Journal of Occupational and Environmental Medicine

Papers
(The TQCC of Journal of Occupational and Environmental Medicine is 3. The table below lists those papers that are above that threshold based on CrossRef citation counts [max. 250 papers]. The publications cover those that have been published in the past four years, i.e., from 2022-06-01 to 2026-06-01.)
ArticleCitations
Binge Drinking Patterns in the Workplace: Insights From a Population of Administrative Staff44
Response to Talc Review Omission35
Changes Over Time in COVID-19 Incidence, Vaccinations, Serum Spike IgG, and Viral Neutralizing Potential Among Individuals From a North American Gaming Venue26
A Prospective Investigation of the Impact of Telemedicine and Telemetry on Global Medical Evacuation Rates26
A Longitudinal Analysis of Long Working Hours and the Onset of Psychological Distress24
Job Demand-Control and Hypertension in African Americans and Non–African Americans21
On-Duty Resting Heart Rate Variability at the Fire Station Is Related to Cardiorespiratory Fitness and Physical Activity Levels in Firefighters20
The Effects of Increasing Heat Waves on Outpatient Caregivers—Attitudes, Measures, and Outlook18
Impact of a Participatory Wellness Continuing Medical Education Program on Physician Burnout and Well-Being18
Occupational Dust Exposure as a Risk Factor for Developing Lung Function Impairment18
Integration of Total Worker Health® Training for Occupational Health and Safety Professionals With Efforts to Promote Worker Health, Safety, and Well-being in Mexico17
Do Sleep Problems Explain the Association Between Work Stress and the Trajectories of Work Ability From Midlife to Pensionable Age?17
Predicting Heat-Induced Physiological Strain and Dehydration Among Male Agricultural Workers in Eastern India17
Impact of Telework on Body Composition, Physical Fitness, and Physical Symptoms in Japanese Workers16
Differences in Resilience and Mental Health Symptoms Among US First Responders With Secure and Insecure Attachment16
General Approach to Initial Assessment and Documentation16
The Effect of Working From Home on Device-Measured Physical Activity Among Japanese White-Collar Workers16
Understanding Sleep Behaviors and Barriers to OSA Evaluation and Treatment Among Highway Maintenance Vehicle Operators16
First-Responder Attachment–Related Distress and Suicide15
Shiftwork and the Risk of Metabolic Syndrome Among Health Care Workers15
Historical Cohort Study of Male Styrene-Based Products Manufacturers15
The Intersection of Gender and Occupational Roles in Agriculture15
A Cross-Sectional Descriptive Analysis of Diversity, Equity, and Inclusion Presence Among United States Occupational and Environmental Medicine Residency Program Websites15
Postpandemic Sedentary Behavior and Physical Activity Among IT Workers15
Long Term Cardiovascular Health Effects of Intelligent Physical Exercise Training Among Office Workers—A 2 Year Follow up of a Randomized Controlled Trial15
Incidence and lifestyle risk factors for same-level falls among Japanese workers14
Associations of Employment Factors With Cardiovascular Disease in a National Sample of US Firefighters: Findings From the National Health Interview Survey14
A Study on Nonvibration-Exposed Organs Correlated Indices as Diagnostic Biomarkers of Hand-Arm Vibration Syndrome14
Measuring the Health Related Quality of Life and Economic Burden of Illness Among Migrant Workers With Pneumoconiosis14
The Future of Occupational and Environmental Medicine14
Investigating Blood Lead Levels and Its Health Effects on Employees of a Petroleum Industry and the Surrounding Residents14
Physiological Stress Responses to a Live-Fire Training Evolution in Career Structural Firefighters14
Suicides in Massachusetts by Industry and Occupation, 2016–201913
Prospective Associations Between Organizational Changes and Health Outcomes Among French Employees Who Remained in Employment13
Association Between the Metabolic Syndrome and Retinal Microvascular Diameters Among Police Officers13
Primary Care Consultations Among UK Police Officers and Staff13
Effectiveness of a Workplace Web-Based Multi-Component Intervention on Lifestyle, Health, and Work Productivity in Beauty Consultants: A Randomized Controlled Trial13
Organizational and Individual Contributing Factors to Safety Climate in Healthcare Industries—Bayesian Network Predictive Modeling Approach13
Occupational Risk Factors for SARS-CoV-2 Seropositivity in Healthcare Workers13
Erosion of Traditional Employment12
Ambient Air Pollution and Incident Cardiovascular Disease in People With Type 2 Diabetes Mellitus12
Mental Health Support for First Responders Provided Outside of California’s Workers’ Compensation System12
Productivity Loss of Temporary Work Absenteeism Due to COVID-19 and Its Determinant Factors in Northeastern Iran12
Breaking up Sitting Time With Isometric Wall Squat Exercise During Occupational Activities12
Association of Urinary Phthalate Metabolites With Pulmonary Function in Children12
The Relationship Between Respiratory Complaints and Urine Aluminum Levels in Aluminum Factory Workers12
Health Care Workers’ Reflections, Experiences, and Sequela throughout the COVID-19 Pandemic12
Association Between Workaholism and Work Engagement and the Incidence of Long-Term Sickness Absence11
Why Am I So Exhausted?11
“I’m Going to Work, but It Is Survival, Too”11
Silica Exposure and Cardiovascular, Cerebrovascular, and Respiratory Morbidity in a Cohort of Male Swedish Iron Foundry Workers11
Workplace Infection Control Measures and Perceived Organizational Support During the COVID-19 Pandemic in Japan11
Association of Working Time Control With Health-Related Productivity Loss and Work Engagement11
Sleep Latency and Post-Traumatic Stress Disorder Among Retired Career Florida Firefighters11
Daily Associations Between Presenteeism and Health-Related Factors Among Office Workers11
Predictors of Physical and Mental Health-Related Quality of Life in Tunisian Workers With Type 2 Diabetes10
The Impact of Adjustment on Workplace Attitudes and Behaviors Among Health Care Workers During the COVID-19 Pandemic10
Associations between Perceived Occupational Prestige and Psychological Symptoms in Correctional Supervisors10
Unmet Mental Health Needs Among California Workers Since the Start of the COVID-19 Pandemic10
Practical Role of an Acclimatization Plan in Occupational Heat Stress Management10
Prediction of the preclinical stage of coal workers’ pneumoconiosis on non-imaging data integrating prior knowledge and machine learning9
Immigration and Blood Lead Levels Among Asian Populations in the United States9
An Investigation of Sleep Quality, Stress, and Healthy Eating Status Among Shift-Working Firefighters: A Descriptive Cross-Sectional Study9
Asbestos Exposure in Low-Middle Income Communities of Cartagena, Colombia9
Residual Dialkyl Phosphate Metabolite Concentrations of Organophosphate Pesticides Among Indian Farmworkers9
The Case for a Performance-Based Approach to Mental Health Screening in Aviation9
Burnout and Engagement’s Relationship to Drug Abuse in Lawyers and Law Professionals9
Who Hurt You at Work? Results From a Nationwide Survey of Association Between Absenteeism and Workplace Violence, Stratified by Perpetrator9
Low Job Control and Racial Disparities in Breastfeeding9
Determinants of Sickness Absence Duration After Mild COVID-19 in a Prospective Cohort of Canadian Healthcare Workers9
Work Disability Duration Among Mobile Workers9
Improving Access and Quality of Behavioral Health Services for Health Care Employees9
Navigating Pandemics in Defense Environments9
The Effect of Ketamine-Assisted Group Therapy on Treatment-Resistant Mental Health Conditions in Firefighters9
Remembering History, Now More Than Ever9
Barriers and Facilitators of Achieving Healthy 24-Hour Movement Behaviors in Work-From-Home Desk Workers9
Development and Evaluation of the Firefighter Exposure to Carcinogens Scale9
Psychological General Well-being, Cognitive Failure, and Inflammation Biomarkers Among Workers 4 Months After a Mild/Asymptomatic SARS-CoV-2 Infection8
When Helping Hurts: A Survey of Performance-Related Musculoskeletal Disorders in Music Therapists8
Laboratory Monitoring After Lentiviral Vector Exposure8
Comprehensive Assessment of Cardiovascular Risk Factors among Long-Haul Truck Drivers in South Brazil and its Impact on 3-year follow-up of Cardiovascular Events.8
Lifestyle Factors Associated With Self-Reported Work Productivity and Pandemic Impact8
Paradoxical Associations of Occupational and Nonoccupational Sedentary Behavior With Cardiovascular Disease Risk Measures in Desk Workers8
Exposure to industrial air toxics and risk of breast cancer in California: The Multiethnic Cohort Study8
Association Between Line Manager' Assessment for their Subordinates' Health Condition and Subordinate's Self-Rated Mental Health Status8
Mortality Associated With Occupational Exposure in Helsinki, Finland—A 24-Year Follow-up8
Associations Between Room Function, Office Design, Workplace Spatial Layout and Sitting Patterns During Office Work8
Digital Stress. Effects of Different Intensities of Working From Home on Workers' Health8
Oil and Gas Extraction Industry Workers’ Compensation Claims and Proposed Safety Interventions8
Prevalence of Hearing Loss Among Noise-Exposed US Workers Within the Utilities Sector, 2010–20198
Factors Related to Firefighters' Food Behaviors at the Fire Station8
Managers From Blue Work Sectors Have More Negative Attitudes Towards Common Mental Disorders Than Managers From Other Work Sectors8
The Association between Work-Life Conflict and Mental Health—A Cohort Study8
Implementation of an Occupational Sun Safety Intervention8
Work Productivity Loss in People Living With Long COVID Symptoms Over 2 Years From Infection8
Deployment to Military Bases With Open Burn Pits and Mental Health Conditions and Injury Mortality Among US Veterans8
Offering Concurrent Seasonal Influenza and COVID-19 Vaccination to Medical Center and Healthcare Personnel Increases Uptake7
Increased Mortality Associated With Disability Among Workers’ Compensation Claimants With Upper Extremity Neuropathy7
Association Between Night Shift and Hypertension7
Integrating Power Into Research, Outreach, and Practice to Make the Most of the Next Decade of the Total Worker Health® Program7
Re: TenHarmsel et al., Mortality Among Individuals Diagnosed With Chronic Beryllium Disease and Beryllium Sensitization7
In Response to7
Protecting the Frontline7
Characteristics of Workers’ Compensation Claims in South Korea’s Electronics Industry With a Focus on Occupational Cancers in the Semiconductor and Display Sectors (2013–2022)7
COVID-19 Clusters and Outbreaks Among Non–Health Care, Noncongregate Workers in Chicago, Illinois7
Obituary for Dee W. Edington, PhD (September 3, 1937, to June 21, 2022)7
Validation of the NIOSH Worker Well-Being Questionnaire in Italian Language7
Conditions of Work that Impact the Health Behaviors of Long-Haul Truck Drivers7
The Relationships Between Blood Pb Levels and Blood Pressure Among Lead-Exposed Workers in China: A Repeated-Measure Study7
The Impact of Productivity Loss From Presenteeism and Absenteeism on Mental Health in Japan7
Seniority Versus Age in Work-Related Musculoskeletal Pain Among Preschool Educators7
Filing a Workers' Compensation Claim for Low Back Pain and Associated Factors7
Work-Related Factors Associated With Health and Well-Being of Early Care and Education Workers7
The Association Between Forceful Hand Exertions and Musculoskeletal Disorders of the Neck and Shoulder7
The effectiveness of neuromuscular exercise on multisite pain among currently working health care workers7
Assessing the Physical and Psychological Well-being of Construction Workers During the COVID-19 Pandemic7
Addressing Mental Health Factors to Improve Outcomes in Work-Related COVID-197
The Effectiveness of the DeskCycle in Reducing Sedentary Behavior Among Female Office Workers7
A Mixed-Methods Study of Risk Factors and Experiences of Health Care Workers Tested for the Novel Coronavirus in Canada7
Longitudinal Nephrotoxic Metal Exposure in a Cohort of Farm Workers in Sonora, Mexico7
Maternal Differences in Healthcare Provider-Led Conversations About Patients’ Work Prior to Pregnancy, Pregnancy Risk Assessment Monitoring System, 2016–20216
Increase in Trauma Leading to Psychological Injury Among Canadian Homelessness Services Workers During the COVID-19 Pandemic6
Development and Validation of an Occupational Heat Risk and Illness Index: An Integrated Tool for Assessing Heat Stress Vulnerability in Outdoor Workers6
The Relationship Between Employee Physical Activity Intensity and Workplace Burnout6
Prepandemic Mental Health and Well-being6
Understanding the Mental Health Impacts of the COVID-19 Pandemic on Railway Workers6
Risk Perceptions of Health Care Workers and Occupational Health Experts on Psychological Distress6
Clinical Validation of an AI System for Pneumoconiosis Detection Using Chest X-rays6
COVID-19–Related Medical Vulnerability and Mental Health Outcomes Among US First Responders6
Decreases in Employer Referrals to First-Time Substance Use Treatment for Adults From 2004 to 20206
Occupational Exposure to 50 ppm Isoflurane Impairs Sperm Parameters in Mice6
Improving Cardiorespiratory and Muscular Function of Korean Firefighters6
Impact of Changes in Type of Employment on Absenteeism/Presenteeism Among Korean Workers6
Longitudinal Surveillance for Chronic Health Conditions in Former United States Department of Energy Site Workers6
Grenfell Tower Fire: Toxic Effluents and Assessment of Firefighters’ Health Impacts6
Which Device Is Most Suitable for Measuring Heart Rate Variability in the Field? A Comparative Evaluation of Two Leading Options6
Work-Related Asthma Mortality, Michigan 2003–20236
Examining Long-Haul Truck Driver Needs and Preferences to Improve the Truck Stop Environment6
Impact of sit-stand desks on subjective sitting time and psychological outcomes in office workers: findings from the SUFHA randomized controlled trial6
An Online Training Module to Increase Knowledge and Awareness of Chemical Exposures and Safety Measures Among Nail Salon Workers6
A Debiasing Checklist Has the Potential to Improve Efficiency, Effectiveness, and Outcomes in Claims of Work Injury6
Perceived Workplace Discrimination on the Basis of Parent Status in Australia6
COVID-19 Risk Assessment Among Vulnerable Small Business Owners in El Paso County, Texas6
The Impact of Metabolic Syndrome on the Risk for Disability Pension in Overweight and Obese Employees6
The Incidence of Postmenopausal Breast Cancer in Relation to Occupational Exposure to Textile Fibers and Dusts in Montreal, Canada, 2008–20116
Long-Term Exposure to Dust and Noise Can Increase the Risk of Hypertension—A Population Based, Cross-sectional Study6
Neuron-Specific Enolase as a Biological Marker for Welders’ Pneumoconiosis6
Perceptions About Messaging and Constructs Relevant to Personal Protective Equipment (PPE) Use During Mold Cleanup Among Persons Affected by Hurricane Ida—Louisiana, USA, 20216
Impact of Hand-Arm Vibration on Grip and Pinch Strength of Jackhammer Operators: A Cross-sectional Study6
Reducing Injury Risk in Law Enforcement: Evaluating a Standardized Physical Training Model with Fitness Outcomes6
Karshi-Khanabad Surveillance Program (K2SP)6
Evolution of Posttraumatic Symptoms and Related Factors in Healthcare Workers During the COVID-19 Pandemic6
Relationship Between Work-Family Conflict and Depressive Symptoms Among Male Firefighters in China6
Advancements in AMA Guides Musculoskeletal Impairment Evaluations6
Altered Mental Distress Among Employees From Different Occupational Groups and Industries During the COVID-19 Pandemic in Germany6
The Mediating Role of Fear of COVID-19 in the Association between COVID-19–Related Work Stressors and Subjective Well-being5
Mental Health and Well-Being for Patients and Clinicians5
Association Between Skeletal Muscle Mass and Cardiovascular Risk Factors in Occupational Sedentary Population5
Practical Applications and Observational Implications of Time-Based Coding for Workers’ Compensation Clinical Encounters—A Follow-up to Best Practices in Documenting and Coding High-Value Care in Work5
Guidance for Creating Morally Healthy Organizations That Remediate the Experience of Moral Injury in Health Care5
Industry-Specific Profile of COVID-19–Related Workers' Compensation Claims in New York State5
Effects of the Need for Support From the Workplace and Resilience on Psychological Distress in Japanese Employees5
Impact of Shifting From Office Work to Telework on Workers’ Physical Health5
Workplace Measures Against COVID-19 and Mistreatment in the Workplace Among Japanese Employees5
A Cross-sectional Survey of Burnout Prevalence, Intention to Leave, and Contributing Stressors Among Physiotherapists in Singapore’s Publicly Funded Healthcare Institutions5
Use of Geological Maps in Detecting Asbestos-Related Diseases; A New Region in Anatolia5
Dream BIG! Empowering Employee Well-being Through Wellness Coaching5
Analysis of Recognized Occupational Infectious Diseases in Germany Between 2018 and 20235
Associations of Chronotype, Work Schedule, and Sleep Problems With Work Engagement Experiences in Middle Age—The Northern Finland Birth Cohort 19665
A Socioecological Approach to Work Performance5
Arginine-Proline Metabolism as a Mediator in the Association Between Coal Dust Exposure and Lung Function5
Comparison of Serum Per- and Polyfluoroalkyl Substances Concentrations in Incumbent and Recruit Firefighters and Longitudinal Assessment in Recruits5
Association Between Telecommuting Preference-Frequency Mismatch and Insomnia Among Japanese Workers in the COVID-19 Pandemic5
Efficacy of mHealth-Based Workplace Health Promotion Strategy in Improving Cardiorespiratory Fitness in a Healthcare Setting5
Liposomal-Associated Phospholipase A2 Is More Effective in Predicting Cardiac Risk in Law Enforcement Than Framingham Risk Score and Coronary Artery Calcium Score Calculation5
Workplace Culture and Mental Health of Ethnic Minority Workers in Japan5
Changes in Burnout and Moral Distress Among Veterans Health Administration (VA) Physicians Before and During the COVID-19 Pandemic5
Computer and Furniture Affecting Musculoskeletal Problems and Work Performance in Work From Home During COVID-19 Pandemic5
Causal Effects of High Stress Assessed Via Interviews on Mental and Physical Health5
The Association Between Social Determinants of Health, Risk Factors, Job Performance, and Health Care Costs in an Employed Population5
“I’m Dealing With My Whole Health Right Now”5
Predictors of COVID-19 Vaccine Uptake in Health Care Workers: A Cross-Sectional Study in Greece5
Hot button: A content analysis of public comments on OSHA’s proposed heat injury and illness prevention standard5
What should occupational medicine physicians know about dermal exposure to meta-Phenylenediamine?5
Progressive Massive Fibrosis Risk Factors5
Leveraging Employers’ Influence Over Wages as a Social Determinant of Health5
Response to the Letter to the Editor From Jeffrey Brent, MD, PhD. Re: Mesothelioma Associated With the Use of Cosmetic Talc5
Posttraumatic Stress Symptoms and Predictors Among Spanish Police and Armed Forces During the COVID-19 Pandemic in Spain5
Relationship Between Presenteeism and Work-related Cuts and Abrasions in the Retail Industry: A Prospective Cohort Study in Japan5
How Work Pattern Transformation May Affect the Mental Health of Older Workers Faced With Unmet Health Care Needs During the Pandemic? A Comparative Investigation of Different Work Models5
Feasibility of a Capacity Building Organizational Intervention for Worker Safety and Well-being in the Transportation Industry5
Health and Healthcare Access for Essential, Nonessential, and Nonworkers During the COVID-19 Pandemic5
American Board of Preventive Medicine Updated Occupational and Environmental Medicine Examination Content and Practice Analysis5
Effects of Occupational Stress and Health Behaviors on Heart Rate Variability in Live-Fire Instructors5
Breast Cancer Among Female Flight Attendants and the Role of the Occupational Exposures4
It Is Time for Employers to Recognize and Address Political Anxiety in the Workplace4
JOEM Updates and Thank You to the 2025 Reviewers4
Evaluating the Effectiveness of Camera-Based Fatigue and Distraction Detection Technology in a Rural Truck Driver Cohort4
Occupational Mental Health4
Attenuated Cardiovascular Reactivity to Acute Psychological Stress Predicts Future Fatigue Symptoms in Truck Drivers4
Depressive Symptoms Are Associated With Decreased Quality of Life and Work Ability in Currently Working Health Care Workers With Recurrent Low Back Pain4
EMS Professionals Sleep Disturbance4
Predicting Depressive Symptoms and Psychological Distress by Circulating Inflammatory Mediators4
Family-Related Life Events as Predictors of Labor Market Marginalization Trajectories4
Can Mindfulness Buffer Against Negative Effects of Job Demands for Military and Police Personnel?4
A Cross-sectional Study of the Association of Menopausal Symptoms With Presenteeism Among Female Employees of a Japanese Company4
Does Working in Shifts Matter? A Comparative Study of Occupational Balance and Health-Promoting Lifestyle Profile in Health Care Workers4
Work Productivity Loss in People Living With Long COVID Symptoms: A Good Start and a Missed Opportunity4
Talc Inhalation in Rats and Humans4
Employee Sources of Stress and Their Associations With Absenteeism4
Impacts of Altering Spirometric Prediction Equations in Occupational Health4
Association of Physical Health Indices With Antidepressant and/or Anxiolytic Use in Former US Coal Miners4
Exercise Habits and Resources for Southeastern US Firefighters4
Work-Family Conflict in association with Depression and Anxiety symptoms: An Australian community-based study4
Employment Productivity and Cancer-Related Psychological Symptoms Among Adult Cancer Dyads4
Update on Managing the Risks of Exposure to Lentiviral and Retroviral Vectors4
Ethylene Oxide Exposure and Its Association With Serum Neurofilaments Light Chain Levels in the General Population4
Association of Work Stress With Anxiety and Depression Among Adults in Wuhan, China4
Demographic Differences and Potential Bias From Automated Occupation Coding Among Mothers of Babies Born With or Without Cleft Lip and/or Cleft Palate in the Texas Birth Defects Registry4
Sickness Presenteeism and Psychosocial Risk Factors According to Inequality Axes4
Permanent Unfitness for Work and Musculoskeletal Diseases4
Workplace Harassment and Health4
The Impact of Air Pollution on Acute Angle-Closure Glaucoma in Hefei, China, 2017–20224
The STOP Principle in Preventing Workplace Carcinogenic Risks4
Occupational Dust Exposure as a Determinant of Cerebral Small Vessel Disease Burden in Coal Miners4
Welding fumes and SARS-CoV-2: a dangerous combination4
Impact of Hurricane Harvey on Inpatient Asthma Hospitalization Visits Within Southeast Texas, 2016–20194
Potential Health Impacts of Jet Fuel Exposure on the Hematologic and Cardiovascular Systems4
Impact of a Digital Diabetes Prevention Program on Estimated 8-Year Risk of Diabetes in a Workforce Population4
Poor Sleep Quality and Working From Home Influence the Prevalence of Leisure Time Physical Inactivity During the COVID-19 Pandemic4
Diabetes Prevention at Work: 10-Year Results of Health Coaching and Monetary Incentives4
A Rapid Nucleic Acid Amplification Test–Based, Conditional Release-to-Work Policy for Health Care Personnel With Symptoms Consistent With COVID-194
Changes in Anxiety and Depression Over the First Year of COVID-19 Pandemic in Philadelphia, PA4
Comment on the Update ACOEM Guidance Statement—Role and Value of the Corporate Medical Director4
A Longitudinal Cohort Study of Factors Impacting Healthcare Worker Burnout in New York City During the COVID-19 Pandemic4
Unpredictable Work Schedule Changes and Occupational Accidents: A Comparative Analysis of Korean and European Working Conditions Surveys4
A Study on Vascular Regulators as Early Biomarkers of Hand Arm Vibration Syndrome4
COVID-19 Infections in Health Care Personnel by Source of Exposure and Correlation With Community Incidence4
Presenteeism Caused by Health Conditions and Its Economic Impacts Among Japanese Workers in the Post-COVID-19 Era4
Experiences With Work-Family Conflict, Breastfeeding, and Perinatal Mental Health Among Women Returning to Work After Giving Birth4
Injury Rates and Costs for Direct and Non-direct Care Employees in Four Public Sector Healthcare Facilities4
Seeking Good Work in the COVID-19 Recovery4
Menstruation-Related Diseases, Work Performance, and Oral Contraceptive4
Letter to the Editor California response to “Work-Related Asthma Mortality, Michigan 2003–2023”4
Letter to the Editor4
Understanding the Neurologic and Cognitive and Behavioral Effects Associated With Exposures to Jet Fuels4
Support Needs for Return to Work Among Self-employed Workers4
A 12-Week Cycling Workstation Intervention Improves Cardiometabolic Risk Factors in Healthy Inactive Office Workers4
SARS-CoV-2 Seroprevalence in Employees of Four Essential Non–Health Care Sectors at Moderate/High Risk of Exposure to Coronavirus Infection4
Respirator Medical Examinations4
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