%PDF-1.6
%
1 0 obj
<>
endobj
2 0 obj
<>stream
John D. Beard, Lawrence S. Engel, David B. Richardson, Marilie D. Gammon, Coleen Baird, David M. Umbach, Kelli D. Allen, Catherine L. Stanwyck, Jean Keller, Dale P. Sandler, Silke Schmidt, Freya Kamel
Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival
www.plosone.org
www.plosone.org
endstream
endobj
3 0 obj
<>/XObject<>>>/CropBox[0 0 612 792]/MediaBox[0 0 612 792]/Parent 11 0 R/Annots 12 0 R/Contents 13 0 R/TrimBox[0 0 612 792]>>
endobj
12 0 obj
[14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R]
endobj
14 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref001)>>
endobj
15 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref001)>>
endobj
16 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref002)>>
endobj
17 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref005)>>
endobj
18 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref002)>>
endobj
19 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref006)>>
endobj
20 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref002)>>
endobj
21 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref003)>>
endobj
22 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref002)>>
endobj
23 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref005)>>
endobj
24 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref006)>>
endobj
25 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref002)>>
endobj
26 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref002)>>
endobj
27 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref007)>>
endobj
28 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref010)>>
endobj
29 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref005)>>
endobj
30 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref006)>>
endobj
31 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref011)>>
endobj
32 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref012)>>
endobj
33 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref013)>>
endobj
34 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref011)>>
endobj
35 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref006)>>
endobj
36 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref012)>>
endobj
37 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref005)>>
endobj
38 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref014)>>
endobj
39 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref005)>>
endobj
40 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref015)>>
endobj
41 0 obj
<>/Border[0 0 0]/A 48 0 R>>
endobj
48 0 obj
<>
endobj
42 0 obj
<>/Border[0 0 0]/A 49 0 R>>
endobj
49 0 obj
<>
endobj
43 0 obj
<>/Border[0 0 0]/A 50 0 R>>
endobj
50 0 obj
<>
endobj
44 0 obj
<>/Border[0 0 0]/A 51 0 R>>
endobj
51 0 obj
<>
endobj
45 0 obj
<>/Border[0 0 0]/A 52 0 R>>
endobj
52 0 obj
<>
endobj
46 0 obj
<>/Border[0 0 0]/A 53 0 R>>
endobj
53 0 obj
<>
endobj
47 0 obj
<>/Border[0 0 0]/A 54 0 R>>
endobj
54 0 obj
<>
endobj
13 0 obj
[55 0 R 56 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R]
endobj
55 0 obj
<>stream
q
0.45 0.36 0.35 0.01 k
0 w
575.9997 510.91 m
199.9998 510.91 l
199.9998 511.41 l
575.9997 511.41 l
f*
0.83 0.64 0.02 0 k
341.6882 404.8441 m
346.4504 404.8441 l
h
f*
309.0898 391.8047 m
313.852 391.8047 l
h
f*
377.4047 378.822 m
382.1669 378.822 l
h
f*
387.326 378.822 m
392.0882 378.822 l
h
f*
455.0173 378.822 m
459.7795 378.822 l
h
f*
464.9953 378.822 m
469.7008 378.822 l
h
f*
340.1575 365.8394 m
344.9197 365.8394 l
h
f*
349.3417 365.8394 m
354.1039 365.8394 l
h
f*
462.4441 365.8394 m
467.2063 365.8394 l
h
f*
471.6283 365.8394 m
476.3906 365.8394 l
h
f*
480.8693 365.8394 m
485.6315 365.8394 l
h
f*
251.4331 352.8567 m
256.1953 352.8567 l
h
f*
534.1606 300.8126 m
538.9228 300.8126 l
h
f*
499.6913 261.8079 m
504.4535 261.8079 l
h
f*
509.6126 261.8079 m
519.137 261.8079 l
h
f*
238.6205 235.8425 m
243.3827 235.8425 l
h
f*
247.8614 235.8425 m
252.6236 235.8425 l
h
f*
257.0457 235.8425 m
266.5701 235.8425 l
h
f*
271.0488 235.8425 m
280.5165 235.8425 l
h
f*
278.9858 209.8205 m
288.5102 209.8205 l
h
f*
527.6976 209.8205 m
537.222 209.8205 l
h
f*
346.1102 183.8551 m
350.8724 183.8551 l
h
f*
318.8409 170.8157 m
328.3087 170.8157 l
h
f*
404.1638 170.8157 m
408.926 170.8157 l
h
f*
412.5543 157.8331 m
422.0787 157.8331 l
h
f*
300.8126 131.811 m
305.5748 131.811 l
h
f*
361.7575 92.8063 m
371.2819 92.8063 l
h
f*
0 g
1 j
1 J
11.4998 0 0 11.4998 200.0125 706.3937 cm
BT
/F2 1 Tf
1 TL
-0.0035 Tc
0 0 Td
(Results)Tj
ET
Q
q
1 j
1 J
0 w
9.5 0 0 9.5 200.0125 689.3858 cm
BT
/F0 1 Tf
1 TL
-0.0042 Tc
0 0 Td
(We)Tj
1.7127 0 Td
(observed)Tj
4.2847 0 Td
(446)Tj
1.8679 0 Td
(deaths)Tj
3.1867 0 Td
(during)Tj
2.96 0 Td
(24,267)Tj
3.2404 0 Td
(person-months)Tj
6.8211 0 Td
(of)Tj
1.0503 0 Td
(follow-up)Tj
4.1654 0 Td
(\(median)Tj
3.7895 0 Td
(follow-up:)Tj
4.4459 0 Td
(28)Tj
-37.5246 -1.474 Td
(months\).)Tj
4.0759 0 Td
(Survival)Tj
3.7357 0 Td
(was)Tj
1.9813 0 Td
(shorter)Tj
3.3001 0 Td
(for)Tj
1.3725 0 Td
(cases)Tj
2.8048 0 Td
(who)Tj
2.035 0 Td
(served)Tj
3.1927 0 Td
(before)Tj
3.0196 0 Td
(1950,)Tj
2.6915 0 Td
(were)Tj
2.3631 0 Td
(deployed)Tj
4.2251 0 Td
(to)Tj
1.0444 0 Td
(World)Tj
-35.8417 -1.468 Td
(War)Tj
2.0409 0 Td
(II,)Tj
1.0563 0 Td
(or)Tj
1.098 0 Td
(mixed)Tj
2.8585 0 Td
(and)Tj
1.8619 0 Td
(applied)Tj
3.3956 0 Td
(burning)Tj
3.509 0 Td
(agents,)Tj
3.4672 0 Td
(with)Tj
1.9753 0 Td
(HRs)Tj
2.1484 0 Td
(between)Tj
3.9565 0 Td
(1.58)Tj
2.1424 0 Td
(and)Tj
1.8679 0 Td
(2.57.)Tj
2.4228 0 Td
(Longer)Tj
3.2882 0 Td
(sur-)Tj
-37.0889 -1.474 Td
(vival)Tj
2.1901 0 Td
(was)Tj
1.9812 0 Td
(associated)Tj
4.9472 0 Td
(with)Tj
1.9753 0 Td
(exposure)Tj
4.2848 0 Td
(to:)Tj
1.3248 0 Td
(paint,)Tj
2.6377 0 Td
(solvents,)Tj
4.1237 0 Td
(or)Tj
1.098 0 Td
(petrochemical)Tj
6.3735 0 Td
(substances;)Tj
5.5022 0 Td
(local)Tj
-36.4385 -1.474 Td
(food)Tj
2.1423 0 Td
(not)Tj
1.5934 0 Td
(provided)Tj
4.0043 0 Td
(by)Tj
1.2651 0 Td
(the)Tj
1.5994 0 Td
(Armed)Tj
3.139 0 Td
(Forces;)Tj
3.5268 0 Td
(or)Tj
1.0981 0 Td
(burning)Tj
3.509 0 Td
(agents)Tj
3.1927 0 Td
(or)Tj
1.098 0 Td
(Agent)Tj
2.8048 0 Td
(Orange)Tj
3.5209 0 Td
(in)Tj
0.9847 0 Td
(the)Tj
1.5934 0 Td
(field)Tj
2.029 0 Td
(with)Tj
-37.1009 -1.474 Td
(HRs)Tj
2.1483 0 Td
(between)Tj
3.9566 0 Td
(0.56)Tj
2.1423 0 Td
(and)Tj
1.8679 0 Td
(0.73.)Tj
ET
Q
q
1 j
1 J
0 w
11.4998 0 0 11.4998 200.0125 569.4236 cm
BT
/F2 1 Tf
1 TL
-0.0035 Tc
0 0 Td
(Conclusions)Tj
ET
Q
q
1 j
1 J
0 w
9.5 0 0 9.5 200.0125 552.4157 cm
BT
/F0 1 Tf
1 TL
-0.0042 Tc
0 0 Td
(Although)Tj
4.1176 0 Td
(most)Tj
2.3752 0 Td
(military-related)Tj
6.6897 0 Td
(factors)Tj
3.1987 0 Td
(were)Tj
2.3632 0 Td
(not)Tj
1.5933 0 Td
(associated)Tj
4.9472 0 Td
(with)Tj
1.9753 0 Td
(survival,)Tj
3.8432 0 Td
(associations)Tj
5.6573 0 Td
(we)Tj
-36.7607 -1.474 Td
(observed)Tj
4.2847 0 Td
(with)Tj
1.9753 0 Td
(shorter)Tj
3.3001 0 Td
(survival)Tj
3.5687 0 Td
(are)Tj
1.6471 0 Td
(potentially)Tj
4.6607 0 Td
(important)Tj
4.3445 0 Td
(because)Tj
3.9565 0 Td
(of)Tj
1.0444 0 Td
(the)Tj
1.5933 0 Td
(large)Tj
2.4109 0 Td
(number)Tj
3.5747 0 Td
(of)Tj
1.0503 0 Td
(mili-)Tj
-37.4112 -1.474 Td
(tary)Tj
1.8738 0 Td
(veterans.)Tj
ET
Q
q
1 j
1 J
0 w
11.9999 0 0 11.9999 200.0125 435.9118 cm
BT
/F2 1 Tf
1 TL
-0.0033 Tc
0 0 Td
(Introduction)Tj
ET
Q
q
1 j
1 J
0 w
10 0 0 10 200.0125 418.9039 cm
BT
/F7 1 Tf
1 TL
-0.004 Tc
0 0 Td
(Amyotrophic)Tj
5.5955 0 Td
(lateral)Tj
2.6759 0 Td
(sclerosis)Tj
3.5376 0 Td
(\(ALS\))Tj
2.6022 0 Td
(is)Tj
0.8447 0 Td
(a)Tj
0.6577 0 Td
(debilitating)Tj
4.7678 0 Td
(neurodegenerative)Tj
7.6592 0 Td
(disease)Tj
3.016 0 Td
(of)Tj
1.0148 0 Td
(motor)Tj
2.7269 0 Td
(neu-)Tj
-35.0983 -1.2982 Td
(rons)Tj
2.0069 0 Td
(in)Tj
1.0374 0 Td
(the)Tj
1.4684 0 Td
(central)Tj
2.965 0 Td
(nervous)Tj
3.4129 0 Td
(system)Tj
2.9367 0 Td
([)Tj
0.83 0.64 0.02 0 k
(1)Tj
0 g
(].)Tj
1.6044 0 Td
(Median)Tj
3.3108 0 Td
(survival)Tj
3.3392 0 Td
(after)Tj
2.0353 0 Td
(diagnosis)Tj
3.9571 0 Td
(is)Tj
0.8504 0 Td
(three)Tj
2.262 0 Td
(years,)Tj
2.4888 0 Td
(but)Tj
1.5534 0 Td
(4%)Tj
1.4513 0 Td
(of)Tj
-36.68 -1.3039 Td
(cases)Tj
2.2223 0 Td
(survive)Tj
3.0784 0 Td
(past)Tj
1.8312 0 Td
(10)Tj
1.1735 0 Td
(years)Tj
2.262 0 Td
([)Tj
0.83 0.64 0.02 0 k
(1)Tj
0 g
(].)Tj
1.5988 0 Td
(Factors)Tj
3.1464 0 Td
(consistently)Tj
4.9549 0 Td
(associated)Tj
4.2576 0 Td
(with)Tj
2.0013 0 Td
(rapid)Tj
2.3357 0 Td
(progression)Tj
4.9209 0 Td
(or)Tj
-33.783 -1.2983 Td
(shorter)Tj
3.0784 0 Td
(survival)Tj
3.3391 0 Td
(include)Tj
3.1805 0 Td
(older)Tj
2.296 0 Td
(diagnosis)Tj
3.9629 0 Td
(age)Tj
1.542 0 Td
([)Tj
0.83 0.64 0.02 0 k
(2)Tj
0 g
()Tj
0.83 0.64 0.02 0 k
(5)Tj
0 g
(],)Tj
2.5908 0 Td
(bulbar)Tj
2.812 0 Td
(onset)Tj
2.3584 0 Td
([)Tj
0.83 0.64 0.02 0 k
(2)Tj
0 g
()Tj
0.83 0.64 0.02 0 k
(6)Tj
0 g
(],)Tj
2.5965 0 Td
(clinical)Tj
3.0784 0 Td
(features)Tj
3.3449 0 Td
(\(e.g.,)Tj
-34.1799 -1.2983 Td
(worse)Tj
2.5681 0 Td
(functional/disability)Tj
8.2658 0 Td
(status\))Tj
2.8403 0 Td
([)Tj
0.83 0.64 0.02 0 k
(2)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.2586 0 Td
(3)Tj
0 g
(],)Tj
1.2642 0 Td
(shorter)Tj
3.0784 0 Td
(diagnostic)Tj
4.32 0 Td
(delay)Tj
2.3074 0 Td
([)Tj
0.83 0.64 0.02 0 k
(2)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.2586 0 Td
(5)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
0.924 0 Td
(6)Tj
0 g
(],)Tj
1.2586 0 Td
(and)Tj
1.7291 0 Td
(definite)Tj
3.2655 0 Td
(diagno-)Tj
-34.3386 -1.2982 Td
(sis)Tj
1.2075 0 Td
(category)Tj
3.5943 0 Td
([)Tj
0.83 0.64 0.02 0 k
(2)Tj
0 g
(].)Tj
1.5987 0 Td
(Few)Tj
1.8539 0 Td
(studies,)Tj
3.2088 0 Td
(however,)Tj
3.8324 0 Td
(have)Tj
2.0579 0 Td
(considered)Tj
4.5978 0 Td
(non-clinical)Tj
5.0286 0 Td
(\(e.g.,)Tj
2.1203 0 Td
(occupational)Tj
5.3518 0 Td
(or)Tj
1.0999 0 Td
(envi-)Tj
-35.5519 -1.3039 Td
(ronmental\))Tj
4.7565 0 Td
(prognostic)Tj
4.4843 0 Td
(factors)Tj
2.9027 0 Td
(for)Tj
1.389 0 Td
(ALS)Tj
1.9162 0 Td
(survival,)Tj
3.5603 0 Td
(but)Tj
1.5533 0 Td
(these)Tj
2.2564 0 Td
(factors)Tj
2.9027 0 Td
(could)Tj
2.4548 0 Td
(help)Tj
1.9332 0 Td
(explain)Tj
3.1181 0 Td
(the)Tj
-33.2275 -1.2983 Td
(extremely)Tj
4.1442 0 Td
(heterogeneous)Tj
6.0264 0 Td
(survival)Tj
3.3392 0 Td
(of)Tj
1.0148 0 Td
(ALS)Tj
1.9162 0 Td
(patients.)Tj
3.5943 0 Td
(In)Tj
1.1112 0 Td
(addition,)Tj
3.8211 0 Td
(identifying)Tj
4.575 0 Td
(associations)Tj
-29.5424 -1.2983 Td
(between)Tj
3.5262 0 Td
(non-clinical)Tj
5.0343 0 Td
(factors)Tj
2.9027 0 Td
(and)Tj
1.7291 0 Td
(ALS)Tj
1.9162 0 Td
(survival)Tj
3.3392 0 Td
(could)Tj
2.4491 0 Td
(help)Tj
1.9332 0 Td
(clinicians)Tj
4.0082 0 Td
(target)Tj
2.5115 0 Td
(interventions)Tj
5.5388 0 Td
(that)Tj
-34.8885 -1.3039 Td
(may)Tj
1.9275 0 Td
(have)Tj
2.0579 0 Td
(the)Tj
1.4684 0 Td
(potential)Tj
3.7644 0 Td
(to)Tj
1.0261 0 Td
(lengthen)Tj
3.702 0 Td
(survival,)Tj
3.5603 0 Td
(such)Tj
2.058 0 Td
(as)Tj
1.0147 0 Td
(interdisciplinary)Tj
6.8145 0 Td
(palliative)Tj
3.8097 0 Td
(care)Tj
1.8709 0 Td
([)Tj
0.83 0.64 0.02 0 k
(2)Tj
0 g
(],)Tj
1.6044 0 Td
(to)Tj
-34.6788 -1.2983 Td
(patients)Tj
3.3675 0 Td
(at)Tj
0.9524 0 Td
(greatest)Tj
3.2939 0 Td
(risk)Tj
1.7177 0 Td
(of)Tj
1.0148 0 Td
(shorter)Tj
3.0784 0 Td
(survival.)Tj
-12.2285 -1.2982 Td
(Limited)Tj
3.3618 0 Td
(evidence)Tj
3.7134 0 Td
(suggests)Tj
3.4866 0 Td
(ALS)Tj
1.9162 0 Td
(rates)Tj
2.109 0 Td
(may)Tj
1.9275 0 Td
(be)Tj
1.1509 0 Td
(higher)Tj
2.8006 0 Td
(among)Tj
2.9933 0 Td
(military)Tj
3.3789 0 Td
(veterans,)Tj
3.7587 0 Td
(particularly)Tj
-31.7931 -1.3039 Td
(those)Tj
2.3357 0 Td
(deployed)Tj
3.8494 0 Td
(to)Tj
1.0261 0 Td
(the)Tj
1.4684 0 Td
(19901991)Tj
4.5411 0 Td
(Persian)Tj
3.1861 0 Td
(Gulf)Tj
1.9956 0 Td
(War)Tj
1.9899 0 Td
(\(hereafter)Tj
4.1215 0 Td
(Gulf)Tj
2.3924 0 Td
(War\))Tj
2.7213 0 Td
([)Tj
0.83 0.64 0.02 0 k
(7)Tj
0 g
()Tj
0.83 0.64 0.02 0 k
(10)Tj
0 g
(].)Tj
3.0727 0 Td
(The)Tj
1.7802 0 Td
(few)Tj
-34.4804 -1.2983 Td
(studies)Tj
2.9876 0 Td
(that)Tj
1.7745 0 Td
(examined)Tj
4.1329 0 Td
(associations)Tj
4.989 0 Td
(between)Tj
3.5262 0 Td
(military-related)Tj
6.4516 0 Td
(factors)Tj
2.9027 0 Td
(and)Tj
1.7348 0 Td
(ALS)Tj
1.9162 0 Td
(survival)Tj
3.3335 0 Td
(or)Tj
1.0999 0 Td
(pro-)Tj
-34.8489 -1.2983 Td
(gression)Tj
3.5206 0 Td
([)Tj
0.83 0.64 0.02 0 k
(5)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.2642 0 Td
(6)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
0.9184 0 Td
(11)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.4003 0 Td
(12)Tj
0 g
(])Tj
1.508 0 Td
(conflict)Tj
3.2259 0 Td
(and)Tj
1.7291 0 Td
(contain)Tj
3.2485 0 Td
(sparse)Tj
2.6872 0 Td
(exposure)Tj
3.8154 0 Td
(information.)Tj
5.3008 0 Td
(A)Tj
0.907 0 Td
(study)Tj
2.3868 0 Td
(of)Tj
1.0148 0 Td
(the)Tj
1.4683 0 Td
(ALS)Tj
-34.3953 -1.2982 Td
(Clinical)Tj
3.3165 0 Td
(Assessment,)Tj
5.0853 0 Td
(Research)Tj
3.8041 0 Td
(and)Tj
1.7347 0 Td
(Education)Tj
4.32 0 Td
(database,)Tj
3.8665 0 Td
(a)Tj
0.6519 0 Td
(non-military)Tj
5.3348 0 Td
(database)Tj
3.6397 0 Td
(of)Tj
1.0147 0 Td
(North)Tj
-32.7682 -1.3039 Td
(American)Tj
4.1895 0 Td
(patients)Tj
3.3676 0 Td
([)Tj
0.83 0.64 0.02 0 k
(13)Tj
0 g
(],)Tj
2.0806 0 Td
(found)Tj
2.6192 0 Td
(no)Tj
1.2756 0 Td
(association)Tj
4.6261 0 Td
(between)Tj
3.5263 0 Td
(veteran)Tj
3.1747 0 Td
(status)Tj
2.5002 0 Td
(and)Tj
1.7291 0 Td
(survival)Tj
3.3392 0 Td
([)Tj
0.83 0.64 0.02 0 k
(11)Tj
0 g
(],)Tj
-32.4281 -1.2983 Td
(whereas)Tj
3.4412 0 Td
(a)Tj
0.6576 0 Td
(study)Tj
2.3868 0 Td
(in)Tj
1.0375 0 Td
(Massachusetts)Tj
5.9187 0 Td
(reported)Tj
3.6623 0 Td
(being)Tj
2.4264 0 Td
(a)Tj
0.6577 0 Td
(male)Tj
2.1429 0 Td
(veteran)Tj
3.1692 0 Td
(was)Tj
1.7007 0 Td
(associated)Tj
4.2576 0 Td
(with)Tj
1.9956 0 Td
(faster)Tj
2.3925 0 Td
(pro-)Tj
-35.8467 -1.2983 Td
(gression)Tj
3.5206 0 Td
(after)Tj
2.0352 0 Td
(one)Tj
1.7008 0 Td
(year)Tj
1.9049 0 Td
(of)Tj
1.0148 0 Td
(follow-up)Tj
4.0932 0 Td
([)Tj
0.83 0.64 0.02 0 k
(6)Tj
0 g
(].)Tj
1.5987 0 Td
(Deployment)Tj
5.1987 0 Td
(to)Tj
1.0261 0 Td
(the)Tj
1.4684 0 Td
(Gulf)Tj
1.9956 0 Td
(War)Tj
1.9899 0 Td
(was)Tj
1.7007 0 Td
(associated)Tj
4.2577 0 Td
(with)Tj
-33.5053 -1.3039 Td
(shorter)Tj
3.0784 0 Td
(survival)Tj
3.3391 0 Td
(in)Tj
1.0319 0 Td
(one)Tj
1.7007 0 Td
(study)Tj
2.3925 0 Td
([)Tj
0.83 0.64 0.02 0 k
(12)Tj
0 g
(],)Tj
2.0749 0 Td
(but)Tj
1.5534 0 Td
(not)Tj
1.5704 0 Td
(another)Tj
3.3335 0 Td
([)Tj
0.83 0.64 0.02 0 k
(5)Tj
0 g
(].)Tj
1.5987 0 Td
(The)Tj
1.7858 0 Td
(latter,)Tj
2.5172 0 Td
(based)Tj
2.4718 0 Td
(on)Tj
1.2756 0 Td
(the)Tj
1.4683 0 Td
(U.S.)Tj
1.8822 0 Td
(National)Tj
-33.0744 -1.2983 Td
(Registry)Tj
3.4809 0 Td
(of)Tj
1.0148 0 Td
(Veterans)Tj
3.7757 0 Td
(with)Tj
1.9956 0 Td
(ALS)Tj
1.9218 0 Td
(\(hereafter)Tj
4.1216 0 Td
(Registry\))Tj
4.6034 0 Td
([)Tj
0.83 0.64 0.02 0 k
(14)Tj
0 g
(],)Tj
2.075 0 Td
(also)Tj
1.7688 0 Td
(found)Tj
2.6192 0 Td
(shorter)Tj
3.0841 0 Td
(survival)Tj
3.3335 0 Td
(was)Tj
1.7008 0 Td
(asso-)Tj
-35.4952 -1.2982 Td
(ciated)Tj
2.5908 0 Td
(with)Tj
2.0012 0 Td
(deployment)Tj
4.9833 0 Td
(to)Tj
1.0262 0 Td
(Vietnam,)Tj
3.9344 0 Td
(but)Tj
1.5477 0 Td
(not)Tj
1.5761 0 Td
(with)Tj
1.9956 0 Td
(cumulative)Tj
4.6431 0 Td
(military)Tj
3.3789 0 Td
(service,)Tj
3.1691 0 Td
(service)Tj
2.948 0 Td
(branch,)Tj
-33.7944 -1.3039 Td
(or)Tj
1.0941 0 Td
(deployment)Tj
4.989 0 Td
(to)Tj
1.0261 0 Td
(Korea)Tj
2.6305 0 Td
([)Tj
0.83 0.64 0.02 0 k
(5)Tj
0 g
(].)Tj
1.5988 0 Td
(We)Tj
1.61 0 Td
(evaluated)Tj
3.9912 0 Td
(associations)Tj
4.9889 0 Td
(between)Tj
3.5263 0 Td
(ALS)Tj
1.9162 0 Td
(survival)Tj
3.3392 0 Td
(and)Tj
1.7291 0 Td
(aspects)Tj
3.0388 0 Td
(of)Tj
-35.4782 -1.2983 Td
(military)Tj
3.3788 0 Td
(service,)Tj
3.1691 0 Td
(deployments,)Tj
5.5729 0 Td
(and)Tj
1.7291 0 Td
(39)Tj
1.1736 0 Td
(related)Tj
2.9423 0 Td
(exposures)Tj
4.1783 0 Td
(using)Tj
2.3867 0 Td
(additional)Tj
4.2803 0 Td
(data)Tj
1.9162 0 Td
(on)Tj
1.2756 0 Td
(a)Tj
0.652 0 Td
(subset)Tj
2.6985 0 Td
(of)Tj
-35.3534 -1.2983 Td
(Registry)Tj
3.4809 0 Td
(cases)Tj
2.2223 0 Td
(enrolled)Tj
3.515 0 Td
(in)Tj
1.0374 0 Td
(the)Tj
1.4684 0 Td
(Genes)Tj
2.6929 0 Td
(and)Tj
1.7291 0 Td
(Environmental)Tj
6.2588 0 Td
(Exposures)Tj
4.32 0 Td
(in)Tj
1.0375 0 Td
(Veterans)Tj
3.7757 0 Td
(with)Tj
1.9956 0 Td
(Amyotro-)Tj
-33.5336 -1.3039 Td
(phic)Tj
1.9558 0 Td
(Lateral)Tj
2.9651 0 Td
(Sclerosis)Tj
3.6566 0 Td
(study)Tj
2.3868 0 Td
(\(GENEVA\))Tj
4.8699 0 Td
([)Tj
0.83 0.64 0.02 0 k
(15)Tj
0 g
(].)Tj
ET
Q
q
1 j
1 J
0 w
576 737.1 m
36 737.1 l
36 737.6 l
576 737.6 l
f*
36 741.2598 107.1496 23.6976 re
W* n
q
107.0929 0 0 23.6409 36 741.3165 cm
q
/I0 Do
Q
Q
Q
q
0 0 612 792 re
W* n
1 j
1 J
0 w
7.9999 0 0 7.9999 360.9637 745.7952 cm
BT
/F0 1 Tf
1 TL
-0.005 Tc
0 0 Td
(Military)Tj
3.3236 0 Td
(service,)Tj
3.6071 0 Td
(deploymen)Tj
4.8048 0 Td
(ts,)Tj
1.2614 0 Td
(and)Tj
1.8567 0 Td
(exposure)Tj
4.0394 0 Td
(s)Tj
0.7158 0 Td
(and)Tj
1.8567 0 Td
(ALS)Tj
2.0835 0 Td
(survival)Tj
ET
Q
q
1 j
1 J
0 w
36 48.0002 m
576 48.0002 l
576 47.5002 l
36 47.5002 l
f*
0.83 0.64 0.02 0 k
81.5811 34.9228 m
237.8835 34.9228 l
h
f*
0 g
7.9999 0 0 7.9999 36 36 cm
BT
/F0 1 Tf
1 TL
-0.005 Tc
0 0 Td
(PLOS)Tj
2.8559 0 Td
(ONE)Tj
2.3669 0 Td
(|)Tj
0.83 0.64 0.02 0 k
0.4748 0 Td
(https://doi.or)Tj
5.4142 0 Td
(g/10.137)Tj
3.8198 0 Td
(1/journal.po)Tj
5.1236 0 Td
(ne.01857)Tj
4.089 0 Td
(51)Tj
0 g
2.0906 0 Td
(October)Tj
3.7276 0 Td
(10,)Tj
1.5874 0 Td
(2017)Tj
33.5908 0 Td
(2)Tj
0.7654 0 Td
(/)Tj
0.496 0 Td
(22)Tj
ET
Q
q
0.83 0.64 0.02 0 k
1 j
1 J
0 w
58.1102 663.6472 m
123.6472 663.6472 l
h
f*
62.8157 652.6488 m
133.9087 652.6488 l
h
f*
73.4173 569.6504 m
153.0142 569.6504 l
h
f*
114.4063 547.6535 m
174.6142 547.6535 l
h
f*
38.4378 492.6614 m
116.7874 492.6614 l
h
f*
38.4378 459.6661 m
94.6772 459.6661 l
h
f*
0 g
7.9999 0 0 7.9999 36 708.7181 cm
BT
/F9 1 Tf
1 TL
-0.025 Tc
0 0 Td
(however,)Tj
3.6 0 Td
(a)Tj
0.6449 0 Td
(formal)Tj
2.622 0 Td
(data)Tj
1.793 0 Td
(request)Tj
2.9905 0 Td
(must)Tj
2.126 0 Td
(be)Tj
1.1126 0 Td
(submitted)Tj
-14.889 -1.3748 Td
(and)Tj
1.5874 0 Td
(approved.)Tj
3.9118 0 Td
(The)Tj
1.5874 0 Td
(authors)Tj
3.0473 0 Td
(invite)Tj
2.1756 0 Td
(those)Tj
2.2677 0 Td
(wishing)Tj
3.0827 0 Td
(to)Tj
-17.6599 -1.3748 Td
(access)Tj
2.7496 0 Td
(the)Tj
1.3677 0 Td
(raw)Tj
1.5874 0 Td
(data)Tj
1.7929 0 Td
(that)Tj
1.63 0 Td
(were)Tj
2.0055 0 Td
(used)Tj
2.0126 0 Td
(for)Tj
1.2544 0 Td
(this)Tj
1.5661 0 Td
(analysis)Tj
-15.9662 -1.3748 Td
(to)Tj
0.9496 0 Td
(contact)Tj
2.9409 0 Td
(the)Tj
1.3678 0 Td
(Repository)Tj
4.252 0 Td
(Coordinat)Tj
3.5929 0 Td
(ors,)Tj
1.6512 0 Td
(Kristina)Tj
-14.7544 -1.3748 Td
(Felder)Tj
2.459 0 Td
(\()Tj
0.83 0.64 0.02 0 k
(kristina.fe)Tj
3.8906 0 Td
(lder@va.gov)Tj
0 g
4.6063 0 Td
(\))Tj
0.5315 0 Td
(and)Tj
1.5875 0 Td
(Meghan)Tj
-13.0749 -1.3748 Td
(O'Leary)Tj
3.0472 0 Td
(\()Tj
0.83 0.64 0.02 0 k
(meghan.o)Tj
4.0182 0 Td
('leary@va.go)Tj
4.748 0 Td
(v)Tj
0 g
(\),)Tj
1.1764 0 Td
(to)Tj
0.9425 0 Td
(discuss)Tj
3.0473 0 Td
(the)Tj
-16.9796 -1.3748 Td
(details)Tj
2.6008 0 Td
(of)Tj
0.9496 0 Td
(the)Tj
1.3677 0 Td
(VA)Tj
1.2685 0 Td
(CSPEC-Durha)Tj
5.1449 0 Td
(m)Tj
0.978 0 Td
(Data)Tj
1.9063 0 Td
(and)Tj
1.5874 0 Td
(Serum)Tj
-15.8032 -1.3748 Td
(Repository)Tj
4.2449 0 Td
(data)Tj
1.7929 0 Td
(access)Tj
2.7496 0 Td
(approval)Tj
3.4087 0 Td
(process)Tj
2.9339 0 Td
(.)Tj
/F8 1 Tf
-15.13 -2.126 Td
(Funding:)Tj
/F9 1 Tf
3.5716 0 Td
(This)Tj
1.7788 0 Td
(work)Tj
2.0622 0 Td
(was)Tj
1.7008 0 Td
(supported)Tj
3.9969 0 Td
(by)Tj
1.1126 0 Td
(the)Tj
-14.2229 -1.3749 Td
(Intramural)Tj
4.0819 0 Td
(Research)Tj
3.6921 0 Td
(Program)Tj
3.4867 0 Td
(of)Tj
0.9496 0 Td
(the)Tj
1.3677 0 Td
(National)Tj
-13.578 -1.3748 Td
(Institutes)Tj
3.6425 0 Td
(of)Tj
0.9496 0 Td
(Health,)Tj
2.7992 0 Td
(National)Tj
3.2387 0 Td
(Institute)Tj
3.2244 0 Td
(of)Tj
-13.8544 -1.3748 Td
(Environme)Tj
3.9897 0 Td
(ntal)Tj
1.5662 0 Td
(Health)Tj
2.5725 0 Td
(Sciences)Tj
3.5149 0 Td
(\(NIEHS;)Tj
3.182 0 Td
(Z01)Tj
-14.8253 -1.3748 Td
(ES049005\))Tj
4.3653 0 Td
(\()Tj
0.83 0.64 0.02 0 k
(https://www)Tj
4.8402 0 Td
(.niehs.nih.g)Tj
4.2662 0 Td
(ov/)Tj
0 g
(\),)Tj
1.9063 0 Td
(grants)Tj
-15.378 -1.3748 Td
(from)Tj
2.0126 0 Td
(the)Tj
1.3677 0 Td
(NIEHS)Tj
2.6504 0 Td
(\(R01)Tj
2.0622 0 Td
(ES13244\))Tj
3.8906 0 Td
(and)Tj
1.5874 0 Td
(the)Tj
1.3748 0 Td
(ALS)Tj
-14.9457 -1.3748 Td
(Association)Tj
4.4929 0 Td
(\(ALSA)Tj
2.5795 0 Td
(1230\))Tj
2.4166 0 Td
(\()Tj
0.83 0.64 0.02 0 k
(http://ww)Tj
3.7772 0 Td
(w.alsa.org/)Tj
0 g
(\),)Tj
-13.2662 -1.3748 Td
(and)Tj
1.5874 0 Td
(training)Tj
3.0118 0 Td
(grants)Tj
2.5725 0 Td
(from)Tj
2.0126 0 Td
(the)Tj
1.3677 0 Td
(NIEHS)Tj
-10.552 -1.3749 Td
(\(T32ES00)Tj
3.6708 0 Td
(7018\))Tj
2.4237 0 Td
(and)Tj
1.5874 0 Td
(the)Tj
1.3677 0 Td
(Centers)Tj
3.0473 0 Td
(for)Tj
1.2543 0 Td
(Disease)Tj
-13.3512 -1.3748 Td
(Control)Tj
2.9197 0 Td
(and)Tj
1.5874 0 Td
(Prevention,)Tj
4.415 0 Td
(Nationa)Tj
2.8205 0 Td
(l)Tj
0.4181 0 Td
(Institute)Tj
3.2244 0 Td
(for)Tj
-15.3851 -1.3748 Td
(Occupationa)Tj
4.6134 0 Td
(l)Tj
0.4181 0 Td
(Safety)Tj
2.5158 0 Td
(and)Tj
1.5874 0 Td
(Health)Tj
2.5724 0 Td
(\(T42OH008)Tj
4.3229 0 Td
(67302\))Tj
-16.03 -1.3748 Td
(\()Tj
0.83 0.64 0.02 0 k
(http://ww)Tj
3.7771 0 Td
(w.cdc.gov/n)Tj
4.5001 0 Td
(iosh/)Tj
0 g
(\).)Tj
2.5724 0 Td
(The)Tj
1.5875 0 Td
(National)Tj
3.2386 0 Td
(Registry)Tj
-15.6757 -1.3748 Td
(of)Tj
0.9496 0 Td
(Veterans)Tj
3.4653 0 Td
(with)Tj
1.7859 0 Td
(ALS)Tj
1.7433 0 Td
(was)Tj
1.7008 0 Td
(supporte)Tj
3.2953 0 Td
(d)Tj
0.6945 0 Td
(by)Tj
1.1197 0 Td
(the)Tj
1.3677 0 Td
(U.S.)Tj
-16.1221 -1.3748 Td
(Department)Tj
4.5921 0 Td
(of)Tj
0.9496 0 Td
(Veteran)Tj
2.8205 0 Td
(s)Tj
0.6449 0 Td
(Affairs)Tj
2.6008 0 Td
(\(CSP)Tj
2.0977 0 Td
(#500A\))Tj
-13.7056 -1.3748 Td
(\()Tj
0.83 0.64 0.02 0 k
(http://ww)Tj
3.7771 0 Td
(w.va.gov/)Tj
0 g
(\).)Tj
4.3087 0 Td
(JK)Tj
1.1623 0 Td
(is)Tj
0.8362 0 Td
(employed)Tj
3.8551 0 Td
(by)Tj
1.1126 0 Td
(Westat,)Tj
-15.052 -1.3749 Td
(Inc.,)Tj
1.8212 0 Td
(a)Tj
0.6378 0 Td
(commercial)Tj
4.578 0 Td
(company.)Tj
3.8835 0 Td
(Westat,)Tj
3.026 0 Td
(Inc.,)Tj
-13.9465 -1.3819 Td
(provided)Tj
3.4582 0 Td
(support)Tj
3.0969 0 Td
(in)Tj
0.8859 0 Td
(the)Tj
1.3677 0 Td
(form)Tj
2.0126 0 Td
(of)Tj
0.9496 0 Td
(salary)Tj
2.4024 0 Td
(for)Tj
1.2614 0 Td
(an)Tj
1.1126 0 Td
(author)Tj
-16.5473 -1.3748 Td
([JK],)Tj
2.0055 0 Td
(but,)Tj
1.6441 0 Td
(along)Tj
2.2535 0 Td
(with)Tj
1.7859 0 Td
(the)Tj
1.3677 0 Td
(other)Tj
2.1544 0 Td
(funders)Tj
2.8205 0 Td
(,)Tj
0.4464 0 Td
(did)Tj
1.3607 0 Td
(not)Tj
-15.8387 -1.3748 Td
(have)Tj
1.9559 0 Td
(any)Tj
1.5378 0 Td
(additional)Tj
3.7913 0 Td
(role)Tj
1.6158 0 Td
(in)Tj
0.8858 0 Td
(the)Tj
1.3678 0 Td
(study)Tj
2.2677 0 Td
(design,)Tj
2.8985 0 Td
(data)Tj
-16.3206 -1.3748 Td
(collection)Tj
3.7417 0 Td
(and)Tj
1.5874 0 Td
(analysis)Tj
2.9623 0 Td
(,)Tj
0.4464 0 Td
(decision)Tj
3.2882 0 Td
(to)Tj
0.9496 0 Td
(publish,)Tj
3.1465 0 Td
(or)Tj
-16.1221 -1.3748 Td
(preparation)Tj
4.4433 0 Td
(of)Tj
0.9496 0 Td
(the)Tj
1.3677 0 Td
(manuscript.)Tj
4.6347 0 Td
(The)Tj
1.5945 0 Td
(specific)Tj
3.0189 0 Td
(role)Tj
1.6158 0 Td
(of)Tj
-17.6245 -1.3748 Td
(this)Tj
1.5661 0 Td
(author)Tj
2.6221 0 Td
([JK])Tj
1.7787 0 Td
(is)Tj
0.8363 0 Td
(articulated)Tj
4.0535 0 Td
(in)Tj
0.8929 0 Td
(the)Tj
1.3678 0 Td
(Author)Tj
-13.1174 -1.3748 Td
(Contribution)Tj
4.5709 0 Td
(s)Tj
0.9992 0 Td
(section.)Tj
/F8 1 Tf
-5.5701 -2.126 Td
(Competing)Tj
4.3795 0 Td
(interests)Tj
3.3307 0 Td
(:)Tj
/F9 1 Tf
0.4819 0 Td
(Jean)Tj
1.956 0 Td
(Keller)Tj
2.2819 0 Td
(is)Tj
0.8291 0 Td
(employed)Tj
3.8552 0 Td
(by)Tj
-17.1143 -1.3749 Td
(Westat,)Tj
3.026 0 Td
(Inc.)Tj
1.5945 0 Td
(There)Tj
2.3173 0 Td
(are)Tj
1.3677 0 Td
(no)Tj
1.1693 0 Td
(patents,)Tj
3.1678 0 Td
(patent)Tj
-12.6426 -1.3748 Td
(application)Tj
3.9897 0 Td
(s,)Tj
0.8717 0 Td
(or)Tj
0.9992 0 Td
(products)Tj
3.515 0 Td
(in)Tj
0.8858 0 Td
(development)Tj
5.0032 0 Td
(or)Tj
0.9993 0 Td
(for)Tj
-16.2639 -1.3748 Td
(market)Tj
2.7992 0 Td
(to)Tj
0.9496 0 Td
(declare.)Tj
3.104 0 Td
(This)Tj
1.7787 0 Td
(does)Tj
2.0126 0 Td
(not)Tj
1.4244 0 Td
(alter)Tj
1.8142 0 Td
(the)Tj
1.3749 0 Td
(authors)Tj
2.8204 0 Td
(')Tj
-18.078 -1.3748 Td
(adherence)Tj
4.0535 0 Td
(to)Tj
0.9496 0 Td
(all)Tj
1.0276 0 Td
(the)Tj
1.3677 0 Td
(PLOS)Tj
2.3315 0 Td
(ONE)Tj
1.8709 0 Td
(policies)Tj
3.0119 0 Td
(on)Tj
1.1693 0 Td
(sharing)Tj
-15.782 -1.3748 Td
(data)Tj
1.7929 0 Td
(and)Tj
1.5874 0 Td
(materials,)Tj
3.8339 0 Td
(as)Tj
1.063 0 Td
(detailed)Tj
3.0685 0 Td
(online)Tj
2.452 0 Td
(in)Tj
0.8858 0 Td
(the)Tj
1.3678 0 Td
(guide)Tj
-16.0513 -1.3748 Td
(for)Tj
1.2543 0 Td
(authors.)Tj
3.274 0 Td
(The)Tj
1.5874 0 Td
(other)Tj
2.1473 0 Td
(authors)Tj
3.0473 0 Td
(declare)Tj
2.8772 0 Td
(they)Tj
1.7929 0 Td
(have)Tj
1.963 0 Td
(no)Tj
-17.9434 -1.3748 Td
(competing)Tj
ET
endstream
endobj
56 0 obj
<>stream
endstream
endobj
57 0 obj
<>stream
endstream
endobj
58 0 obj
<>stream
endstream
endobj
59 0 obj
<>stream
endstream
endobj
60 0 obj
<>stream
endstream
endobj
61 0 obj
<>stream
endstream
endobj
62 0 obj
<>stream
endstream
endobj
63 0 obj
<>stream
endstream
endobj
64 0 obj
<>stream
endstream
endobj
65 0 obj
<>stream
endstream
endobj
66 0 obj
<>stream
endstream
endobj
67 0 obj
<>stream
endstream
endobj
68 0 obj
<>stream
BT
4.1598 -53.7523 Td
(interests.)Tj
ET
Q
endstream
endobj
69 0 obj
<>/XObject<>>>/CropBox[0 0 612 792]/MediaBox[0 0 612 792]/Parent 11 0 R/Annots 72 0 R/Contents 73 0 R/TrimBox[0 0 612 792]>>
endobj
72 0 obj
[74 0 R 75 0 R 76 0 R 77 0 R 78 0 R 79 0 R 80 0 R 81 0 R 82 0 R 83 0 R 84 0 R 85 0 R 86 0 R 87 0 R 88 0 R 89 0 R 90 0 R 91 0 R 92 0 R 93 0 R 94 0 R 95 0 R 96 0 R 97 0 R 98 0 R 99 0 R 100 0 R]
endobj
74 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref014)>>
endobj
75 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref015)>>
endobj
76 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref016)>>
endobj
77 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref017)>>
endobj
78 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref017)>>
endobj
79 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref014)>>
endobj
80 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref015)>>
endobj
81 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref014)>>
endobj
82 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref015)>>
endobj
83 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref018)>>
endobj
84 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref009)>>
endobj
85 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref010)>>
endobj
86 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref019)>>
endobj
87 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref014)>>
endobj
88 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref016)>>
endobj
89 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref014)>>
endobj
90 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref014)>>
endobj
91 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref020)>>
endobj
92 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref017)>>
endobj
93 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.g001)>>
endobj
94 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref021)>>
endobj
95 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref022)>>
endobj
96 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref016)>>
endobj
97 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref023)>>
endobj
98 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref024)>>
endobj
99 0 obj
<>/Border[0 0 0]/Dest(Rpone.0185751.ref023)>>
endobj
100 0 obj
<>/Border[0 0 0]/A 101 0 R>>
endobj
101 0 obj
<>
endobj
73 0 obj
[102 0 R 103 0 R 104 0 R 105 0 R 106 0 R 107 0 R 108 0 R 109 0 R 110 0 R 111 0 R 112 0 R 113 0 R 114 0 R 115 0 R 116 0 R 117 0 R 118 0 R]
endobj
102 0 obj
<>stream
q
0.83 0.64 0.02 0 k
297.1843 657.0142 m
306.7087 657.0142 l
h
f*
266.1165 643.9748 m
275.6409 643.9748 l
h
f*
524.4094 618.0094 m
533.9339 618.0094 l
h
f*
538.4126 618.0094 m
547.937 618.0094 l
h
f*
351.326 591.9874 m
360.8504 591.9874 l
h
f*
226.5449 552.9827 m
236.0693 552.9827 l
h
f*
240.548 552.9827 m
250.0724 552.9827 l
h
f*
380.0693 540 m
389.537 540 l
h
f*
394.0157 540 m
403.5402 540 l
h
f*
407.9622 540 m
417.4866 540 l
h
f*
505.9843 527.0173 m
510.7465 527.0173 l
h
f*
515.2252 527.0173 m
524.7496 527.0173 l
h
f*
428.0315 500.9953 m
437.5559 500.9953 l
h
f*
385.5685 488.0126 m
395.0929 488.0126 l
h
f*
421.5685 475.0299 m
431.0929 475.0299 l
h
f*
242.9858 461.9906 m
252.5102 461.9906 l
h
f*
548.7874 436.0252 m
558.3118 436.0252 l
h
f*
200.0126 422.9858 m
209.537 422.9858 l
h
f*
227.5087 410.0031 m
237.0331 410.0031 l
h
f*
481.7197 397.0205 m
501.2787 397.0205 l
h
f*
504.5102 253.9843 m
514.0346 253.9843 l
h
f*
515.7354 228.0189 m
525.2598 228.0189 l
h
f*
480.189 214.9795 m
489.7134 214.9795 l
h
f*
293.8961 189.0142 m
303.4205 189.0142 l
h
f*
443.5654 189.0142 m
453.0898 189.0142 l
h
f*
356.2583 162.9921 m
365.726 162.9921 l
h
f*
0 g
1 j
1 J
0 w
11.9999 0 0 11.9999 200.0125 706.0535 cm
BT
/F2 1 Tf
1 TL
-0.0033 Tc
0 0 Td
(Materials)Tj
4.5071 0 Td
(and)Tj
1.989 0 Td
(methods)Tj
/F0 1 Tf
-6.4961 -1.4976 Td
(Study)Tj
2.7543 0 Td
(population)Tj
4.7622 0 Td
(and)Tj
1.8662 0 Td
(outcome)Tj
4.0158 0 Td
(assessment)Tj
ET
Q
q
1 j
1 J
0 w
10 0 0 10 200.0125 671.074 cm
BT
/F7 1 Tf
1 TL
-0.004 Tc
0 0 Td
(GENEVA)Tj
4.1895 0 Td
(is)Tj
0.8447 0 Td
(a)Tj
0.6577 0 Td
(case-control)Tj
5.1137 0 Td
(study)Tj
2.3867 0 Td
(of)Tj
1.0148 0 Td
(veterans,)Tj
3.7644 0 Td
(conducted)Tj
4.4277 0 Td
(from)Tj
2.2053 0 Td
(20052010,)Tj
4.7679 0 Td
(that)Tj
1.7744 0 Td
(includes)Tj
3.549 0 Td
(ALS)Tj
-34.6958 -1.2982 Td
(cases)Tj
2.2223 0 Td
(from)Tj
2.2053 0 Td
(the)Tj
1.4684 0 Td
(Registry)Tj
3.4809 0 Td
([)Tj
0.83 0.64 0.02 0 k
(14)Tj
0 g
(])Tj
1.8538 0 Td
(and)Tj
1.7292 0 Td
(controls)Tj
3.4866 0 Td
(identified)Tj
4.0591 0 Td
(via)Tj
1.372 0 Td
(U.S.)Tj
1.8822 0 Td
(Department)Tj
5.091 0 Td
(of)Tj
1.0148 0 Td
(Veterans)Tj
3.7757 0 Td
(Affairs)Tj
-33.6413 -1.3039 Td
(\(VA\))Tj
2.2733 0 Td
(databases)Tj
3.9968 0 Td
([)Tj
0.83 0.64 0.02 0 k
(15)Tj
0 g
(].)Tj
2.075 0 Td
(Although)Tj
3.9968 0 Td
(participants)Tj
4.9549 0 Td
(did)Tj
1.5421 0 Td
(not)Tj
1.5704 0 Td
(have)Tj
2.0522 0 Td
(to)Tj
1.0205 0 Td
(have)Tj
2.0579 0 Td
(been)Tj
2.1203 0 Td
(deployed)Tj
3.8438 0 Td
(to)Tj
1.0205 0 Td
(war)Tj
1.7064 0 Td
(to)Tj
1.0205 0 Td
(enroll)Tj
-35.2514 -1.2983 Td
(in)Tj
1.0318 0 Td
(GENEVA,)Tj
4.4163 0 Td
(they)Tj
1.9276 0 Td
(did)Tj
1.542 0 Td
(have)Tj
2.0579 0 Td
(to)Tj
1.0262 0 Td
(have)Tj
2.0579 0 Td
(been)Tj
2.126 0 Td
(members)Tj
3.9458 0 Td
(of)Tj
1.0148 0 Td
(the)Tj
1.4683 0 Td
(U.S.)Tj
1.8822 0 Td
(Army,)Tj
2.7723 0 Td
(Air)Tj
1.5477 0 Td
(Force,)Tj
2.6929 0 Td
(Navy,)Tj
2.5285 0 Td
(Marine)Tj
-34.0382 -1.2983 Td
(Corps,)Tj
2.8629 0 Td
(Coast)Tj
2.4832 0 Td
(Guard,)Tj
3.0217 0 Td
(activated)Tj
3.7814 0 Td
(Reserves)Tj
3.6623 0 Td
(or)Tj
1.0942 0 Td
(National)Tj
3.6963 0 Td
(Guard)Tj
2.795 0 Td
(at)Tj
0.9524 0 Td
(some)Tj
2.3301 0 Td
(point)Tj
2.3584 0 Td
(in)Tj
1.0375 0 Td
(time)Tj
2.0239 0 Td
([)Tj
0.83 0.64 0.02 0 k
(16)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.7404 0 Td
(17)Tj
0 g
(].)Tj
1.7348 0 Td
(We)Tj
-35.5745 -1.2982 Td
(previously)Tj
4.3483 0 Td
(used)Tj
2.0636 0 Td
(data)Tj
1.9105 0 Td
(on)Tj
1.2756 0 Td
(GENEVA)Tj
4.1896 0 Td
(cases)Tj
2.2223 0 Td
(and)Tj
1.7292 0 Td
(controls)Tj
3.4865 0 Td
(to)Tj
1.0262 0 Td
(evaluate)Tj
3.4582 0 Td
(associations)Tj
4.989 0 Td
(between)Tj
3.5319 0 Td
(mili-)Tj
-34.2309 -1.3039 Td
(tary-related)Tj
4.8528 0 Td
(factors)Tj
2.9027 0 Td
(and)Tj
1.7291 0 Td
(ALS)Tj
1.9162 0 Td
(etiology)Tj
3.3902 0 Td
([)Tj
0.83 0.64 0.02 0 k
(17)Tj
0 g
(].)Tj
2.0807 0 Td
(The)Tj
1.7801 0 Td
(present)Tj
3.1634 0 Td
(analysis)Tj
3.3279 0 Td
(focused)Tj
3.2768 0 Td
(on)Tj
1.2756 0 Td
(ALS)Tj
1.9162 0 Td
(survival)Tj
3.3392 0 Td
(and)Tj
-34.9509 -1.2983 Td
(included)Tj
3.7133 0 Td
(cases)Tj
2.2224 0 Td
(only.)Tj
-4.7395 -1.2983 Td
(Methods)Tj
3.7587 0 Td
(used)Tj
2.0636 0 Td
(to)Tj
1.0205 0 Td
(enroll)Tj
2.5681 0 Td
(cases)Tj
2.2224 0 Td
(first)Tj
1.8028 0 Td
(in)Tj
1.0375 0 Td
(the)Tj
1.4683 0 Td
(Registry,)Tj
3.7077 0 Td
(then)Tj
2.0183 0 Td
(in)Tj
1.0374 0 Td
(GENEVA,)Tj
4.4164 0 Td
(were)Tj
2.1203 0 Td
(published)Tj
4.1272 0 Td
(previ-)Tj
-34.5654 -1.3039 Td
(ously)Tj
2.313 0 Td
([)Tj
0.83 0.64 0.02 0 k
(14)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.7405 0 Td
(15)Tj
0 g
(].)Tj
1.7348 0 Td
(Briefly,)Tj
3.0784 0 Td
(the)Tj
1.4683 0 Td
(VA)Tj
1.5987 0 Td
(started)Tj
2.931 0 Td
(the)Tj
1.474 0 Td
(Registry)Tj
3.481 0 Td
(because)Tj
3.3222 0 Td
(of)Tj
1.0147 0 Td
(increased)Tj
3.9969 0 Td
(ALS)Tj
1.9219 0 Td
(rates)Tj
2.1032 0 Td
(among)Tj
2.9991 0 Td
(veter-)Tj
-35.1777 -1.2983 Td
(ans)Tj
1.5647 0 Td
(who)Tj
1.9388 0 Td
(had)Tj
1.7065 0 Td
(been)Tj
2.1203 0 Td
(deployed)Tj
3.8494 0 Td
(to)Tj
1.0262 0 Td
(the)Tj
1.4683 0 Td
(Gulf)Tj
2.0012 0 Td
(War)Tj
1.99 0 Td
([)Tj
0.83 0.64 0.02 0 k
(14)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.7347 0 Td
(15)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.3947 0 Td
(18)Tj
0 g
(].)Tj
1.7404 0 Td
(Recruitment)Tj
5.2441 0 Td
(of)Tj
1.0148 0 Td
(potential)Tj
3.7587 0 Td
(cases)Tj
-32.5528 -1.2982 Td
(occurred)Tj
3.7927 0 Td
(from)Tj
2.2053 0 Td
(2003)Tj
2.126 0 Td
(to)Tj
1.0261 0 Td
(2007)Tj
2.1203 0 Td
(\(i.e.,)Tj
1.9276 0 Td
(the)Tj
1.4683 0 Td
(year)Tj
1.9049 0 Td
(the)Tj
1.4683 0 Td
(original)Tj
3.3279 0 Td
(Gulf)Tj
1.9956 0 Td
(War)Tj
1.9899 0 Td
(ALS)Tj
1.9218 0 Td
(studies)Tj
2.9821 0 Td
([)Tj
0.83 0.64 0.02 0 k
(9)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
1.2642 0 Td
(10)Tj
0 g
(])Tj
1.508 0 Td
(were)Tj
2.126 0 Td
(pub-)Tj
-35.155 -1.3039 Td
(lished)Tj
2.5738 0 Td
(to)Tj
1.0261 0 Td
(when)Tj
2.4038 0 Td
(funding)Tj
3.3902 0 Td
(expired\))Tj
3.5546 0 Td
(and)Tj
1.7292 0 Td
(included)Tj
3.7133 0 Td
(searches)Tj
3.549 0 Td
(of)Tj
1.0148 0 Td
(national)Tj
3.5036 0 Td
(VA)Tj
1.5987 0 Td
(databases)Tj
3.9968 0 Td
(for)Tj
1.389 0 Td
(patients)Tj
-33.4429 -1.2983 Td
(with)Tj
/F10 1 Tf
1.9955 0 Td
[()39()22()11()2()-9()6()22()7()4()11()6()11( )]TJ
5.4255 0 Td
[(\n)1( )4()10()10()12()-8()4(\r)7()22()7()4()11()]TJ
5.4368 0 Td
[()11()]TJ
0.9525 0 Td
[()-4()-4()-3()7()-3()8()]TJ
/F7 1 Tf
(,)Tj
/F10 1 Tf
3.668 0 Td
[()10()]TJ
1.491 0 Td
[()2()-5()-13()-4()10()4()11()]TJ
/F7 1 Tf
3.4922 0 Td
([)Tj
0.83 0.64 0.02 0 k
(19)Tj
0 g
(],)Tj
2.075 0 Td
(codes)Tj
2.4661 0 Td
(of)Tj
1.0148 0 Td
(the)Tj
1.4683 0 Td
(form)Tj
2.2054 0 Td
(335.2X)Tj
2.999 0 Td
(\(motor)Tj
-34.6901 -1.2983 Td
(neuron)Tj
3.1464 0 Td
(diseases\))Tj
3.719 0 Td
(and)Tj
1.7291 0 Td
(publicizing)Tj
4.6715 0 Td
(the)Tj
1.4683 0 Td
(Registry)Tj
3.481 0 Td
([)Tj
0.83 0.64 0.02 0 k
(14)Tj
0 g
(].)Tj
2.0806 0 Td
(In)Tj
1.1055 0 Td
(total,)Tj
2.228 0 Td
(there)Tj
2.2677 0 Td
(were)Tj
2.1203 0 Td
(7,116)Tj
2.3471 0 Td
(potential)Tj
3.7644 0 Td
(cases)Tj
-34.1289 -1.2982 Td
(identified,)Tj
4.2802 0 Td
(4,626)Tj
2.3528 0 Td
(who)Tj
1.9389 0 Td
(completed)Tj
4.405 0 Td
(a)Tj
0.6519 0 Td
(telephone)Tj
4.1386 0 Td
(screening)Tj
4.0478 0 Td
([)Tj
0.83 0.64 0.02 0 k
(16)Tj
0 g
(],)Tj
2.0807 0 Td
(and)Tj
1.7291 0 Td
(2,600)Tj
2.3471 0 Td
(who)Tj
1.9388 0 Td
(reported)Tj
3.6624 0 Td
(a)Tj
0.6519 0 Td
(past)Tj
-34.2252 -1.3039 Td
(diagnosis)Tj
3.9571 0 Td
([)Tj
0.83 0.64 0.02 0 k
(14)Tj
0 g
(].)Tj
2.0749 0 Td
(Of)Tj
1.2586 0 Td
(these,)Tj
2.4775 0 Td
(there)Tj
2.262 0 Td
(were)Tj
2.126 0 Td
(2,400)Tj
2.3471 0 Td
(who)Tj
1.9388 0 Td
(consented)Tj
4.2803 0 Td
(to)Tj
1.0262 0 Td
(join,)Tj
2.0239 0 Td
(2,265)Tj
2.3471 0 Td
(who)Tj
1.9388 0 Td
(allowed)Tj
3.2882 0 Td
(their)Tj
2.109 0 Td
(med-)Tj
-35.4555 -1.2983 Td
(ical)Tj
1.5873 0 Td
(records)Tj
3.2088 0 Td
(to)Tj
1.0262 0 Td
(be)Tj
1.1508 0 Td
(reviewed)Tj
3.7928 0 Td
(by)Tj
1.1792 0 Td
(ALS)Tj
1.9218 0 Td
(specialist)Tj
3.8155 0 Td
(neurologists,)Tj
5.3291 0 Td
(and)Tj
1.7348 0 Td
(2,122)Tj
2.347 0 Td
(who)Tj
1.9389 0 Td
(had)Tj
1.7065 0 Td
(a)Tj
0.6576 0 Td
(diagnosis)Tj
3.9571 0 Td
(of)Tj
-35.3534 -1.2983 Td
(ALS)Tj
1.9162 0 Td
(or)Tj
1.0998 0 Td
(another)Tj
3.3278 0 Td
(motor)Tj
2.727 0 Td
(neuron)Tj
3.1464 0 Td
(disease)Tj
3.016 0 Td
(confirmed)Tj
4.3937 0 Td
(using)Tj
2.3924 0 Td
(the)Tj
1.4684 0 Td
(Revised)Tj
3.2995 0 Td
(El)Tj
1.0375 0 Td
(Escorial)Tj
3.3958 0 Td
(Criteria)Tj
3.3166 0 Td
([)Tj
0.83 0.64 0.02 0 k
(14)Tj
0 g
(,)Tj
0.83 0.64 0.02 0 k
-34.5371 -1.3039 Td
(20)Tj
0 g
(].)Tj
1.7347 0 Td
(These)Tj
2.5682 0 Td
(2,122)Tj
2.3471 0 Td
(cases)Tj
2.2223 0 Td
(were)Tj
2.1203 0 Td
(followed)Tj
3.651 0 Td
(until)Tj
2.109 0 Td
(2009)Tj
2.1203 0 Td
(via)Tj
1.3776 0 Td
(standardized)Tj
5.3575 0 Td
(semi-annual)Tj
5.176 0 Td
(telephone)Tj
4.1386 0 Td
(inter-)Tj
-34.9226 -1.2983 Td
(views)Tj
2.4094 0 Td
([)Tj
0.83 0.64 0.02 0 k
(17)Tj
0 g
(].)Tj
-1.2132 -1.2982 Td
(The)Tj
1.7858 0 Td
(ascertainment)Tj
5.8677 0 Td
(of)Tj
1.0148 0 Td
(GENEVA)Tj
4.1895 0 Td
(cases)Tj
2.2281 0 Td
(from)Tj
2.2053 0 Td
(the)Tj
1.4683 0 Td
(Registry)Tj
3.481 0 Td
(is)Tj
0.8503 0 Td
(shown)Tj
2.846 0 Td
(in)Tj
0.83 0.64 0.02 0 k
1.0375 0 Td
(Fig)Tj
1.4797 0 Td
(1)Tj
0 g
(.)Tj
0.9184 0 Td
(Of)Tj
1.2586 0 Td
(1,856)Tj
2.347 0 Td
(ALS)Tj
-34.1742 -1.3039 Td
(cases,)Tj
2.4491 0 Td
(there)Tj
2.262 0 Td
(were)Tj
2.1203 0 Td
(1,837)Tj
2.3527 0 Td
(who)Tj
1.9389 0 Td
(gave)Tj
1.9956 0 Td
(permission)Tj
4.6601 0 Td
(to)Tj
1.0262 0 Td
(be)Tj
1.1508 0 Td
(re-contacted)Tj
5.2498 0 Td
(for)Tj
1.3889 0 Td
(further)Tj
3.0274 0 Td
(studies,)Tj
3.2088 0 Td
(1,356)Tj
2.3471 0 Td
(who)Tj
-35.1777 -1.2983 Td
(consented)Tj
4.2802 0 Td
(to)Tj
1.0262 0 Td
(join)Tj
1.7971 0 Td
(the)Tj
1.4684 0 Td
(Registry)Tj
3.4866 0 Td
(DNA)Tj
2.3754 0 Td
(bank,)Tj
2.4321 0 Td
(and)Tj
1.7291 0 Td
(847)Tj
1.6498 0 Td
(who)Tj
1.9388 0 Td
(were)Tj
2.1203 0 Td
(able)Tj
1.8312 0 Td
(to)Tj
1.0262 0 Td
(be)Tj
1.1508 0 Td
(contacted)Tj
4.1046 0 Td
(regarding)Tj
-32.4168 -1.2983 Td
(GENEVA)Tj
4.1895 0 Td
(enrollment.)Tj
4.8756 0 Td
(Of)Tj
1.2586 0 Td
(these,)Tj
2.4774 0 Td
(there)Tj
2.2621 0 Td
(were)Tj
2.1259 0 Td
(726)Tj
1.6441 0 Td
(who)Tj
1.9389 0 Td
(consented)Tj
4.2803 0 Td
(to)Tj
1.0261 0 Td
(join)Tj
1.8028 0 Td
(and)Tj
1.7292 0 Td
(630)Tj
1.6441 0 Td
(who)Tj
1.9388 0 Td
(enrolled,)Tj
-33.1934 -1.3039 Td
(of)Tj
1.0147 0 Td
(which)Tj
2.6476 0 Td
(we)Tj
1.3266 0 Td
(included)Tj
3.7134 0 Td
(616)Tj
1.6497 0 Td
(in)Tj
1.0318 0 Td
(this)Tj
1.6781 0 Td
(analysis)Tj
3.3222 0 Td
(because)Tj
3.3222 0 Td
(they)Tj
1.9219 0 Td
(had)Tj
1.7121 0 Td
(information)Tj
5.074 0 Td
(on)Tj
1.2755 0 Td
(diagnosis)Tj
3.9629 0 Td
(date)Tj
1.8992 0 Td
(and)Tj
-35.5519 -1.2983 Td
(were)Tj
2.1203 0 Td
(not)Tj
1.576 0 Td
(enrolled)Tj
3.5149 0 Td
(posthumously)Tj
5.8734 0 Td
(by)Tj
1.1792 0 Td
(proxy.)Tj
2.7609 0 Td
(These)Tj
2.5682 0 Td
(cases)Tj
2.2223 0 Td
(were)Tj
2.126 0 Td
(comprised)Tj
4.4334 0 Td
(of)Tj
1.0148 0 Td
(patients)Tj
3.3732 0 Td
(with)Tj
1.9956 0 Td
(clini-)Tj
-34.7582 -1.2982 Td
(cally)Tj
2.0239 0 Td
(definite,)Tj
3.4866 0 Td
(probable,)Tj
3.9628 0 Td
(possible,)Tj
3.634 0 Td
(or)Tj
1.0998 0 Td
(suspected)Tj
4.0819 0 Td
(ALS.)Tj
-17.0928 -1.2983 Td
(The)Tj
1.7858 0 Td
(outcome)Tj
3.7247 0 Td
(we)Tj
1.3266 0 Td
(used)Tj
2.0636 0 Td
(was)Tj
1.6951 0 Td
(days)Tj
2.0012 0 Td
(from)Tj
2.2054 0 Td
(diagnosis)Tj
3.9571 0 Td
(date)Tj
1.9049 0 Td
(to)Tj
1.0261 0 Td
(death)Tj
2.4265 0 Td
(date)Tj
1.9048 0 Td
(or)Tj
1.0999 0 Td
(end)Tj
1.7178 0 Td
(of)Tj
1.0148 0 Td
(follow-up)Tj
4.0932 0 Td
(\(July)Tj
-35.1437 -1.3039 Td
(25,)Tj
1.3889 0 Td
(2013\),)Tj
2.6816 0 Td
(with)Tj
1.9899 0 Td
(late)Tj
1.6157 0 Td
(entry)Tj
2.3074 0 Td
(at)Tj
0.9468 0 Td
(GENEVA)Tj
4.1839 0 Td
(enrollment)Tj
4.6431 0 Td
(date.)Tj
2.126 0 Td
(Time)Tj
2.33 0 Td
(since)Tj
2.2394 0 Td
(diagnosis)Tj
3.9515 0 Td
(was)Tj
1.6951 0 Td
(the)Tj
1.4626 0 Td
(most)Tj
2.194 0 Td
(clin-)Tj
-35.7559 -1.2983 Td
(ically)Tj
2.2903 0 Td
(meaningful)Tj
4.7906 0 Td
(time)Tj
2.0239 0 Td
(scale)Tj
2.1089 0 Td
(and)Tj
1.7348 0 Td
(allowing)Tj
3.617 0 Td
(for)Tj
1.3833 0 Td
(late)Tj
1.6214 0 Td
(entry)Tj
2.3187 0 Td
(at)Tj
0.9525 0 Td
(enrollment)Tj
4.6544 0 Td
(date)Tj
1.9049 0 Td
(addressed)Tj
4.1726 0 Td
(potential)Tj
-33.5733 -1.2982 Td
(immortal)Tj
3.9798 0 Td
(person-time)Tj
5.108 0 Td
(bias,)Tj
2.0182 0 Td
(which)Tj
2.6476 0 Td
(occurs)Tj
2.8346 0 Td
(when)Tj
2.4038 0 Td
(follow-up)Tj
4.0932 0 Td
(time)Tj
2.0296 0 Td
(that)Tj
1.7801 0 Td
(occurs)Tj
2.8346 0 Td
(before)Tj
2.7383 0 Td
(the)Tj
1.4683 0 Td
(last)Tj
-33.9361 -1.3039 Td
(event)Tj
2.3697 0 Td
(required)Tj
3.6397 0 Td
(to)Tj
1.0204 0 Td
(enter)Tj
2.2847 0 Td
(the)Tj
1.474 0 Td
(study)Tj
2.3868 0 Td
(is)Tj
0.8504 0 Td
(counted)Tj
3.4752 0 Td
(as)Tj
1.0148 0 Td
(person-time)Tj
5.108 0 Td
(at)Tj
0.9525 0 Td
(risk)Tj
1.7178 0 Td
(for)Tj
1.3833 0 Td
(death)Tj
2.4321 0 Td
([)Tj
0.83 0.64 0.02 0 k
(21)Tj
0 g
(],)Tj
2.0749 0 Td
(from)Tj
2.2054 0 Td
(left)Tj
-34.3897 -1.2983 Td
(truncation.)Tj
4.6657 0 Td
(Time)Tj
2.3414 0 Td
(to)Tj
1.0262 0 Td
(death)Tj
2.4321 0 Td
(is)Tj
0.8504 0 Td
(recommended)Tj
6.0321 0 Td
(over)Tj
1.9785 0 Td
(other)Tj
2.3471 0 Td
(ALS)Tj
1.9162 0 Td
(survival)Tj
3.3392 0 Td
(outcomes)Tj
4.0875 0 Td
(\(e.g.,)Tj
2.126 0 Td
(time)Tj
2.0296 0 Td
(to)Tj
1.0261 0 Td
(use)Tj
-36.1981 -1.2983 Td
(of)Tj
1.0147 0 Td
(ventilator)Tj
4.0706 0 Td
(or)Tj
1.0941 0 Td
(death\),)Tj
2.9991 0 Td
(which)Tj
2.6475 0 Td
(are)Tj
1.4513 0 Td
(not)Tj
1.5704 0 Td
(uniformly)Tj
4.252 0 Td
(defined)Tj
3.2258 0 Td
(or)Tj
1.0998 0 Td
(used)Tj
2.058 0 Td
(across)Tj
2.6815 0 Td
(centers)Tj
3.0671 0 Td
([)Tj
0.83 0.64 0.02 0 k
(22)Tj
0 g
(].)Tj
-30.0357 -1.3039 Td
(We)Tj
1.61 0 Td
(extracted)Tj
3.8891 0 Td
(information)Tj
5.074 0 Td
(on)Tj
1.2756 0 Td
(diagnosis)Tj
3.9571 0 Td
(date)Tj
1.9049 0 Td
(from)Tj
2.2054 0 Td
(medical)Tj
3.3618 0 Td
(records)Tj
3.2032 0 Td
([)Tj
0.83 0.64 0.02 0 k
(16)Tj
0 g
(].)Tj
2.0806 0 Td
(We)Tj
1.61 0 Td
(obtained)Tj
3.7304 0 Td
(vital)Tj
-35.0983 -1.2983 Td
(status)Tj
2.5001 0 Td
(information)Tj
5.074 0 Td
(from)Tj
2.2053 0 Td
(the)Tj
1.474 0 Td
(Austin)Tj
2.9027 0 Td
(Vital)Tj
2.16 0 Td
(Status)Tj
2.6192 0 Td
(File,)Tj
1.9048 0 Td
(which)Tj
2.6532 0 Td
(contains)Tj
3.6057 0 Td
(information)Tj
5.0796 0 Td
(from)Tj
2.2054 0 Td
(several)Tj
-34.384 -1.2982 Td
(sources)Tj
3.1861 0 Td
(within)Tj
2.8063 0 Td
(the)Tj
1.4626 0 Td
(VA)Tj
1.5931 0 Td
([)Tj
0.83 0.64 0.02 0 k
(23)Tj
0 g
(].)Tj
2.0749 0 Td
(Using)Tj
2.5909 0 Td
(the)Tj
1.4626 0 Td
(National)Tj
3.6851 0 Td
(Death)Tj
2.6305 0 Td
(Index)Tj
2.5228 0 Td
([)Tj
0.83 0.64 0.02 0 k
(24)Tj
0 g
(])Tj
1.8425 0 Td
(as)Tj
1.0092 0 Td
(the)Tj
1.4626 0 Td
(gold)Tj
1.9616 0 Td
(standard,)Tj
3.9401 0 Td
(a)Tj
0.652 0 Td
(valida-)Tj
-34.8829 -1.2983 Td
(tion)Tj
1.8425 0 Td
(study)Tj
2.3867 0 Td
(found)Tj
2.6192 0 Td
(the)Tj
1.4683 0 Td
(Austin)Tj
2.9084 0 Td
(Vital)Tj
2.16 0 Td
(Status)Tj
2.6135 0 Td
(File)Tj
1.6838 0 Td
(was)Tj
1.7007 0 Td
(98.3%)Tj
2.6306 0 Td
(sensitive)Tj
3.6226 0 Td
(and)Tj
1.7291 0 Td
(99.8%)Tj
2.6306 0 Td
(specific)Tj
3.1918 0 Td
(\()Tj
/F11 1 Tf
()Tj
/F7 1 Tf
1.0998 0 Td
(=)Tj
0.7994 0 Td
(0.981\))Tj
-35.087 -1.3039 Td
(for)Tj
1.3832 0 Td
(identifying)Tj
4.5751 0 Td
(deaths)Tj
2.795 0 Td
(among)Tj
2.9933 0 Td
(veterans)Tj
3.5377 0 Td
([)Tj
0.83 0.64 0.02 0 k
(23)Tj
0 g
(].)Tj
2.0749 0 Td
(Thus,)Tj
2.4718 0 Td
(it)Tj
0.788 0 Td
(is)Tj
0.8448 0 Td
(likely)Tj
2.3584 0 Td
(we)Tj
1.3266 0 Td
(missed)Tj
2.9763 0 Td
(only)Tj
1.9786 0 Td
(a)Tj
0.652 0 Td
(small)Tj
2.33 0 Td
(proportion)Tj
-33.0857 -1.2983 Td
(of)Tj
1.0147 0 Td
(deaths)Tj
2.7893 0 Td
(among)Tj
2.9934 0 Td
(GENEVA)Tj
4.1896 0 Td
(cases.)Tj
-9.7908 -1.2982 Td
(The)Tj
1.7858 0 Td
(Institutional)Tj
5.159 0 Td
(Review)Tj
3.0954 0 Td
(Boards)Tj
3.0047 0 Td
(\(IRBs\))Tj
2.8006 0 Td
(of)Tj
1.0148 0 Td
(the)Tj
1.4684 0 Td
(Durham)Tj
3.6396 0 Td
(VA)Tj
1.5988 0 Td
(Medical)Tj
3.4299 0 Td
(Center,)Tj
3.1747 0 Td
(Duke)Tj
2.4038 0 Td
(Univer-)Tj
-33.7717 -1.304 Td
(sity)Tj
1.5987 0 Td
(Medical)Tj
3.4355 0 Td
(Center,)Tj
3.1748 0 Td
(and)Tj
1.7292 0 Td
(the)Tj
1.4683 0 Td
(National)Tj
3.6907 0 Td
(Institute)Tj
3.5829 0 Td
(of)Tj
1.0148 0 Td
(Environmental)Tj
6.2589 0 Td
(Health)Tj
2.9197 0 Td
(Sciences)Tj
3.5659 0 Td
(approved)Tj
-32.4394 -1.2982 Td
(GENEVA;)Tj
4.4106 0 Td
(this)Tj
1.6781 0 Td
(ancillary)Tj
3.6454 0 Td
(study)Tj
2.3867 0 Td
(was)Tj
1.7008 0 Td
(approved)Tj
3.9741 0 Td
(by)Tj
1.1792 0 Td
(the)Tj
1.4684 0 Td
(IRB)Tj
1.7631 0 Td
(of)Tj
1.0148 0 Td
(the)Tj
1.4684 0 Td
(University)Tj
4.405 0 Td
(of)Tj
1.0148 0 Td
(North)Tj
2.6588 0 Td
(Carolina)Tj
3.6907 0 Td
(at)Tj
-36.4589 -1.2983 Td
(Chapel)Tj
3.033 0 Td
(Hill.)Tj
1.9729 0 Td
(All)Tj
1.3946 0 Td
(participants)Tj
4.955 0 Td
(provided)Tj
3.821 0 Td
(written)Tj
3.1068 0 Td
(or)Tj
1.0998 0 Td
(oral)Tj
1.7802 0 Td
(informed)Tj
3.9741 0 Td
(consent)Tj
3.3279 0 Td
(before)Tj
2.7382 0 Td
(enrollment,)Tj
-31.2035 -1.3039 Td
(which)Tj
2.6475 0 Td
(we)Tj
1.3266 0 Td
(tracked)Tj
3.1975 0 Td
(via)Tj
1.3776 0 Td
(Microsoft)Tj
4.1329 0 Td
(Access)Tj
2.897 0 Td
(databases)Tj
4.0025 0 Td
(and)Tj
1.7291 0 Td
(documented)Tj
5.244 0 Td
(by)Tj
1.1849 0 Td
(maintaining)Tj
5.1194 0 Td
(copies)Tj
2.7155 0 Td
(of)Tj
ET
Q
q
1 j
1 J
0 w
576 737.1 m
36 737.1 l
36 737.6 l
576 737.6 l
f*
36 741.2598 107.1496 23.6976 re
W* n
q
107.0929 0 0 23.6409 36 741.3165 cm
q
/I0 Do
Q
Q
Q
q
0 0 612 792 re
W* n
1 j
1 J
0 w
7.9999 0 0 7.9999 360.9637 745.7952 cm
BT
/F0 1 Tf
1 TL
-0.005 Tc
0 0 Td
(Military)Tj
3.3236 0 Td
(service,)Tj
3.6071 0 Td
(deploymen)Tj
4.8048 0 Td
(ts,)Tj
1.2614 0 Td
(and)Tj
1.8567 0 Td
(exposure)Tj
4.0394 0 Td
(s)Tj
0.7158 0 Td
(and)Tj
1.8567 0 Td
(ALS)Tj
2.0835 0 Td
(survival)Tj
ET
Q
q
1 j
1 J
0 w
36 48.0002 m
576 48.0002 l
576 47.5002 l
36 47.5002 l
f*
0.83 0.64 0.02 0 k
81.5811 34.9228 m
237.8835 34.9228 l
h
f*
0 g
7.9999 0 0 7.9999 36 36 cm
BT
/F0 1 Tf
1 TL
-0.005 Tc
0 0 Td
(PLOS)Tj
2.8559 0 Td
(ONE)Tj
2.3669 0 Td
(|)Tj
0.83 0.64 0.02 0 k
0.4748 0 Td
(https://doi.or)Tj
5.4142 0 Td
(g/10.137)Tj
3.8198 0 Td
(1/journal.po)Tj
5.1236 0 Td
(ne.01857)Tj
4.089 0 Td
(51)Tj
0 g
2.0906 0 Td
(October)Tj
3.7276 0 Td
(10,)Tj
1.5874 0 Td
(2017)Tj
33.5908 0 Td
(3)Tj
0.7654 0 Td
(/)Tj
ET
endstream
endobj
103 0 obj
<>stream
endstream
endobj
104 0 obj
<>stream
endstream
endobj
105 0 obj
<>stream
endstream
endobj
106 0 obj
<>stream
endstream
endobj
107 0 obj
<>stream
endstream
endobj
108 0 obj
<>stream
endstream
endobj
109 0 obj
<>stream
endstream
endobj
110 0 obj
<>stream
endstream
endobj
111 0 obj
<>stream
endstream
endobj
112 0 obj
<>stream
endstream
endobj
113 0 obj
<>stream
endstream
endobj
114 0 obj
<>stream
endstream
endobj
115 0 obj
<>stream
endstream
endobj
116 0 obj
<>stream
endstream
endobj
117 0 obj
<>stream
endstream
endobj
118 0 obj
<>stream
BT
66.402 0 Td
(22)Tj
ET
Q
endstream
endobj
119 0 obj
<>/XObject<>>>/CropBox[0 0 612 792]/MediaBox[0 0 612 792]/Parent 11 0 R/Annots 121 0 R/Contents 122 0 R/TrimBox[0 0 612 792]>>
endobj
120 0 obj
<>stream
xy?W]o jm"j7)B0q *[YTBhDB`\!UTJ!.MQT*Dd'1I|_r~|~ϝ{,~yά:ۖ!f24¡pǮ%B,ݺAk(=ူДɟ
7CP< 6۴
@lzUh#..vקZ[KJVNLKJ0 ؍^i{ӟ?ֳea?RCПe]=/^3Ym'9/=y|3!J<1l{c+ɁQ @;43"&xē??RR |[_]Q}N3zVV}E/*"-_`^r%;:///hG?[[
{~$8
1F zӓVb-O{;>9_W͌Ix___E_w~wY?ڄK_//;)LѪ<>%vIfzӞt`\(ҩ=OΥ9}rU|+GȕW^Uo~S?S>Sɟx ʪNj70 |32V5Gvjuv
qCJ
ſO|/ qM>6Tƺ?Y]]^{-^*lI((}NOM^%P[![ts=k?~
d3ymꕉ|op.wQЇ+}le4\|ȇ|IFڽ~W|peJE [L]i#kTd1^Pn*F]&//y mBovJ!w?ʤDˑ1t__/Kr9ʳ_>>#>#?IcۍsCshhΏzԣ"Bnڃ-;#Av?#?2+7oD&~ʈ$g쟥SM}k_Gs6DInڋ:pF/5Ex[ޒyC"x.` `e}g}W2U)H%B]J7_KxK]USpsX|;^O\pr/Ynw;|2Ph5_5w~W\qE:,aR~="v;ଓ|ϊ%P%pȝC=8˻A_%prs:ܽ
^V>~g~yEbX}}LYE@n#>12Ib!G~GnD=o\MT;r6;RB?#lMMƒfd_={%l
9_b2gI)LeRve>#7Xn"cn!kk.HpZx8,0Ll jI9*8%݄Lf.OK/hw.۴1e~2,;ғ$FM3mnh[aEǟ5yonqL(!9pv2lş6S?SokSwN_ΙB.,C2~_Ty<|'|ԩrѤdMF'>BLׄ$ 7\2|eZOQӸ&M?-J/2_v;CxNfSʇ8\><5\g?"9320W %b{=ĂF/<'C[]9p_&زO*,|:SB+'xnJuRmE4 ¯sQ[*/QU06Euu24B[ ʺH%q7_QQtwJJvK 1,[E|2\[2Kcl^,(cB /m'nt=:aMiٙ7d-l.-ւXfmk,IqL5܈WF{TEDfLwp60OL:xQzo?Ms'afX:ʥ]ւޛ&/}O/+6W2l4X~}9f9k|'fԷRk+L [Kv4҄Oc.'oo~'}Yz%t4hS^T$>q(K
+vJs$X^~Ԗxn\S@ !PE-)8 MNи1ciY#i3mٕ?JP&|^E'4t܍Mvi
2܊NĜeVZqStUʟvf 5;B-y{c'*߹eWkheYy}NR97E%+E&F↦/}K3"dhO?uG%犖h0{m菲\9>33Fgb)#ٺewڬ/_.P?AN_Ie~G4Nз>y6J=>-RKJNUv_nĐt
ɧ x=URalF۫^*7S&䬬8)e?ٱ9ͳDI)LJS=贊/A_&ؕ@-KY,3&>_2&ma~'@/!AEm)#$2/11!ׇq<ܐ;/5Xu^TvFdmSp*~8ҥX-e%B>/bQmP5t*DP1i}%ڴ"m_Ib
*h1@CP_e֟VLKo-^m((O6+],&J\d7ęF NWF~(MFմ?daFaؑմ2]naH2aKNqǶYU"miMifd͎hzJTYZ/>6j
Gz8C{i㵫8.5[Y