World Trade Center Responders Research Articles

Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study.

World Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York's (FDNY's) WTC Health Program cohort to estimate ILD incidence and progression. This longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeled risk factors, including WTC-exposure and forced vital capacity (FVC), associated with ILD. Follow-up time ended at the earliest of incident diagnosis, end of study period/case ascertainment, transplant or death. ILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years with the majority of deaths occurring among those with PPF (PPF: n = 13; ILD without PPF: n = 6). The prevalence of post-9/11 ILD was more than two-fold greater than the general population. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.

0894 Effects of Chronic Rhinosinusitis (CRS) on Sleep Duration and Variability in World Trade Center (WTC) Responders

0894 Effects of Chronic Rhinosinusitis (CRS) on Sleep Duration and Variability in World Trade Center (WTC) Responders

Graph theory-based analysis reveals neural anatomical network alterations in chronic post-traumatic stress disorder

Abstract Multimodal imaging using network connectivity techniques shows promise for investigating neuropathology influencing Post-Traumatic Stress Disorder (PTSD) symptom maintenance and course. We recruited World Trade Center (WTC) responders who continued to suffer from chronic PTSD into a diffusion tensor neuroimaging protocol (n=100), along with nine unexposed controls without PTSD from other sources. Using a graph theory approach to probe network alterations in brain diffusion images, we calculated weighted characteristics path length as a surrogate marker for the effective neuroanatomical distance between anatomical nodes. The sample (N=109; 47 with chronic PTSD) was in their mid-fifties, and the majority were male. Responders were matched in terms of cognitive performance, occupation, and demographics. The anatomical connectivity graph was constructed for each participant using deterministic diffusion tractography. We identified a significant difference in weighted Characteristic Path Length (wCPL) between trauma-exposed WTC responders (Cohen’s d = 0.42, P<0.001) that was highest in people with PTSD, and not explained by WTC exposure severity or duration. We also found that wCPL was associated with PTSD symptom severity in responders with PTSD. In the largest study to date to examine the relationship between chronic PTSD and anatomy, we examined the anatomical topography of neural connections and found that wCPL differed between the PTSD+ and PTSD- diagnostic categories.

Normal Lung Function and Mortality in World Trade Center Responders and National Health and Nutrition Examination Survey III Participants.

Rationale: Low FEV1 is a biomarker of increased mortality. The association of normal lung function and mortality is not well described. Objectives: To evaluate the FEV1-mortality association among participants with normal lung function. Methods: A total of 10,999 Fire Department of the City of New York (FDNY) responders and 10,901 Third National Health and Nutrition Examination Survey (NHANES III) participants, aged 18-65 years with FEV1 ⩾80% predicted, were analyzed, with FEV1 percent predicted calculated using Global Lung Function Initiative Global race-neutral reference equations. Mortality data were obtained from linkages to the National Death Index. Cox proportional hazards models estimated the association between FEV1 and all-cause mortality, controlling for age, sex, race/ethnicity, smoking history, and, for FDNY, work assignment. Cohorts were followed for a maximum of 20.3 years. Measurements and Main Results: We observed 504 deaths (4.6%) of 10,999 for FDNY and 1,237 deaths (9.4% [weighted]) of 10,901 for NHANES III. Relative to FEV1 ⩾120% predicted, mortality was significantly higher for FEV1 100-109%, 90-99%, and 80-89% predicted in the FDNY cohort. In the NHANES III cohort, mortality was significantly higher for FEV1 90-99% and 80-89% predicted. Each 10% higher predicted FEV1 was associated with 15% (hazard ratio, 0.85; 95% confidence interval, 0.80-0.91) and 23% (hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) lower mortality for FDNY and NHANES III, respectively. Conclusions: In both cohorts, higher FEV1 is associated with lower mortality, suggesting higher FEV1 is a biomarker of better health. These findings demonstrate that a single cross-sectional measurement of FEV1 is predictive of mortality over two decades, even when FEV1 is in the normal range.

Mediterranean diet intervention among World Trade Center responders with post-traumatic stress disorder: Feasibility and outcomes of a pilot randomized controlled trial.

Responders of the World Trade Center (WTC) disaster suffer from co-morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post-traumatic stress disorder (PTSD). WTC Health Program members (N=62), 45-65years, males 87%, body mass index (BMI) 27-45kg/m2 randomized to MedDiet (n=31) or usual nutrition counseling (n=31). The 10-week intervention included online nutrition education, text messages, and group experiential cooking; both groups had three in-person individual nutrition counseling. Anthropometrics, serum biomarkers, psychosocial factors, MedDiet score, and PTSD symptoms were assessed at baseline, post-intervention, and 3-months (follow-up). The primary outcome was intervention feasibility and secondary outcomes were within- and between-group changes of all measures at post-intervention and follow-up. Nonparametric Wilcoxon rank sum tests for between-group comparisons and Wilcoxon signed rank tests for pre-post within-group comparisons. A total of 58(94%) and 46(74%) participants completed the post-intervention and follow-up measurements, respectively. Both groups experienced significant improvements in anthropometrics, MedDiet score, oxidized low-density lipoprotein, and PTSD symptoms. Baseline median (range) were weight 100.42 (73.66-135.17)kg, BMI 33.20 (27.50-41.75)kg/m2, and Waist circumference (WC) 109.22 (90.17-150.62)cm. Median % weight loss at post-intervention was MedDiet: -3% (-11%-7%), p=0.0002; Control: -1% (-13%-4%), p=0.008 and at follow-up MedDiet: -2% (-14%-12%), p=0.07; Control: -2% (-20%-3%), p=0.006. The overall BMI was reduced by -0.68kg/m2 (-4.61-2.09)kg/m2 p<0.0001 at post-intervention and by -0.60kg/m2 (-6.91-3.39)kg/m2, p<0.0009 at follow-up. Overall, median WC was reduced (p<0.0001); post-intervention -3.81cm (-33.00-3.30)cm and follow-up -4.45(-38.10-4.57)cm. There were group differences in HbA1c (p=0.019) and serum ω6/ω3 (p=0.029) at post-intervention. Online intervention with personal counseling was feasible in this population. Improvements in anthropometrics, MedDiet score, selected serum biomarkers and PTSD symptoms were found in both groups; group differences in HbA1c and serum ω6/ω3. A larger study with a delayed control is needed to better assess intervention effects.

Effects of Daily Posttraumatic Stress Disorder Symptoms on Heart Rate Variability.

Posttraumatic stress disorder (PTSD) is common, debilitating, and associated with an increased risk of health problems, including cardiovascular disease. PTSD is related to poor autonomic function indicated by reduced heart rate variability (HRV). However, very little work has tested the timescale or direction of these effects, given that most evidence comes from cross-sectional studies. Documentation of when effects occur and in what direction can shed light on mechanisms of cardiovascular disease risk and inform treatment. The present study of 169 World Trade Center responders, oversampled for PTSD, tested how daily PTSD symptoms were associated with autonomic function as reflected through HRV. Participants ( N = 169) completed surveys of PTSD symptoms three times a day at 5-hour intervals for 4 days while also wearing ambulatory monitors to record electrocardiograms to derive HRV (i.e., mean absolute value of successive differences between beat-to-beat intervals). HRV did not predict PTSD symptoms. However, PTSD symptoms during a 5-hour interval predicted reduced HRV at the next 5-hour interval ( β = -0.09, 95% confidence interval = -0.16 to -0.02, p = .008). Results held adjusting for baseline age, current heart problems, and current PTSD diagnosis. Findings underscore growing awareness that PTSD symptoms are not static. Even their short-term fluctuations may affect cardiovascular functioning, which could have more severe impacts if disruption accumulates over time. Research is needed to determine if momentary interventions can halt increases in PTSD symptoms or mitigate their impact on cardiovascular health.

Occupational Etiology of Oropharyngeal Cancer: A Literature Review.

While abundant evidence exists linking alcohol, tobacco, and HPV infection to a carcinogenic impact on the oropharynx, the contribution of inhalational workplace hazards remains ill-defined. We aim to determine whether the literature reveals occupational environments at a higher-than-average risk of developing oropharyngeal cancer (OPC) and summarize the available data. To identify studies assessing the relationship between occupational exposure and risk of OPC, a search of the literature through the PubMed-NCBI database was carried out and, ultimately, 15 original articles meeting eligibility criteria were selected. Only original articles in English focusing on the association between occupational exposure and risk or death of specifically OPC were included. The available data are supportive of a potentially increased risk of OPC in waiters, cooks and stewards, artistic workers, poultry and meat workers, mechanics, and World Trade Center responders exposed to dust. However, the available literature on occupation-related OPC is limited. To identify occupational categories at risk, large cohorts with long follow-ups are needed. Identification of causal associations with occupation-related factors would require dose-response analyses adequately adjusted for confounders.

65 The Impact of PTSD and Mild Cognitive Impairment on Resting State Brain Functional Connectivity in World Trade Center Responders

Objective:Functional connectivity of the default mode network (DMN) during rest has been shown to be different among adults with Mild Cognitive Impairment (MCI) relative to aged-matched individuals without MCI and is predictive of transition to dementia. Post-traumatic stress disorder (PTSD) is also associated with aberrant connectivity of the DMN. Prior work from this group has demonstrated a higher rate of MCI and PTSD among World Trade Center (WTC) responders relative to the general population. The current study sought to investigate the main and interactive effects of MCI and PTSD on DMN functioning. Based on prior work, we hypothesized that MCI, but not PTSD, would predict aberrant connectivity in the DMN.Participants and Methods:99 WTC responders aged 44–65 stratified by MCI status (yes/no) and PTSD status (yes/no) and matched for age in years, sex (male vs. female), race (white, black, and other), and educational attainment (high school or less, some college / technical school, and university degree), and occupation on September 11, 2001 (law enforcement vs. other) underwent fMRI using a 3T Siemens Biograph MR scanner. A single 10-minute continuous functional MR sequence was acquired while participants were at rest with their eyes open. Group-level analyses were conducted using SPM-12, with correction for multiple comparisons using AFNI's 3dClustSim. Based on this threshold, the number of comparisons in our imaging volume, and the smoothness of our imaging data as measured by 3dFWHMx-acf, a minimum cluster size of 1134 voxels was required to have a corrected p . .05 with 2-sided thresholding. Spherical 3 mm seeds were placed in the dorsal (4, -50, 26) and ventral (4, -60, 46) posterior cingulate cortex (PCC).Results:Individuals with PTSD demonstrated significantly less connectivity of the dorsal posterior cingulate cortex (PCC) with medial insula (T = 5.21), subthalamic nucleus (T = 4.66), and postcentral gyrus (T = 3.81). There was no difference found in this study for connectivity between groups stratified by MCI status. There were no significant results for the ventral PCC seed.Conclusions:Contrary to hypotheses that were driven by a study of cortical thickness in WTC responders, the impact of PTSD appears to outweigh the impact of MCI on dorsal DMN connectivity among WTC responders stratified by PTSD and MCI status. This study is limited by several issues, including low number of female and minority participants, relatively small group cell sizes (n = 23–27 per cell), a brief resting state sequence (10 minutes), and lack of a non-WTC control group. Importantly, responders are a unique population so generalizability to other populations may be limited. Individuals in the current study are now being followed longitudinally to relate baseline resting state functional connectivity with cognitive changes and changes in connectivity over a four-year period.

Perceived social support and longitudinal trajectories of depression and anxiety in World Trade Center responders.

While severely distressing events are known to affect mental health adversely, some survivors develop only short-lived or no psychiatric symptoms in the aftermath of a disaster. In the WTC Health Program General Responder Cohort (WTCHP GRC) we examined whether social support was protective against the development of depression or anxiety symptoms after the 9/11 WTC attacks and explored in a subsample whether trait resilience moderated this relationship. We analyzed data from 14,033 traditional and 13,478 non-traditional responders who attended at least three periodic health monitoring visits between 2002 and 2019. Linear mixed-effects models were used to examine depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder screener; GAD-7) scores. In a subsample of 812 participants, we also assessed if the association between social support and symptoms was moderated by an individual's trait resilience level (Connor-Davidson Resilience Scale, CD-RISC). For both traditional and non-traditional responders, perceived social support around 9/11 was associated with lower levels of depressive (β = -0.24, S.E. = 0.017, z = -14.29, p < 0.001) and anxiety symptoms (β = -0.17, S. E. = 0.016, z = -10.48, p < 0.001). Trait resilience scores were higher in responders with at least one source of social support during the aftermath of 9/11 compared to those without (mean 71.56, SD 21.58 vs mean 76.64, SD 17.06; β=5.08, S.E.=0.36, p<0.001). Trait resilience moderated the association between social support and depressive (p < 0.001) and anxiety trajectories (p < 0.001) for traditional responders. Our findings suggest that perceived social support around a severely distressing event may have long-term protective effects on symptoms of depression and anxiety.

A - 33 Clock Drawing Performance Differences in World Trade Center Responders at Midlife.

World Trade Center (WTC) responders demonstrate elevated risk for cognitive impairment (CI) consistent with Alzheimer's Disease and Related Dementias (ADRD). Neuropsychological test performance is valuable in early detection efforts and non-invasive longitudinal tracking of populations at risk of ADRD. We hypothesized that WTC-CI would be associated with a greater number of errors on the clock drawing task (CDT). The CDT was administered to responders with/without CI who participated in a case/control study. WTC-CI was diagnosed following NIA-AA guidelines for diagnosing early-onset ADRD (ages <66years). CDT performance was evaluated using subsets of clock errors derived from four existing variations in CDT evaluation measuring the number of errors. An ANOVA was conducted to compare mean differences in clock characteristics. From 99 participants, responders with CI (n = 50, Mage = 55.82) had more errors when compared to responders without CI (n = 49, Mage = 55.94) in the following CDT components: contour (p = 0.006), hands (p < 0.001), hands similarity (p = 0.005), moderate graphical errors (p = 0.042), left-side number crowding (p = 0.038), time incorrectness (p < 0.001), and extra marks on clock face (p = 0.006). In this study, we demonstrated that CDT performance decline is associated with WTC-CI. CDT can be used as a non-invasive investigative tool that can track cognitive performance longitudinally, which can better aid in the early detection, monitoring, and intervention strategies when dealing with the emergence of encephalopathy in high-risk ADRD populations, such as the WTC cohort. Future research should evaluate additional measures that can address other comorbid issues that can arise in such populations, such as post-traumatic stress disorder (PTSD).

The Association of Air Pollution Exposure With Glucose and Lipid Levels: The Role of an Extreme Air Pollution Event Alongside 2 Decades of Moderate Exposure.

Extreme air pollution events and moderate exposure to fine particulate matter (PM2.5) are associated with increased cardiometabolic risk. The World Trade Center (WTC) Health Program general responder cohort includes responders to the WTC disaster. We investigated whether their exposure to this extreme air pollution event (2001) was associated with long-term metabolic outcomes, independently from the associations of intermediate-term PM2.5 exposure later in life (2004-2019). We included 22,447 cohort members with cholesterol (n= 96,155) and glucose (n= 81,599) laboratory results. Self-reported WTC exposure was derived from a questionnaire. PM2.5 exposure was derived from a satellite-based model. We observed an increase of 0.78 mg/dL (95% confidence interval (CI): 0.30, 1.26) in glucose and 0.67 mg/dL (95% CI: 1.00, 2.35) in cholesterol levels associated with an interquartile range increase in PM2.5 averaged 6 months before the study visit. Higher WTC-exposure categories were also associated with higher cholesterol (0.99 mg/dL, 95% CI: 0.30, 1.67, for intermediate exposure) and glucose (0.82 mg/dL, 95% CI: 0.22, 1.43, for high exposure) levels. Most associations were larger among people with diabetes. Extreme air pollution events and intermediate PM2.5 exposure have independent metabolic consequences. These exposures contributed to higher glucose and lipids levels among WTC responders, which may be translated into increased cardiovascular risk.

Behavioral Impairments and Increased Risk of Cortical Atrophy Risk Scores Among World Trade Center Responders.

Objective: World Trade Center (WTC) responders are susceptible to both cognitive and neuropsychiatric impairments, particularly chronic posttraumatic stress disorder. The present study examined self-reported behavioral impairments in a sample of 732 WTC responders, 199 of whom were determined to have high risk of WTC-related cortical atrophy by an artificial neural network. Results: We found that responders at increased risk of cortical atrophy showed behavioral impairment across five domains: motivation, mood, disinhibition, empathy, and psychosis (14.6% vs 3.9% in the low-risk group; P = 3.90 × 10-7). Factor analysis models revealed that responders at high risk of cortical atrophy tended to have deficits generalized across all aspects of behavioral impairment with focal dysfunction in sensory psychosis. We additionally describe how relationships are modulated by exposure severity and pharmacological treatments. Discussion: Our findings suggest a potential link between sensory deficits and the development of cortical atrophy in WTC responders and may indicate symptoms consistent with a clinical portrait of parietal dominant Alzheimer's disease or a related dementia (ADRD). Results underscore the importance of investigating neuropsychiatric symptomatology in clinical evaluations of possible ADRD.

Functional changes in neural mechanisms underlying post-traumatic stress disorder in World Trade Center responders

World Trade Center (WTC) responders exposed to traumatic and environmental stressors during rescue and recovery efforts have a high prevalence of chronic WTC-related post-traumatic stress disorder (WTC-PTSD). We investigated neural mechanisms underlying WTC-PTSD by applying eigenvector centrality (EC) metrics and data-driven methods on resting state functional magnetic resonance (fMRI). We identified how EC differences relate to WTC-exposure and behavioral symptoms. We found that connectivity differentiated significantly between WTC-PTSD and non-PTSD responders in nine brain regions, as these differences allowed an effective discrimination of PTSD and non-PTSD responders based solely on analysis of resting state data. Further, we found that WTC exposure duration (months on site) moderates the association between PTSD and EC values in two of the nine brain regions; the right anterior parahippocampal gyrus and the left amygdala (p = 0.010; p = 0.005, respectively, adjusted for multiple comparisons). Within WTC-PTSD, a dimensional measure of symptom severity was positively associated with EC values in the right anterior parahippocampal gyrus and brainstem. Functional neuroimaging can provide effective tools to identify neural correlates of diagnostic and dimensional indicators of PTSD.

0739 Effect of Obstructive Sleep Apnea and Insomnia on Cognitive Impairment in World Trade Center (WTC) Responders

Abstract Introduction Mild Cognitive Impairment (MCI) is defined as a noticeable decline in cognitive abilities that doesn't interfere with daily activities; MCI may be a precursor of Alzheimer’s disease and related dementia. Elevated risk of MCI has been shown in subjects with obstructive sleep apnea (OSA) in a sleep clinic population and in subjects with insomnia in a general population. OSA and Insomnia both have a high prevalence among members of the World Trade Center Health Program General Responders’ Cohort (WTCHP GRC). Previous research indicated they had a high prevalence of MCI but did not examine sleep. We examined the association between MCI with OSA and/or Insomnia in the WTCHP GRC. Methods We assessed MCI by the Montreal Cognitive Assessment (MoCA) in English (n=115) and Spanish (n=27). MoCA &amp;lt; 26 defines MCI. OSA defined by AHI4&amp;gt;=5 or RDI&amp;gt;=15 events/hr, was assessed by home sleep test or in-lab NPSG. A score&amp;gt;7 on the Insomnia Severity Index (ISI) defined insomnia. Education was categorized as &amp;lt; or &amp;gt; bachelor’s (BA/BS) degree; subjects were categorized as Latino or not. Variables were analyzed using linear correlation, t-tests and chi-square tests as appropriate. Results The study population consisted of 142 subjects (80%M/20%F, age 58±8 years, BMI=29.7±5 kg/m2., Non-Latino/White=57%, Latino/any race=35%, &amp;lt; BA/BS=65%). OSA prevalence was 65.5% (mean AHI4=10.8±12.5/hr and RDI=21.42±16/hr). Insomnia prevalence was 48% (ISI=8.8 + 6). 48% (n=68) of subjects were classified as MCI. No correlation was observed between MoCA and OSA severity (r=0.1,p=0.24) or ISI (r=-0.1,p=0.1). Subjects without OSA had higher MCI prevalence (MCI_OSA=21.5% vs MCI_noOSA=37%, p=0.018). Lower educational level, race/ethnicity, and language (Spanish/English) (p&amp;lt; 0.001) were associated with MCI. Conclusion In this heterogenous cohort, we showed an unexpected lower MCI prevalence in OSA subjects. As shown by others, MCI defined by the MoCA was highly impacted by race/ethnicity, language and education. This suggests that our findings may be influenced by differences in the MoCA scoring and MCI cutoffs in Hispanic populations. To understand the relationship between MCI and sleep disorders in the WTC population, future studies should re-assess the cutoffs used in MoCA scoring or use tools to assess MCI less dependent on ethnicity and educational level. Support (if any) NIOSH/CDC U01OH011481, K24HL109156

Glial suppression and post-traumatic stress disorder: A cross-sectional study of 1,520 world trade center responders

BackgroundChronically re-experiencing the memory of a traumatic event might cause a glial response. This study examined whether glial activation would be associated with PTSD in a study of responders present after the 9/11 World Trade Center attacks without comorbid cerebrovascular disease. MethodsPlasma was retrieved from 1,520 WTC responders and stored for a cross-sectional sample of responders of varying levels of exposure and PTSD. Plasma levels (pg/ml) of glial fibrillary acidic protein (GFAP) were assayed. Because stroke and other cerebrovascular diseases cause distributional shifts in GFAP levels, multivariable-adjusted finite mixture models analyzed GFAP distributions in responders with and without possible cerebrovascular disease. ResultsResponders were aged 56.3 years and primarily male; 11.07% (n = 154) had chronic PTSD. Older age was associated with increased GFAP, whereas higher body mass was associated with decreased GFAP. Multivariable-adjusted finite mixture models revealed that severe re-experiencing trauma from 9/11 was associated with lower GFAP (B = −0.558, p = 0.003). ConclusionThis study presents evidence of reduced plasma GFAP levels among WTC responders with PTSD. Results suggest re-experiencing traumatic events might cause glial suppression.

TERT and BRAF V600E mutations in thyroid cancer of World Trade Center Responders.

The 2-fold excess thyroid cancer risk reported in multiple World Trade Center (WTC) disaster exposed cohorts cannot entirely be explained by surveillance and physician bias thus highlighting the need to investigate the potential consequences of the dust exposure, containing carcinogenic and endocrine disruptive elements, on the thyroid. This study investigated the presence of TERT promoter and BRAF V600E mutations in 20 WTC-exposed versus 23 matched non-exposed thyroid cancers as potential mechanism explaining the excess risk. Although no significant difference in BRAF V600E mutation was found, TERT promoter mutations were significantly more prevalent in WTC thyroid cancer versus non-exposed thyroid cancers (P = 0.021). The odds of a TERT promoter mutation was significantly higher in the WTC versus the non-WTC thyroid cancers after adjustment [ORadj: 7.11 (95% CI: 1.21-41.83)]. These results may indicate that exposure to the mixture of pollutants present in the WTC dust resulted in an excess thyroid cancer risk and potentially more aggressive thyroid cancer, warranting investigating WTC responders on thyroid-associated symptoms during their health checkups. Future studies should include long-term follow-up to provide important insights in whether thyroid-specific survival is negatively affected by WTC dust exposure and whether this is because of the presence of one or more driver mutations.

Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders.

How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders. We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders. Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment. Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one. People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.

Prevalence of and Risk Factors for Hepatitis C Virus Infection in World Trade Center Responders.

The risk of hepatitis C virus (HCV) infection among emergency responders exposed to human remains, blood/bodily fluids, and/or sewage is unknown.Methods: A cross-sectional study of 3871 World Trade Center General Responder Cohort (WTCGRC) members followed at the Icahn School of Medicine at Mount Sinai, born from 1945-1965, and recruited from 2016-2018 were tested for HCV infection, and prevalence was compared to National Health and Nutrition Examination Survey data from 2003 to 2012. A nested case-control study compared 61 HCV antibody positive cases to 2571 controls. Multivariable logistic regression models adjusting for time of birth, traditional HCV risk factors, and type of work at the World Trade Center (WTC) site, determined if contact with human remains, blood/bodily fluids, and/or sewage at the WTC site was associated with HCV infection.Results: The age-standardized point prevalence of HCV infection among WTCGRC members was 2.98% [95% CI (2.39, 3.56)] and in the US population was 3.33% [95% CI (2.54, 4.11)] [% difference = 0.35%, 95% CI (- 0.31%, 1.01%), P=0.47]. In separate multivariable models, adjusting for possible confounders, contact with human remains was not associated with HCV infection [OR = 1.10, 95%CI(0.63, 1.91), P = 0.74)], contact with blood and/or bodily fluids was not associated with HCV infection [OR = 1.45, 95%CI(0.82, 2.56), P = 0.20], and contact with sewage was significantly associated with HCV infection [OR = 1.72, 95%CI(1.00, 2.98), P = 0.05].Conclusion: Contact with sewage may increase the risk of HCV infection.

Explainable automated evaluation of the clock drawing task for memory impairment screening.

The clock drawing task (CDT) is frequently used to aid in detecting cognitive impairment, but current scoring techniques are time-consuming and miss relevant features, justifying the creation of an automated quantitative scoring approach. We used computer vision methods to analyze the stored scanned images (N=7,109), and an intelligent system was created to examine these files in a study of aging World Trade Center responders. Outcomes were CDT, Montreal Cognitive Assessment (MoCA) score, and incidence of mild cognitive impairment (MCI). The system accurately distinguished between previously scored CDTs in three CDT scoring categories: contour (accuracy=92.2%), digits (accuracy=89.1%), and clock hands (accuracy=69.1%). The system reliably predicted MoCA score with CDT scores removed. Predictive analyses of the incidence of MCI at follow-up outperformed human-assigned CDT scores. We created an automated scoring method using scanned and stored CDTs that provided additional information that might not be considered in human scoring.

Genetic Liability, Exposure Severity, and Post-Traumatic Stress Disorder Predict Cognitive Impairment in World Trade Center Responders.

There is a high incidence of cognitive impairment among World Trade Center (WTC) responders, comorbid with post-traumatic stress disorder (PTSD). Yet, it remains unknown whether genetic liability for Alzheimer's disease, PTSD, educational attainment, or for a combination of these phenotypes, is associated with cognitive impairment in this high-risk population. Similarly, whether the effects of genetic liability are comparable to PTSD and indicators of exposure severity remains unknown. In a study of 3,997 WTC responders, polygenic scores for Alzheimer's disease, PTSD, and educational attainment were used to test whether genome-wide risk for one or more of these phenotypes is associated with cognitive impairment, controlling for population stratification, while simultaneously estimating the effects of demographic factors and indicators of 9/11 exposure severity, including symptoms of PTSD. Polygenic scores for Alzheimer's disease and educational attainment were significantly associated with an increase and decrease, respectively, in the hazard rate of mild cognitive impairment. The polygenic score for Alzheimer's disease was marginally associated with an increase in the hazard rate of severe cognitive impairment, but only age, exposure severity, and symptoms of PTSD were statistically significant predictors. These results add to the emerging evidence that many WTC responders are suffering from mild cognitive impairments that resemble symptoms of Alzheimer's disease, as genetic liability for Alzheimer's disease predicted incidence of mild cognitive impairment. However, compared to polygenic scores, effect sizes were larger for PTSD and the type of work that responders completed during rescue and recovery efforts.