Chest Imaging Archive and had a minimum of 2 spirometries between 2002 and 2018 (mean [SD] follow up=7.2 [3.9] years). We used mixed linear models to test for association between change in first-second forced expiratory volume (∆FEV1) or forced vital capacity (∆FVC) and change in body mass index (∆BMI) between sequential visits, and vice versa. All models included sex, race, educational level, age at each visit, smoking status, arrival at the WTC site within 48 hours, baseline value for the predictor of interest (lung function measure or change in body mass index), and intervals between test dates (accounting for unequal intervals). Results: In multivariable analyses, a 200 ml loss in FEV1 or FVC was associated with 0.29 kg/m2 (95% CI=0.26, 0.33) and 0.22 kg/m2 (95% CI=0.20, 0.22) increment in BMI, respectively. On the other hand, a 0.2 kg/m2 gain in BMI between visits was associated with losses of 7 ml (95% CI= -6 to -8 ml) and 9 ml (95% CI= -8 to -1) ml in FEV1 and FVC, respectively. Conclusion: Change in BMI and change in FEV1 or FVC were inversely associated with each other, and this association was bidirectional. Further work is needed to identify the mechanisms underlying these associations.

The primordial CMB B-mode search is on the spotlight of the scientific community due to the large amount of cosmological information that is encoded in the primeval signal. However, the detection of this signal is challenging from the data analysis point of view, due to the relative low amplitude compared to the foregrounds, the lensing contamination coming from the leakage of E-modes, and the instrumental noise. Here, we studied the viability of the detection of the primordial polarization B-mode with a ground-based telescope operating in the microwave low-frequency regime (i.e., from 10 GHz–120 GHz) in a handful of different scenarios: i. the instrument's channels distribution and noise, ii. the tensor-to-scalar ratio (r) detectability considering different possible r values and degrees of delensing, iii. the effect of including a possible source of polarized anomalous microwave emission (AME), iv. the strengths and weaknesses of different observational strategies and, v. the atmospheric and systematic noise impact on the recovery. We focused mainly on the removal of galactic foregrounds as well as noise contamination by applying a full-parametric pixel-based maximum likelihood component separation technique. Moreover, we developed a numerical methodology to estimate the residuals power spectrum left after component separation, which allow us to mitigate possible biases introduced in the primordial B-mode power spectrum reconstruction. Among many other results, we found that this sort of experiment is capable of detecting Starobinsky's r even when no delensing is performed or, a possible polarized AME contribution is taken into account. Besides, we showed that this experiment is a powerful complement to other on-ground or satellite missions, such as LiteBIRD, since it can help significantly with the low-frequency foregrounds characterization., EdlH acknowledge partial financial support from the Concepción Arenal Programme of the Universidad de Cantabria. The authors would like to thank Spanish Agencia Estatal de Investigación (AEI, MICIU) for the financial support provided under the projects with references ESP2017-83921-C2-1-R and AYA2017-90675-REDC, cofunded with EU FEDER funds, and also acknowledge the funding from Unidad de Excelencia María de Maeztu (MDM-2017-0765).

Objective: A positive association between mental health conditions and poor asthma control has been documented in the World Trade Center-exposed population. Whether factors such as medication adherence mediate this association is unknown. Methods: The study population was drawn from adult participants of the World Trade Center Health Registry Cohort who self-reported as asthmatic after the disaster and who were currently prescribed a long-term control medication (LTCM). Multivariable linear regression was used to estimate the associations between mental health condition (PTSD, depression, or anxiety) and continuous adherence and Asthma Control Test (ACT) scores. Results: In the study sample of 1,293, 49% were not adherent to their LTCM and two thirds reported poorly or very poorly controlled asthma. Presence of any mental health condition was associated with a 2-point decline in ACT and half a point decrease in adherence scores. However, in the multivariable model, better adherence was statistically significantly associated with slightly worse control. Conclusions: The total effect of mental health on asthma control was opposite in sign from the product of the paths between mental health and adherence and adherence and asthma control; we therefore found no evidence to support the hypothesis that adherence mediated the negative association between poor mental health and adequate asthma control. More research is needed to understand the complex causal mechanisms that underlie the association between mental and respiratory health.

LiteBIRD has been selected as JAXA's strategic large mission in the 2020s, to observe the cosmic microwave background (CMB) $B$-mode polarization over the full sky at large angular scales. The challenges of LiteBIRD are the wide field-of-view (FoV) and broadband capabilities of millimeter-wave polarization measurements, which are derived from the system requirements. The possible paths of stray light increase with a wider FoV and the far sidelobe knowledge of $-56$ dB is a challenging optical requirement. A crossed-Dragone configuration was chosen for the low frequency telescope (LFT : 34--161 GHz), one of LiteBIRD's onboard telescopes. It has a wide field-of-view ($18^\circ \times 9^\circ$) with an aperture of 400 mm in diameter, corresponding to an angular resolution of about 30 arcminutes around 100 GHz. The focal ratio f/3.0 and the crossing angle of the optical axes of 90$^\circ$ are chosen after an extensive study of the stray light. The primary and secondary reflectors have rectangular shapes with serrations to reduce the diffraction pattern from the edges of the mirrors. The reflectors and structure are made of aluminum to proportionally contract from warm down to the operating temperature at $5\,$K. A 1/4 scaled model of the LFT has been developed to validate the wide field-of-view design and to demonstrate the reduced far sidelobes. A polarization modulation unit (PMU), realized with a half-wave plate (HWP) is placed in front of the aperture stop, the entrance pupil of this system. A large focal plane with approximately 1000 AlMn TES detectors and frequency multiplexing SQUID amplifiers is cooled to 100 mK. The lens and sinuous antennas have broadband capability. Performance specifications of the LFT and an outline of the proposed verification plan are presented., Comment: 21 pages, 14 figures

Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown.To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions.We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance.Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB.Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self-management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions.Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population.

Introduction The heterogeneity of symptoms in obstructive sleep apnea (OSA) patients has been recently formalized into 3 distinct clusters: Sleepy, Disturbed Sleep, and Minimally Symptomatic. Our previous data showed that OSA is highly prevalent (>75%) in World Trade Center (WTC) responders, and positive airway pressure (PAP) treatment adherence is very poor ( Methods 643 subjects with no history of OSA or reported loud and frequent snoring before 9/11/2001 from the WTC health program clinical centers at Rutgers RWJMS, New Jersey, NYU School of Medicine, and Icahn School Medicine at Mount Sinai, New York underwent 2 nights of home sleep testing using the ARES unicorder (SleepMed, Inc., West Palm Beach, FL, USA). Epworth Sleepiness Scale (ESS), sleep onset insomnia, and sleep maintenance insomnia were assessed with questionnaires. OSA was defined as (AHI4%>=5 or RDI>=15/hr). The three clusters were defined as 1) Sleepy (ESS>10 and/or sleep onset/maintenance insomnia); 2) Disturbed Sleep (not sleepy (ESS Results Among the subjects diagnosed with OSA (N 440; AHI4%=13(15); RDI =28(19); median(iqr); 81% men; age, 33–87 years; BMI, 27.4±3.7 kg/m2), the distribution of clinical phenotypes was 31.4% sleepy, 48.9% disturbed sleep, and 19.7% minimally symptomatic, and did not differ between OSA severity groups. In comparison to SAGIC and HCHS/SOL, the WTC cohort exhibited significantly increased prevalence of the disturbed sleep phenotype (WTC vs SAGIC: 48.9% vs. 19.8%, □2=54.9; p Conclusion The predominant clinical phenotype of OSA in the WTC cohort is disturbed sleep (insomnia) and its prevalence is significantly greater than what has been observed in other large OSA cohorts. These findings may help explain the poor adherence to PAP treatment observed in the WTC cohort. Support (if any) NIOSH U01OH01415; AASM Foundation 233-BS-20.

BackgroundExposure to violence has been associated with lower lung function in cross-sectional studies.MethodsWe examined whether increasing violence-related distress over time is associated with worse lung function and worse asthma control or quality of life in a secondary analysis of a 48-week randomised clinical trial in 98 youth with asthma (aged 9–16 years) treated with low-dose inhaled corticosteroids (Vitamin D Kids Asthma Study (VDKA)). We then replicated our findings for lung function in a prospective study of 232 Puerto Rican youth followed for an average of 5.4 years. Violence-related distress was assessed using the Checklist of Children's Distress Symptoms (CCDS) scale. Our outcomes of interest were percent predicted lung function measures and (in VDKA only) asthma control (assessed using the Asthma Control Test) and asthma-related quality of life (assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ)).ResultsIn a multivariable analysis in VDKA, each 1-point increment in CCDS score was associated with decrements of 3.27% in forced expiratory volume in 1 s (FEV1) % pred (95% CI −6.44– −0.22%; p=0.04), 2.65% in forced vital capacity (FVC) % pred (95% CI −4.86– −0.45%; p=0.02) and 0.30 points in the overall PAQLQ score (95% CI −0.50– −0.10 points; p1 and FVC were obtained in the prospective study of Puerto Rican youth.ConclusionsOur findings suggest that violence-related distress may worsen lung function and quality of life in youth with asthma (even those treated with low-dose inhaled corticosteroids), and further support policies to reduce exposure to violence among children in the USA and Puerto Rico.

To analyze possible alterations of thyroid function related to dosimetric values in health care workers exposed to ionizing radiation.Forty-six health care workers exposed to ionizing radiation at a tertiary hospital previously exposed to ionizing radiation were included in the study. Age, sex, history of thyroid diseases, thyroid hormones, work post, service, dosimetric values of previous year, and 5 y period were considered. Alterations of thyroid function and other variables were analyzed by exact logistic regression univariate model.7.1% workers showed an increased serum thyroid-stimulating hormone without free T3 or free T4 alteration. A significant relationship between workers with increased thyroid-stimulating hormone and dosimetric values of previous year (odds ratio 6.35, 95% confidence interval 1.20-98.1, p = 0.021) and previous 5 y period of radiation exposure (odds ratio 1.72, 95% confidence interval 1.12-3.34, p = 0.007) was obtained.An increased risk of subclinical hypothyroidism related to radiation doses was observed in this pilot study on a group of health care workers exposed to ionizing radiation.

BACKGROUND: We previously reported that wall area percent (WAP), a quantitative CT (QCT) indicator of airway wall thickness and, presumably, inflammation, is associated with adverse longitudinal expiratory flow trajectories in WTC workers, but that obesity and weight gain also seemed to be independently predictive of the latter. Previous studies have reported no association between WAP and obesity, so we investigated that association in nonsmoking WTC-exposed individuals and healthy unexposed controls. METHODS: We assessed WAP using the Chest Imaging Platform QCT system in a segmental bronchus in 118 former WTC workers, and 89 COPDGene® WTC-unexposed and asymptomatic subjects. We used multiple regression to model WAP vs. body mass index (BMI) in the two groups, adjusting for important subject and CT image characteristics. RESULTS: Unadjusted analyses revealed significant differences between the two groups with regards to WAP, age, gender, scan pixel spacing and slice interval, but not BMI or total lung capacity. In adjusted analysis, there was a significant interaction between BMI and WTC exposure on WAP. BMI was significantly and positively associated with WAP in the WTC group, but not in the COPDGene® group, but stratified analyses revealed that the effect was significant in WTC subjects with clinical evidence of lower airway disease (LAD). DISCUSSION: Unlike non-diseased subjects, BMI was significantly associated with WAP in WTC workers and, in stratified analyses, the association was significant only among those with LAD. Our findings suggest that this adverse effect of obesity on airway structure and inflammation may be confined to already diseased individuals.

We examined the chest CT scans of 1,453 WTC responders using the International Classification of High-resolution CT for Occupational and Environmental Respiratory Diseases. Univariate and bivariate analyses of potential work-related pleural abnormalities were performed with pre-WTC and WTC-related occupational exposure data, spirometry, demographics and quantitative CT measurements. Logistic regression was used to evaluate occupational predictors of those abnormalities. Chest CT scans were performed first at a median of 6.8 years after 9/11/2001. Pleural abnormalities were the most frequent (21.1%) across all occupational groups In multivariable analyses, significant pre-WTC occupational asbestos exposure, and work as laborer/cleaner were predictive of pleural abnormalities, with prevalence being highest for the Polish subgroup (n = 237) of our population. Continued occupational lung disease surveillance is warranted in this cohort.

BACKGROUND: A reduced forced vital capacity without obstruction (low FVC) is the predominant spirometric abnormality reported in workers and volunteers exposed to dust, gases, and fumes at the World Trade Center (WTC) disaster site in 2001–2002. While low FVC has been associated with obesity and metabolic syndrome, its association with WTC occupational exposures has not been demonstrated. We estimated the prevalence of this abnormality and examined its association with WTC exposure level. METHODS: Longitudinal study of the relation between arrival at the WTC site within 48 hours and FVC below the lower limit of normal (FVC

RATIONALE: Occupational exposures at the WTC site after September 11, 2001 have been associated with several presumably inflammatory lower airway diseases. Pulmonary arterial enlargement, as suggested by an increased ratio of the diameter of the pulmonary artery to the diameter of the aorta (PAAr) has been reported as a computed tomographic (CT) scan marker of adverse respiratory health outcomes, including WTC-related disease. In this study, we sought to utilize a novel quantitative CT (QCT) measurement of PAAr to test the hypothesis that an increased ratio is associated with FEV(1) below each subject’s statistically determined lower limit of normal (FEV(1)

Background: We previously found that wall area percent (WAP), a quantitative CT (QCT) indicator of bronchial airway wall thickness and, presumably, inflammation, is associated with adverse longitudinal expiratory flow trajectories in WTC workers, but that obesity and weight gain are also independently predictive of the latter. Studies in asymptomatic nondiseased subjects have not reported an association of WAP with obesity, so we decided to examine the predictors of WAP in diseased and nondiseased individuals. Methods: We assessed WAP using the Chest Imaging Platform QCT system in the 3rd bronchial generation of the right upper lobe in 285 former WTC workers, and 91 COPDGene WTC-unexposed and asymptomatic subjects. We used multiple regression to model the determinants of WAP in the two groups, including age, height, gender, body mass index (BMI), total lung capacity (TLC CT ), and CT pixel spacing and slice thickness. Results: Unadjusted analyses revealed significant differences between the two groups with regard to WAP, age, height, gender, pixel spacing and slice interval (all p CT (p Discussion: Unlike non-diseased subjects, BMI was linked to WAP among WTC workers, who have a high prevalence of lower airway diseases. Our findings suggest that the adverse effects of obesity on airway inflammation is confined to diseased individuals.

Aim of special session The World Trade Centre research enterprise posed particular logistical and strategical challenges, and its research findings have made contribution to occupational health and the understanding of respiratory health and chronic airway disease. All of those aspects will be discussed in this session. 1 Philip J. Landrigan, MD, MS, DIH, 1 Roberto G. Lucchini, MD, 2 Laurie Breyer, JD, MA, 2 Dr. Max Lum, Ed.D, MPA, 1 Rafael E. de la Hoz, MD, MPH, MSc 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA 2 Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, GA, USA

The terrorist attack on 9/11/2001, and subsequent rescue, recovery, and service restoration of the World Trade Centre disaster site in New York City, created an unprecedented and unique occupational and environmental exposure that affected a large and diverse group of rescue workers and volunteers. The workers were exposed to a mixture of poorly characterised inhaled toxicants. A variety of acute and chronic respiratory illnesses have been reported among all exposed workers, which are the subject of large scale ongoing investigation and follow up. The predominant WTC related chronic lower airway disorders have been clinically characterised as irritant-induced asthma, nonspecific chronic bronchitis, chronic bronchiolitis, and aggravated pre-existent chronic airway disease. In addition to those, several often limited case reports, case series, and small studies have suggested other associated lung diseases among those workers. Lung function surveillance, which demonstrated an exaggerated one time expiratory flow loss (about 500 ml), has shown an average expiratory flow decline in subsequent years that seems to follow age-related rates. This episode clearly invited reflection on the characterisation of chronic airway diseases, risk factors for respiratory health, and respiratory epidemiology methods.