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Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.

Background: World Trade Center (WTC) rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens.Objective: The purpose of this investigation was to evaluate cancer incidence in responders during the first 7 years after 11 September 2001.Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure.Results: A total of 575 cancers were diagnosed in 552 individuals. Increases above registry-based expectations were noted for all cancer sites combined (SIR = 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR = 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR = 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR = 1.36; 95% CI: 1.07, 1.71), and soft tissue cancers (SIR = 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed ≥ 6 months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust, compared with responders who reported lower levels of exposure.Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow-up and surveillance of WTC responders.

The World Trade Center Health Program (WTCHP) General Responder Cohort (the cohort) consists of workers and volunteers who were part of the rescue and recovery effort that followed the 11 September 2001 attack on the World Trade Center towers. Fire Department of New York (FDNY) and Pentagon and Shanksville responders are not included in this cohort but are covered by other similar programmes. This self-selected, open, de facto cohort began to form within a month of 9/11when the rescue and recovery workers began presenting with a variety of respiratory complaints at Mount Sinai's Irving J. Selikoff Center for Occupational and Environmental Medicine. 1-4 In 2002, the National Institute for Occupational Safety and Health (NIOSH) provided funds to provide a one-time medical evaluation, and support for physical and mental health treatment came from philanthropic sources. NIOSH also provided funding, in 2004, for additional medical evaluations and, in 2006, for treatment of both physical and mental health conditions. With the passing of the James Zadroga 9/11 Health and Compensation Act of 2010, 5 more years of medical monitoring and treatment were provided. Who is in the cohort? Estimates of how many rescue and recovery workers and volunteers worked on the WTC effort vary and may never be known, but the City of New York estimate is 91 000. 5,6 As of 31 March 2014, the WTCHP had information on 48 389 potential enrollees (Figure 1), 34 225 of whom were eligible because of their participation in earlier programmes and 3056 more of whom were subsequently deemed eligible. Eligibility criteria are: (i) the person worked or volunteered on the WTC effort for either 4 h

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This paper shows that a previously developed technique for analyzing simulations of GI/G/s queues and Markov chains applies to discrete-event simulations that can be modeled as regenerative processes. It is possible to address questions of simulation run duration and of starting and stopping simulations because of the existence of a random grouping of observations that produces independent identically distributed blocks in the course of the simulation. This grouping allows one to obtain confidence intervals for a general function of the steady-state distribution of the process being simulated and for the asymptotic cost per unit time. The technique is illustrated with a simulation of a retail inventory distribution system.

The assault and subsequent collapse of the World Trade Center towers in New York City on September 11, 2001 (9/11), released more than a million tons of debris and dust into the surrounding area, engulfing rescue workers as they rushed to aid those who worked in the towers, and the thousands of nearby civilians and children who were forced to flee. In December 2015, almost 15 years after the attack, and 5 years after first enactment, Congress reauthorized the James Zadroga 9/11 Health and Compensation Act, a law designed to respond to the adverse health effects of the disaster. This reauthorization affords an opportunity to review human inhalation exposure science in relation to the World Trade Center collapse. In this Special Article, we compile observations regarding the collective medical response to the environmental health disaster with a focus on efforts to address the adverse health effects experienced by nearby community members including local residents and workers. We also analyze approaches to understanding the potential for health risk, characterization of hazardous materials, identification of populations at risk, and shortfalls in the medical response on behalf of the local community. Our overarching goal is to communicate lessons learned from the World Trade Center experience that may be applicable to communities affected by future environmental health disasters. The World Trade Center story demonstrates that communities lacking advocacy and preexisting health infrastructures are uniquely vulnerable to health disasters. Medical and public health personnel need to compensate for these vulnerabilities to mitigate long-term illness and suffering.