Medicine and Health Sciences Commons^™

Prostaglandin D2/J2 Signaling Pathway In A Rat Model Of Neuroinflammation Displaying Progressive Parkinsonian-Like Pathology: Potential Novel Therapeutic Targets, Chuhyon Corwin, Anastasia Nikolopoulou, Allen L. Pan, Mariela Nunez-Santos, Shankar Vallabhajosula, Peter A. Serrano, John Babich, Maria E. Figueiredo-Pereira

Publications and Research

Background: Prostaglandins are products of the cyclooxygenase pathway, which is implicated in Parkinson’s disease (PD). Limited knowledge is available on mechanisms by which prostaglandins contribute to PD neurodegeneration. To address this gap, we focused on the prostaglandin PGD2/J2 signaling pathway, because PGD2 is the most abundant prostaglandin in the brain, and the one that increases the most under pathological conditions. Moreover, PGJ2 is spontaneously derived from PGD2.

Methods: In this study, we determined in rats the impact of unilateral nigral PGJ2-microinfusions on COX-2, lipocalin-type PGD2 synthase (L-PGDS), PGD2/J2 receptor 2 (DP2), and 15 hydroxyprostaglandin dehydrogenase (15-PGDH). Nigral dopaminergic (DA) and …

Oxytocin And Cancer: An Emerging Link, Ben Lerman, Trisheena Harricharran, Olorunseun O. Ogunwobi

Publications and Research

The neuropeptide hormone oxytocin, which is released from the posterior pituitary gland, is involved in a number of physiological processes. Understanding of its effects is gradually increasing due to new research in this area. While mostly recognized as a reproductive system hormone, oxytocin also regulates other organ systems such as the brain and cardiovascular system. Recently, research has focused on unraveling its involvement in cancer, and emerging evidence suggests a potential role for oxytocin as a cancer biomarker. This review summarizes observations linking oxytocin and cancer, with a special emphasis on prostate cancer, where it may promote cell proliferation. Research …

Testing A Web-Based Interactive Comic Tool To Decrease Obesity Risk Among Minority Preadolescents: Protocol For A Pilot Randomized Control Trial, May May Leung, Katrina F. Mateo, Sandra Verdaguer, Katarzyna Wyka

Publications and Research

Background: Childhood obesity is a public health crisis, particularly in low-income, minority populations in the United States. Innovative and technology-enhanced interventions may be an engaging approach to reach at-risk youth and their parents to improve dietary behaviors and feeding practices. However, such tools are limited, especially ones that are theory-based; co-developed with user-centered approaches; tailored to low-income, minority preadolescents; and include parent-focused content.

Objective: The objectives of this study include assessing the feasibility and acceptability and exploring the potential impact of the Intervention INC (Interactive Nutrition Comics for urban, minority preadolescents) Web-based tool, which is focused on decreasing childhood obesity …

Vaccination Recommendations For Oral Health Professionals, Susan H. Davide, Christine Macarelli, Anty Lam

Publications and Research

Dental teams should familiarize themselves with vaccination recommendations to reduce the risk of infectious diseases and better educate patients about the importance of immunizations

A Severe Case Of Neutropenia Secondary To Clopidogrel, Harrynauth Persaud, William B. Chung

Publications and Research

An 83-year-old male patient presented with complaints of generalized body aches, fever, rhinorrhea, and worsening dyspnea for the past 5 days. Four weeks ago, he was started on clopidogrel after he underwent stent placement to his left leg. Current admission laboratory findings revealed a white blood cell (WBC) count of 1180, with no neutrophils corresponding to an absolute neutrophil count of zero. After an extensive negative infectious workup, clopidogrel was determined to be the offending agent. This medication was discontinued and the patient was placed on a leukocyte growth factor with significant improvement in his WBC and neutrophil counts. On …

Maternal Experiences Of Intimate Partner Violence And C-Reactive Protein Levels In Young Children In Tanzania, Natalie Slopen, Jing Zhang, Samuel S. Urlacher, Gretchen De Silva, Mona Mittal

Publications and Research

Intimate partner violence (IPV) is a critical public health issue that impacts women and children across the globe.Prior studies have documented that maternal experiences of IPV are associated with adverse psychological and physical health outcomes in children; however, research on the underlying physiological pathways linking IPV to these conditions is limited. Drawing on data from the 2010 Tanzania Demographic and Health Survey, we examined the relationship between maternal report of IPV in the past 12 months and inflammation among children ages 6 months to 5 years. Our study included 503 children who were randomly selected to provide a blood sample …

Genetic Determinants Of Telomere Length In African American Youth, Andrew M. Zeiger, Marquitta J. White, Celeste Eng, Sam S. Oh, Jonathan Witonsky, Pagé C. Goddard, Maria G. Contreras, Jennifer R. Elhawary, Donglei Hu, Angel C. Y. Mak, Eunice Y. Lee, Kevin L. Keys, Lesly-Anne Samedy, Oona Risse Adams, Joaquín Magaña, Scott Huntsman, Sandra Salazar, Adam Davis, Kelley Meade, Emerita Brigino-Buenaventura, Michael A. Lenoir, Harold J. Farber, Kirsten Bibbins-Domingo, Luisa N. Borrell, Esteban G. Burchard

Publications and Research

Telomere length (TL) is associated with numerous disease states and is affected by genetic and environmental factors. However, TL has been mostly studied in adult populations of European or Asian ancestry. These studies have identified 34 TL-associated genetic variants recently used as genetic proxies for TL. The generalizability of these associations to pediatric populations and racially diverse populations, specifically of African ancestry, remains unclear. Furthermore, six novel variants associated with TL in a population of European children have been identified but not validated. We measured TL from whole blood samples of 492 healthy African American youth (children and adolescents between …

An Impact Evaluation Of Two Rounds Of Mass Drug Administration On The Prevalence Of Active Trachoma: A Clustered Cross Sectional Survey, Asrat G. Amnie

Publications and Research

Introduction We investigated the impact of two round of mass drug administration on trachoma prevalence in Plateau and Nasarawa States of Nigeria. The mass drug administration was conducted as a component of the SAFE Strategy, a combination of interventions recommended for the global elimination of blinding trachoma.

Methods The study consisted of a two-stage cross-sectional clustered sample survey in which 3990 people from 793 households were screened for clinical signs of trachoma.

Results Of the total 3990 people examined, 1530 were children, of which 808 (53%) were boys and 704 (47%) were girls. The impact of intervention as measured by …

Leveraging Pet To Image Folate Receptor Α Therapy Of An Antibody-Drug Conjugate, Christian Brand, Ahmad Sadique, Jacob L. Houghton, Kishore Gangagari, Jose F. Ponte, Jason S. Lewis, Naga Vara Kishore Pillarsetty, Joseph A. Konner, Thomas Reiner

Publications and Research

Background: The folate receptor α (FRα)-targeting antibody-drug conjugate (ADC), IMGN853, shows great antitumor activity against FRα-expressing tumors in vivo, but patient selection and consequently therapy outcome are based on immunohistochemistry. The aim of this study is to develop an antibody-derived immuno-PET imaging agent strategy for targeting FRα in ovarian cancer as a predictor of treatment success. Methods: We developed [89Zr]Zr-DFO-M9346A, a humanized antibody-based radiotracer targeting tumorassociated FRα in the preclinical setting. [89Zr]Zr-DFO-M9346A’s binding ability was tested in an in vitro uptake assay using cell lines with varying FRα expression levels. The diagnostic potential of [89Zr]Zr-M9346A was evaluated in KB and …

Empowering With Prep (E-Prep), A Peer-Led Social Media–Based Intervention To Facilitate Hiv Preexposure Prophylaxis Adoption Among Young Black And Latinx Gay And Bisexual Men: Protocol For A Cluster Randomized Controlled Trial, Viraj V. Patel, Zoë Ginsburg, Sarit A. Golub, Keith J. Horvath, Nataly Rios, Kenneth H. Mayer, Ryunh S. Kim, Julia H. Arnsten

Publications and Research

Background: Young black and Latinx, gay, bisexual, and other men who have sex with men (YBLGBM, aged 18-29 years) have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions. Preexposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, is highly efficacious in reducing HIV acquisition and could help stop the HIV epidemic in YBLGBM. Use of social media (eg, Facebook, Twitter, online dating sites) is ubiquitous among young people, providing an efficient avenue to engage YBLGBM to facilitate PrEP adoption.

Objective: …

“My Sexuality…It Creates A Stress”: Hiv-Related Communication Among Bisexual Black And Latino Men, New York City, Kirk D. Henny, Kathryn Drumhiller, Madeline Y. Sutton, Jose Nanín

Publications and Research

Men who have sex with men and women (including bisexual men) comprise 35% of all men who have sex with men (MSM) in the U.S. It is estimated that 121,800 men who have been bisexually active within the past year are living with HIV in the U.S. Communication about HIV may result in risk-reduction behaviors. However, little is known about the nature or context for HIV prevention communication among bisexual men, particularly for blacks and Hispanic/Latinos who are disproportionately at greater HIV risk. Therefore, we explored patterns and contexts of HIV-related communications occurring within personal social networks among bisexual black …

Supermarket Retailers’ Perspectives On Healthy Food Retail Strategies: In-Depth Interviews, Olivia Martinez, Noemi Rodriguez, Allison Mercurio, Marie Bragg, Brian Elbel

Publications and Research

Background

Excess calorie consumption and poor diet are major contributors to the obesity epidemic. Food retailers, in particular at supermarkets, are key shapers of the food environment which influences consumers’ diets. This study seeks to understand the decision-making processes of supermarket retailers—including motivators for and barriers to promoting more healthy products—and to catalogue elements of the complex relationships between customers, suppliers, and, supermarket retailers.

Methods

We recruited 20 supermarket retailers from a convenience sample of full service supermarkets and national supermarket chain headquarters serving low- and high-income consumers in urban and non-urban areas of New York. Individuals responsible for making …

Tributyltin Inhibits Neural Induction Of Human Induced Pluripotent Stem Cells, Shigeru Yamada, Yusuke Kubo, Daiju Yamazaki, Yuko Sekino, Yoko Nomura, Sachiko Yoshida, Yusunari Kanda

Publications and Research

Tributyltin (TBT), one of the organotin compounds, is a well-known environmental pollutant. In our recent study, we reported that TBT induces mitochondrial dysfunction, in human-induced pluripotent stem cells (iPSCs) through the degradation of mitofusin1 (Mfn1), which is a mitochondrial fusion factor. However, the effect of TBT toxicity on the developmental process of iPSCs was not clear. The present study examined the effect of TBT on the differentiation of iPSCs into the ectodermal, mesodermal, and endodermal germ layers. We found that exposure to nanomolar concentration of TBT (50 nM) selectively inhibited the induction of iPSCs into the ectoderm, which is the …

Disparities In Pulmonary Fibrosis Care In The United States: An Analysis From The Nationwide Inpatient Sample, Adam W. Gaffney, Steffie Woolhander, David Himmelstein, Danny Mccormick

Publications and Research

Background: Idiopathic pulmonary fibrosis is a disease with high morbidity and mortality. Care for these patients, including lung transplantation, may provide significant benefits, but is resource-intensive and expensive. Disadvantaged patients with IPF may hence be at risk for receiving inferior care.

Methods: We analyzed data from the Nationwide Inpatient Sample, a database consisting of all hospitalizations from a 20% sample of US hospitals. We identified adults hospitalized with IPF between 1998 and 2011 using ICD-9 codes. We assessed the effect of insurance coverage and socioeconomic status (SES) on lung transplantation, a treatment that may improve survival. We also examined the …

“Our Lab Is The Community”: Defining Essential Supporting Infrastructure In Engagement Research, Donald E. Nease Jr., Dee Burton, Sarah L. Cutrona, Lauren Edmundson, Alex H. Krist, Michael Barton Laws, Montelle Tamez

Publications and Research

Introduction: Effective patient engagement is central to patient-centered outcomes research. A well-designed infrastructure supports and facilitates patient engagement, enabling study development and implementation. We sought to understand infrastructure needs from recipients of Patient-Centered Outcomes Research Institute (PCORI) pilot grant awards. Methods: We surveyed recipients of PCORI pilot project awards on self-perceived strengths in engagement infrastructure through PCORI’s Ways of Engaging-Engagement Activity Tool survey, and interviewed leaders of 8 projects who volunteered as exemplars. Descriptive statistics summarized the survey findings. We conducted a thematic analysis of the interview transcripts. Results: Of the 50 surveyed pilots, 22 answered the engagement infrastructure questions …

Changing Neighborhoods And Residents’ Health Perceptions: The Heart Healthy Hoods Qualitative Study, Paloma Conde, Marta Gutiérrez, Maria Sandin, Julia Díez, Luisa N. Borrell, Jesús Rivera-Navarro, Manuel Franco

Publications and Research

Cities, and therefore neighborhoods, are under constant change. Neighborhood changes may affect residents’ health in multiple ways. The Heart Healthy Hoods (HHH) project studies the association between neighborhood and residents’ health. Focusing on a middle–low-socioeconomic neighborhood in Madrid (Spain), our aim was to describe qualitatively its residents’ perceptions on the urban changes and their impacts on health. We designed a qualitative study using 16 semi-structured interviews including adult residents and professionals living or working in the area. Firstly, we described the perceived main social and neighborhood changes. Secondly, we studied how these neighborhood changes connected to residents’ health perceptions. Perceived …

Very Low-Carbohydrate, High-Fat, Weight Reduction Diet Decreases Hepatic Gene Response To Glucose In Obese Rats, Kathleen V. Axen, Marianna A. Harper, Yu Fu Kuo, Kenneth Axen

Publications and Research

Background: Very low carbohydrate (VLC) diets are used to promote weight loss and improve insulin resistance (IR) in obesity. Since the high fat content of VLC diets may predispose to hepatic steatosis and hepatic insulin resistance, we investigated the effect of a VLC weight-reduction diet on measures of hepatic and whole body insulin resistance in obese rats.

Methods: In Phase 1, adult male Sprague-Dawley rats were made obese by ad libitum consumption of a high-fat (HF1, 60% of energy) diet; control rats ate a lower-fat (LF, 15%) diet for 10 weeks. In Phase 2, obese rats were fed energy-restricted amounts …

Comparison Of The Acute Effects Of Traditional Versus High Velocity Resistance Training On Metabolic, Cardiovascular, And Psychophysiological Responses In Elderly Hypertensive Women, Vânia Silva Macedo Orsano, Wilson Max Almeida Monteiro De Moraes, Nuno Manuel Frade De Sousa, Felipe Carmo De Moura, Ramires Alsamir Tibana, Alessandro De Oliveira Silva, Silvana Schwerz Funghetto, Brad J. Schoenfeld, Jonato Prestes

Publications and Research

Objectives: The aim of the present study was to compare the acute effects of traditional resistance training (RT) versus high velocity RT (HVRT) on metabolic, cardiovascular, and psychophysiological responses in elderly hypertensive women.

Methods: Fifteen elderly women (mean age ± standard deviation, 67.1±6.9 years) classified as having hypertension stage 1 or 2 were randomly allocated to complete traditional RT or HVRT; 1 week later, subjects allocated to RT completed the HVRT session and vice-versa. Heart rate, blood pressure, affective response, perceived effort, and blood samples analyzing lactate, nitrate, nitrite, oxidative damage (thiobarbituric acid reactive substances [TBARS]), and 6-hydroxy-2,5,7,8- tetramethylchroman-2-carboxylic acid …

Obesity Inequalities According To Place Of Birth: The Role Of Education, Elena Rodriguez-Alvarez, Nerea Lanborena, Luisa N. Borrell

Publications and Research

This study examined obesity inequalities according to place of birth and educational attainment in men and in women in Spain. A cross-sectional study was conducted using data from the Spanish National Health Survey 2011–2012 and from the European Health Survey in Spain 2014. We used data for 27,720 adults aged 18–64 years of whom 2431 were immigrants. We used log-binomial regression to quantify the association of place of birth with obesity before and after adjusting for the selected characteristics in women and in men. We found a greater probability of obesity in immigrant women (PR: 1.42; 95% CI: 1.22–1.64) and …

Power Outage Preparedness And Concern Among Vulnerable New York City Residents, Christine Dominianni, Munerah Ahmed, Sarah Johnson, Micheline Blum, Kazuhiko Ito, Kathryn Lane

Publications and Research

Power outages can impact health, and certain populations may be more at risk. Personal preparedness may reduce impacts, but information on power outage preparedness and risk perception among vulnerable populations is limited. We examined power outage preparedness and concern among New York City residents, including vulnerable populations defined as older adults (≥ 65 years), and respondents with household members who require assistance with daily activities or depend on electric medical devices. A random sample telephone survey was conducted during November–December 2016. Preparedness was defined as having a three-day supply of drinking water, non-perishable food, and a working flashlight. Among all …

Exploring The Characteristics And Context That Allow Master Adaptive Learners To Thrive, William B. Cutrer, Holly G. Atkinson, Erica Friedman, Nicole Deiorio, Larry D. Gruppen, Michael Dekhtyar, Martin Pusic

Publications and Research

Because change is ubiquitous in healthcare, clinicians must constantly make adaptations to their practice to provide the highest quality care to patients. In a previous article, Cutrer et al. described a metacognitive approach to learning based on self-regulation, which facilitates the development of the Master Adaptive Learner (MAL). The MAL process helps individuals to cultivate and demonstrate adaptive expertise, allowing them to investigate new concepts (learn) and create new solu- tions (innovate). An individual’s ability to learn in this manner is driven by several internal characteristics and is also impacted by numerous aspects of their context. In this article, the …

To Switch Or Not To Switch: Intentions To Switch To Injectable Prep Among Gay And Bisexual Men With At Least Twelve Months Oral Prep Experience, Kathrine Meyers, Yumeng Wu, Atrina Brill, Theodorus Sandfort, Sarit A. Golub

Publications and Research

Background: Phase III trials of long-acting injectable (LAI) PrEP, currently underway, have great potential for expanding the menu of HIV prevention options. Imagining a future in which multiple PrEP modalities are available to potential users of biomedical HIV prevention, we investigated which factors might help direct a patient-physician shared-decision making process to optimize the choice of biomedical HIV prevention method.

Methods: Participants (n = 105; ages 19–63; 46.7% men of color) were former participants in a PrEP demonstration project and had taken daily oral PrEP for 12 months. Participants were given information about LAI PrEP and asked whether they would …

Anthropometrics, Metabolic Syndrome, And Mortality Hazard, Nir Krakauer, Jesse C. Krakauer

Publications and Research

Independent indices (height, body mass index, a body shape index, and hip index) derived from basic anthropometrics have been found to be powerful predictors of mortality hazard, especially when the attributable risks are summed over these indices to give an anthropometric risk index (ARI). The metabolic syndrome (MS) is defined based on the co-occurrence of anthropometric, clinical, and laboratory criteria and is also widely employed for evaluating disease risk. Here, we investigate correlations between ARI and MS in a general population sample, the United States Third National Health and Nutrition Examination Survey. Baseline values of ARI and MS were also …

Discriminating Radiation Injury From Recurrent Tumor With [18f]Parpi And Amino Acid Pet In Mouse Models, Patrick L. Donabedian, Susanne Kossatz, John A. Engelbach, Stephen A. Jannetti, Brandon Carney, Robert J. Young, Wolfgang A. Weber, Joel R. Garbow, Thomas Reiner

Publications and Research

Background

Radiation injury can be indistinguishable from recurrent tumor on standard imaging. Current protocols for this differential diagnosis require one or more follow-up imaging studies, long dynamic acquisitions, or complex image post-processing; despite much research, the inability to confidently distinguish between these two entities continues to pose a significant dilemma for the treating clinician. Using mouse models of both glioblastoma and radiation necrosis, we tested the potential of poly(ADP-ribose) polymerase (PARP)-targeted PET imaging with [¹⁸F]PARPi to better discriminate radiation injury from tumor.

Results

In mice with experimental radiation necrosis, lesion uptake on [¹⁸F]PARPi-PET was similar to …

Consensus On Molecular Subtypes Of High-Grade Serous Ovarian Carcinoma, Gregory M. Chen, Lavanya Kannan, Ludwig Geistlinger, Victor Kofia, Zhaleh Safikhani, Deena Ma Gendoo, Giovanni Parmigiani, Michael Birrar, Benjamin Haibe-Kains, Levi Waldron

Publications and Research

Purpose: The majority of ovarian carcinomas are of high-grade serous histology, which is associated with poor prognosis. Surgery and chemotherapy are the mainstay of treatment, and molecular characterization is necessary to lead the way to targeted therapeutic options. To this end, various computational methods for gene expression-based subtyping of high-grade serous ovarian carcinoma (HGSOC) have been proposed, but their overlap and robustness remain unknown.

Experimental Design: We assess three major subtype classifiers by meta-analysis of publicly available expression data, and assess statistical criteria of subtype robustness and classifier concordance. We develop a consensus classifier that represents the subtype classifications of …

Future Ozone-Related Acute Excess Mortality Under Climate And Population Change Scenarios In China: A Modeling Study, Kai Chen, Arlene M. Fiore, Renjie Chen, Leiwen Jiang, Bryan Jones, Alexandra Schneider, Annette Peters, Jun Bi, Haidong Kan, Patrick L. Kinney

Publications and Research

Background Climate change is likely to further worsen ozone pollution in already heavily polluted areas, leading to increased ozone-related health burdens. However, little evidence exists in China, the world's largest greenhouse gas emitter and most populated country. As China is embracing an aging population with changing population size and falling age-standardized mortality rates, the potential impact of population change on ozone-related health burdens is unclear. Moreover, little is known about the seasonal variation of ozone-related health burdens under climate change. We aimed to assess near-term (mid-21st century) future annual and seasonal excess mortality from short-term exposure to ambient ozone in …

Depression, Anxiety, Post-Traumatic Stress Disorder And A History Of Pervasive Gender-Based Violence Among Women Asylum Seekers Who Have Undergone Female Genital Mutilation/Cutting: A Retrospective Case Review, Hazel Lever, Deborah Ottenheimer, Jimmitti Teysir, Elizabeth Singer, Holly G. Atkinson

Publications and Research

We sought to evaluate the frequency of anxiety, depression, PTSD, and any experiences of violence in women who had undergone Female Genital Mutilation/Cutting (FGM/C) and were seeking asylum in the United States. We undertook a retrospective qualitative descriptive study of FGM/C cases seen in an asylum clinic over a 2-year period. Standardized questionnaires provided quantitative scores for anxiety, depression and PTSD. Clients’ personal and physician medical affidavits were analyzed for experiences of violence. Of the 13 cases, anxiety and depression were exhibited by 92 and 100% of women, while all seven women screened for PTSD had symptoms. Qualitative analysis revealed …

Should Patients With Diabetes Be Encouraged To Integrate Social Media Into Their Care Plan?, Arun R. Nelakurthi, Angela Marinilli Pinto, Curtiss B. Cook, Lynne Jones, Mary Boyle, Jieping Ye, Theodoros Lappas, Jingrui He

Publications and Research

AIM: To evaluate the use of social media of individuals with diabetes mellitus (DM).

MATERIALS & METHODS: Both web-based and in-clinic surveys were collected from individuals with DM. Descriptive and correlation analyses were employed to evaluate respondents' diabetes-specific social networking site behaviors.

RESULTS: Forty-five patients with DM completed the web-based survey and 167, the clinic-based survey, of whom only 40 visited diabetes-specific social networking sites. Analysis of online survey data indicated that self-reported adherence to lifestyle recommendations was significantly correlated (p < 0.01) with visiting the sites. Clinic-based survey data found that patients who reported using DM-specific web sites monitored home glucose values more often and had better compliance with insulin administration (both p < 0.05) compared with nonusers.

CONCLUSION: This study provides insight into why individuals visit DM-specific social networking sites. Certain self-management behaviors may improve as …

Incorporating The New Blood Pressure Guidelines Into Practice, Susan H. Davide, Anty Lam

Publications and Research

No abstract provided.

Post-Traumatic Stress Disorder And Cardiovascular Diseases: A Cohort Study Of Men And Women Involved In Cleaning The Debris Of The World Trade Center Complex, Molly Remsch, Zoey Laskaris, Janine D. Flory, Consuelo Mora-Mclaughlin, Alfredo Morabia

Publications and Research

BACKGROUND: To determine whether post-traumatic stress disorder (PTSD) is a risk factor for myocardial infarction (MI) and stroke, beyond the expected effects from recognized cardiovascular risk factors and depression.

METHODS AND RESULTS: World Trade Center-Heart is an observational prospective cohort study of 6481 blue-collar first responders nested within the World Trade Center Health Program in New York City. Baseline measures in 2012 and 2013 included blood pressure, weight and height, and blood lipids. PTSD, depression, smoking, and dust exposure during the 2001 cleanup were self-reported. During the 4-year follow-up, outcomes were assessed through (1) interview-based incident, nonfatal MI, and stroke, …