The Impact of 9/11 and Other Terrible Global Events on Tourism in the U.S. and Hawaii

This paper reviews recent trends in travel and tourism in the U.S. and Hawaii to ascertain how the terrorist attacks of 9/11 and subsequent terrible global events affected their tourism flows and the manner and pace of their recovery. We note that tourism in the U.S. has not fully recovered from 9/11 and other international shocks; indeed recovery of international travel to the U.S. may be a long way off. By contrast, Hawaii tourism is enjoying robust growth in the aftermath of 9/11 as growth in tourist arrivals from the U.S. mainland has more than offset declines in Japanese and other international visitors. We suggest that Hawaii's current tourism boom is in part explained by the diversion of U.S. travel from foreign travel. The paper demonstrates the usefulness of vector error correction models to generate dynamic visitor forecasts which we use to ascertain whether tourism in Hawaii has fully recovered from 9/11 and other terrible international events. The paper considers policy options for facilitating the recovery of international tourism to the U.S.

The Impact of 9/11 and Other Terrible Global Events on Tourism in the U.S. and Hawaii

This paper reviews recent trends in travel and tourism in the U.S. and Hawaii to ascertain how the terrorist attacks of 9/11 and subsequent terrible global events affected their tourism flows and the manner and pace of their recovery. We note that tourism in the U.S. has not fully recovered from 9/11 and other international shocks; indeed recovery of international travel to the U.S. may be a long way off. By contrast, Hawaii tourism is enjoying robust growth in the aftermath of 9/11 as growth in tourist arrivals from the U.S. mainland has more than offset declines in Japanese and other international visitors. We suggest that Hawaiis current tourism boom is in part explained by the diversion of U.S. travel from foreign travel. The paper demonstrates the usefulness of vector error correction models to generate dynamic visitor forecasts which we use to ascertain whether tourism in Hawaii has fully recovered from 9/11 and other terrible international events. The paper considers policy options for facilitating the recovery of international tourism to the U.S.Tourism, Terrorism, Impact, Recovery

COST EFFECTIVENESS OF NUTRIENT MANAGEMENT AND BUFFERS: COMPARISONS OF FOUR SPATIAL SCENARIOS

Policymakers are seeking cost effective methods to reduce nutrient pollution from agriculture. Predicted costs and pollution reductions from nutrient management and buffers are evaluated under four spatial scenarios describing a watershed. Results will help policymakers evaluate alternative Best Management Practices (BMPs) for water quality protection in agriculture.Environmental Economics and Policy,

A study of molecular forms of the cholinesterases with particular reference to Hirschsprung's disease and neural tube defects

PhD ThesisAcetylcholinesterase [ACNE) and butyrylcholinesterase [EChE) were studied in amniotic fluid in relation to the detection of neural tube defects CNTD), and in rectal tissue in the diagnosis of Hirschsprung's disease. An automated assay is described for measurement of AChE and BChE activity in amniotic Fluid, and an increase in both is found in the presence of NTD. Analysis of AChE molecular forms by sucrose density sedimentation revealed three species with differing sedimentation coefficients and molecular masses: monomeric G1[4. OS, 78KOa), dimeric G2[5.5S, 126KOa) and tetrameric G4(10.35,256KDa). The tetramer, G4 is NTD specific and is largely responsible for the increase in activity seen in the quantitative assessment of'total AChE and for the abnormal band identifiable by polyacrylamide gel electrophoresis in pregnancies affected by NTO. Evidence is presented which indicates that G4 is a soluble species secreted from nerve trunks exposed as a result of the lesion. SChE activity, the likely source of which is fetal plasma is shown to be a less specific indicator of NTD. These results represent the first description of the structural molecular heterogeneity of AChE and SChE forms in amniotic fluid. AChE activity was measured in rectal biopsy specimens from 213 patients in whom a diagnosis of Hirschsprung's disease was suspected. The results from this, the largest study so far reported, indicate the value of AChE measurement in the detection of the disease. The molecular forms of AChE and SChE were investigated in resected bowel segments from patients with Hirschsprung's disease. Four species of AChE were identified: G1[3.55,74KOa), G2[S. OS, 131KDa), 64(9.23,275KOa] and the asymmetric form A12(16.83,811KDa). In all cases there was an increase (4-14 fold] in G4-AChE activity in the aganglionic cola-rectum. The evidence indicates that this is derived from hypertrophied nerve trunks present in the affected zone. The increase in G4-AChE was largely responsible for the increase in total AChE activity in rectal biopsy specimens from patients with Hirschsprung's disease. BChE molecular forms showed no consistent changes in Hirschsprung's disease. Characterisation of the molecular forms of AChE by gel filtration and with respect to their thermal stability, sensitivity to Triton X-100 and response to substrate inhibition is also investigated.Mr J Wagget, Fleming Memorial Hospital

Healthcare professionals' and parents' experiences of the confirmatory testing period:A qualitative study of the UK expanded newborn screening pilot

Background: With further expansion of the number of conditions for which newborn screening can be undertaken, it is timely to consider the impact of positive screening results and the confirmatory testing period on the families involved. This study was undertaken as part of a larger programme of work to evaluate the Expanded Newborn Screening (ENBS) programme in the United Kingdom (UK). It was aimed to determine the views and experiences of healthcare professionals (HCPs) and parents on communication and interaction during the period of confirmatory testing following a positive screening result. Methods: Semi-structured interviews were undertaken with parents of children who had received a positive ENBS result and HCPs who had been involved with the diagnosis and support of parents. Ten parents and 11 healthcare professionals took part in the in-depth interviews. Questions considered the journey from the positive screening result through confirmatory testing to a confirmed diagnosis and the communication and interaction between the parents and HCPs that they had been experienced. Key themes were identified through thematic analysis. Results: The results point to a number of elements within the path through confirmatory testing that are difficult for parents and could be further developed to improve the experience. These include the way in which the results are communicated to parents, rapid turnaround of results, offering a consistent approach, exploring interventions to support family relationships and reviewing the workload and scheduling implications for healthcare professionals. Conclusions: As technology enables newborn screening of a larger number of conditions, there is an increasing need to consider and mediate the potentially negative effects on families. The findings from this study point to a number of elements within the path through confirmatory testing that are difficult for parents and could be further developed to benefit the family experience

Genomic newborn screening: Are we entering a new era of screening?

Population newborn screening (NBS) for phenylketonuria began in the United States in 1963. In the 1990s electrospray ionization mass spectrometry permitted an array of pathognomonic metabolites to be identified simultaneously, enabling up to 60 disorders to be recognized with a single test. In response, differing approaches to the assessment of the harms and benefits of screening have resulted in variable screening panels worldwide. Thirty years on and another screening revolution has emerged with the potential for first line genomic testing extending the range of screening conditions recognized after birth to many hundreds. At the annual SSIEM conference in 2022 in Freiburg, Germany, an interactive plenary discussion on genomic screening strategies and their challenges and opportunities was conducted. The Genomics England Research project proposes the use of Whole Genome Sequencing to offer extended NBS to 100 000 babies for defined conditions with a clear benefit for the child. The European Organization for Rare Diseases seeks to include "actionable" conditions considering also other types of benefits. Hopkins Van Mil, a private UK research institute, determined the views of citizens and revealed as a precondition that families are provided with adequate information, qualified support, and that autonomy and data are protected. From an ethical standpoint, the benefits ascribed to screening and early treatment need to be considered in relation to asymptomatic, phenotypically mild or late-onset presentations, where presymptomatic treatment may not be required. The different perspectives and arguments demonstrate the unique burden of responsibility on those proposing new and far-reaching developments in NBS programs and the need to carefully consider both harms and benefits

Parents’ and children's views of wider genomic testing when used as part of newborn screening to identify cystic fibrosis

Newborn bloodspot screening (NBS) is currently undergoing a ‘revolution’ (Spiekerkoetter et al., 2023). The development of new therapies (Vockley et al., 2023) and the piloting of whole genome sequencing in healthy newborns (e.g. Newborn Genomes Programme, UK, BabySeq USA) are challenging NBS practice and policy, as well as the Wilson & Jungner criteria (Wilson & Jungner, 1968) that underpin them (Andermann et al., 2008; Rahimzadeh et al., 2022; Vears et al., 2023). The capacity to screen for large numbers of variants simultaneously and generate data with potential relevance across the life course, and for family members beyond the screened infant, has prompted widespread discussion of the benefits (e.g., early identification and treatment of screened conditions) and harms (e.g., identification of variants of unknown clinical significance) that such high throughput screening programmes bring (Bick et al., 2022; Remec et al., 2021; Spiekerkoetter et al., 2023; Tluczek et al., 2022)

Stakeholder views of the proposed introduction of next generation sequencing into the cystic fibrosis screening protocol in England

The project aimed to gather, analyze and compare views of stakeholders on the proposed UK cystic fibrosis (CF) screening protocol incorporating next generation sequencing (NGS). The study design was based on principles of Q-methodology with a willingness to pay exercise. Par-ticipants were recruited from 12 CF centers in the UK. Twenty-eight adults with experience of CF (parents of children with CF [n=21], parents of children with CF transmembrane conductance regulator (CFTR)-related metabolic syndrome (CRMS)/CF Screen Positive – Inconclusive Diag-nosis (CFSPID), an uncertain outcome [n=3] and adults with CF [n=4]), and nine health profes-sionals involved in caring for children with CF. Parents and health professionals expressed a preference for a sensitive approach to NGS. This was influenced by the importance participants placed on not missing any children with CF via screening and the balance of harm between missing a case of CF compared to picking up more children with an uncertain outcome (CRMS/CFSPID). Given the preference for a sensitive approach, the need for adequate explana-tions about potential outcomes including uncertainty (CFSPID) at the time of screening was em-phasized. More research is needed to inform definitive guidelines for managing children with an uncertain outcome following CF screening

3q26 Amplification is Rarely Present in Women Whose LSIL Cytology does not Represent CIN 2+ Disease

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionObjective: 10-17% of women with LSIL cytology truly have CIN 2+ disease at colposcopically directed biopsy and 20% of the CIN 2+ lesions derive from women with LSIL cytology. No molecular marker has yet been able to triage LSIL cytology effectively. If possible, the triage would spare women the referral to colposcopy. Irreversible chromosomal damage occurs during oncogenesis. Increasing cervical dysplastic severity occurs with increasing amplification of the 3q26 chromosomal region. The purpose of this study is to evaluate the test characteristics of 3q26 amplification in women whose routine cytology is reported as LSIL with emphasis on the negative predictive value for reassurance. Methods: We conducted a retrospective study using the available SurePath™ liquid cytology LSIL archival samples from women 17-59 years old which were linked to colposcopically directed biopsy samples taken on average 36 days after cytology sampling (3-90 day range). Nuclei from the LSIL samples were hybridized with a single-copy probe for the chromosome 3q26 region and a control probe for the centromeric alpha repeat sequence of chromosome 7, using standard FISH methods. Amplification was defined as five or more signals present in at least 2 cells. Results: Of the 68 paired cytology/biopsy samples, 3q26 amplification occurred in 40% of the women with CIN 2+ disease (sensitivity 95% CI: 12, 74). There was no amplification in 91% of women with less than CIN 2 disease (specificity 95% CI: 81, 97); and the negative predictive value was 90% (79, 96). Conclusions: The lack of 3q26 amplification in women with screening cytology LSIL results offers reassurance that CIN 2+ disease has not developed. Future prospective studies are ongoing