Capability of E-Bike Tourism in Switzerland

AIM OF PAPER AND RESEARCH QUESTIONS The primary aim of this investigation was to examine, if tourism in Switzerland can be stimulated by focusing on e-bike offers. Switzerland is an attractive and manifold country for bike tourism. However, there are plenty of hilly and steep areas, where the topography is quite demanding and cycling is predestined to ambitious sportsperson. Less performance-oriented bike tourists are possibly discouraged by the challenges of the landscape. E-bikes seem to be a reasonable alterna-tive to enable less trained person to attend bike tours in steeper regions as well as to keep heterogeneous groups together. E-bikes are already popular in Switzerland for daily routes as the journey to work, but they are not very common in the tour-istic context. The presented investigation evaluates the current standing of supply and demand for e-bike tourism and asks for opportunities and threats in the future development. LITERTURE REVIEW The existing frameworks to analyse capability in the field of sport tourism are limited, because of the broad variation of sports and tourism types. Still several conceptions are valuable to evaluate the opportunities of e-bike tourism in Switzer-land. According to Higham and Hinch (2009) the potential of touristic products and destinations always depends on the interaction among the factors place, people and activity. Standeven and de Knop (1999) support this position by identify-ing the experience of place as a key component of the sport tourism experience. Bull (2005) assumes that place not only affects experience. In his opinion, the specific spatially located resources are even crucial for the existence of nature sports. He identifies four factors determining the attraction of touristic products or destination, as physical characteristics, accessibility and infrastructural arrangements, political and economic resources as well as cultural and perceptual aspects. Concerning the demand side (people) the contemporary research is guided by an individual psychological focus delivering mainly results about motives and the decision making process (e.g. Görtz & Hürten, 2011). RESEARCH DESIGN AND DATA ANALYSIS The presented study is based on a between method triangulation, consisting of qualitative interviews with important stake-holders on the supply side and a cross sectional survey on the demand side. Qualitative interviews were conducted with the first provider of touristic e-bike routes and with the manager of the leading e-bike rental company in Switzerland. The interviews were evaluated by qualitative content analysis according to Mayring (2008). The survey covered a randomized sample of 748 adult persons and focused on interests and needs of potential consumers. The concluding potentials analy-sis combined the results of the interviews and the survey with the findings of literature research. As central outcome the strengths, weaknesses, opportunities and threats were evaluated and presented by SWOT-analysis. RESULTS Results showed that the development of e-bike tourism in Switzerland was not initiated by tourism promoter, but by an innovative e-bike producer. However, also for the manufacturer the fit between landscape (place), product (activity) and visitors (people) was the crucial criterion. The first e-bike tours were offered in a demanding and rural region, in order that the experience of place was able to promote a positive overall experience. Due to the success of the first touristic e-bike products, several tourism regions started to extend their portfolio with e-bike offers. To date a nationwide network for signalised e-bike tours, rental stations and changing stations for rechargeable batteries is established. Despite the attractive offer, the demand is only moderate. The obtained results of the consumer survey pointed at a certain barrier to use e-bikes for tourism activities. The most substantial barrier is the missing affinity for bike tourism in general. Another notable group considering themselves as “fit enough for normal bike tourism”. Nevertheless 55% of the respondent are interested in tour-istic e-bike products. Looking only at people with e-bike tourism experience, even 92% are interested in further activities. DISCUSSION AN CONCLUSION The current study findings are encouraging because they suggest a superior suitability and an attractive level of e-bike tourism products in Switzerland. The results of the consumer survey indicate an increasing demand for e-bike tourism. The investigation also points at some risks, as the rivalry for bike tourism or the raised safety hazard because of the increased driving speed. Summing up, the results support the conclusion, that e-bike tourism will become more important in the com-ing years. However, to reach the goal relevant trends as the requirement for customised offers must be considered and marketing activities are supposed to be extended. REFERENCES Bull, C. (2005). Sport tourism resource analysis. In J. Higham (Ed.), Sport tourism destination: Issues, opportunities and analysis (pp. 25-38). Amsterdam: Elsevier Butterworth-Heinemann. Görtz, M., & D. Hürten (2011). Motive der Radurlauber, psychografische Merkmale und Reiseverhalten. In A. Dreyer, E. Miglbauer & R. Mühlnickel (Hrsg.), Radtourismus. Entwicklungen, Potenziale, Perspektiven (S. 36-43). München: Olden-bourg. Higham, J., & Hinch, T. (2009). Sport and Tourism. Globalization, Mobility and Identity. Amsterdam: Butterworth-Heinemann. Mayring, P. (2008). Qualitative Inhaltsanalyse. Grundlagen und Techniken (10. Aufl.). Weinheim: Beltz Verlag. Standeven, J., & De Knop, P. (1999). Sport Tourism. Campaign: Human Kinetics.

Motivational profiles of sport event volunteers.

Aim of the study Due to the valuable contribution made by volunteers to sporting events, a better understanding of volunteers’ motivation is imperative for event managers in order to develop effective volunteer re-cruitment and retention strategies. The adoption of working conditions and task domains to the mo-tives and needs of volunteers is one of the key challenges in volunteer management. Conversely, an ignorance of the motives and needs of volunteers could negatively affect their performance and attitude, which will have negative consequences for the execution of events (Strigas & Jackson, 2003). In general, the motives of volunteers are located on a continuum between selflessness (e.g. helping others), and self-interest (e.g. pursuing one’s own interests). Furthermore, it should take into account that volunteers may be motivated by more than one need or goal, and therefore, configure different bundles of motives, resulting in heterogeneous types of motives for voluntary engagement (Dolnicar & Randle, 2007). Despite the extensive number of studies on the motives of sport event volunteers, only few studies focus on the analysis of individual motive profiles concerning volun-teering. Accordingly, we will take a closer look at the following questions: To what extent do volun-teers at sporting events differ in the motives of their engagement, and how can the volunteers be ade-quately classified? Theoretical Background According to the functional approach, relevant subjective motives are related to the outcomes and consequences that volunteering is supposed to lead to and to produce. This means, individuals’ mo-tives determine which incentives are anticipated in return for volunteering (e.g. increase in social contacts), and are important for engaging in volunteering, e.g. the choice between different oppor-tunities for voluntary activity, or different tasks (Stukas et al., 2009). Additionally, inter-individual differences of motive structures as well as matching motives in the reflections of voluntary activities will be considered by using a person-oriented approach. In the person-oriented approach, it is not the specific variables that are made the entities of investigation, but rather persons with a certain combination of characteristic features (Bergmann et al., 2003). Person-orientation in the field of sports event volunteers, it is therefore essential to implement an orientation towards people as a unit of analysis. Accordingly, individual motive profiles become the object of investigation. The individ-ual motive profiles permit a glimpse of intra-individual differences in the evaluation of different motive areas, and thus represent the real subjective perspective. Hence, a person will compare the importance of individual motives for his behaviour primarily in relation to other motives (e.g. social contacts are more important to me than material incentives), and make fewer comparisons with the assessments of other people. Methodology, research design and data analysis The motives of sports event volunteers were analysed in the context of the European Athletics Championships 2014 in Zürich. After data cleaning, the study sample contained a total of 1,169 volunteers, surveyed by an online questionnaire. The VMS-ISA scale developed by Bang and Chel-ladurai (2009) was used and replicated successfully by a confirmatory factor analysis. Accordingly, all seven factors of the scale were included in the subsequent cluster analysis to determine typical motive profiles of volunteers. Before proceeding with the cluster analysis, an intra-individual stand-ardization procedure (according to Spiel, 1998) was applied to take advantage of the intra-individual relationships between the motives of the volunteers. Intra-individual standardization means that every value of each motive dimension was related to the average individual level of ex-pectations. In the final step, motive profiles were determined using a hierarchic cluster analysis based on Ward’s method with squared Euclidean distances. Results, discussion and implications The results reveal that motivational processes differ among sports event volunteers, and that volunteers sometimes combine contradictory bundles of motives. In our study, four different volunteer motive profiles were identified and described by their positive levels on the individual motive dimension: the community supporters, the material incentive seekers, the social networkers, and the career and personal growth pursuers. To describe the four identified motive profiles in more detail and to externally validate them, the clusters were analysed in relation to socio-economic, sport-related, and voluntary work characteristics. This motive-based typology of sports event volunteers can provide valuable guidance for event managers in order to create distinctive and designable working conditions and tasks at sporting events that should, in relation to a person-oriented approach, be tailored to a wide range of individ-ual prerequisites. Furthermore, specific recruitment procedures and appropriate communication measures can be defined in order to approach certain groups of potential volunteers more effectively. References Bang, H., & Chelladurai, P. (2009). Development and validation of the volunteer motivations scale for international sporting events (VMS-ISE). International Journal Sport Management and Market-ing, 6, 332-350. Bergmann, L. R., Magnusson, D., & El-Khouri, B. M. (2003). Studying individual development in an interindividual context. Mahwah, NJ: Erlbaum. Dolnicar, S., & Randle, M. (2007). What motivates which volunteers? Psychographic heterogeneity among volunteers in Australia. Voluntas, 18, 135-155. Spiel, C. (1998). Four methodological approaches to the study of stability and change in develop-ment. Methods of Psychological Research Online, 3, 8-22. Stukas, A. A., Worth, K. A., Clary, E. G., & Snyder, M. (2009). The matching of motivations to affordances in the volunteer environment: an index for assessing the impact of multiple matches on volunteer outcomes. Nonprofit and Voluntary Sector Quarterly, 38, 5-28.

Does a reference to evaluations contribute to discourse quality? The case of Swiss direct-democratic campaigns on school policy: a conceptual framework

This article examines how references to evaluations in school policy debates contribute to discourse quality. The article consists of two parts: First, it presents a descriptive overview of the references to evidence in direct-democratic campaigns. These results are based on a quantitative content analysis of the newspaper coverage and governmental information documents of 103 direct-democratic Swiss school policy votes. In a second step, it discusses these findings in view of the question of whether the incorporation of evaluation results in policy debates contributes to discourse quality. It presents a conceptual framework, including hypotheses and a research design to answer this question.

Acute S100B in serum is associated with cognitive symptoms and memory performance 4 months after paediatric mild traumatic brain injury

OBJECTIVE This study explored whether acute serum marker S100B is related with post-concussive symptoms (PCS) and neuropsychological performance 4 months after paediatric mild traumatic brain injury (mTBI). RESEARCH DESIGN AND METHODS This prospective short-term longitudinal study investigated children (aged 6-16 years) with mTBI (n = 36, 16 males) and children with orthopaedic injuries (OI, n = 27, 18 males) as a control group. S100B in serum was measured during the acute phase and was correlated with parent-rated PCS and neuropsychological performance 4 months after the injury. MAIN OUTCOMES AND RESULTS The results revealed no between-group difference regarding acute S100B serum concentration. In children after mTBI, group-specific significant Spearman correlations were found between S100B and post-acute cognitive PCS (r = 0.54, p = 0.001) as well as S100B and verbal memory performance (r = -0.47, p = 0.006). In children after OI, there were insignificant positive relations between S100B and post-acute somatic PCS. In addition, insignificant positive correlations were found between neuropsychological outcome and S100B in children after OI. CONCLUSIONS S100B was not specific for mild brain injuries and may also be elevated after OI. The group-specific association between S100B and ongoing cognitive PCS in children after mTBI should motivate to examine further the role of S100B as a diagnostic biomarker in paediatric mTBI.

Preclinical atherosclerosis and inflammation in 61-year-old men with newly diagnosed diabetes and established diabetes.

OBJECTIVE The aim of this study was to investigate the occurrence of subclinical atherosclerosis and underlying mechanisms in men with newly diagnosed diabetes and established diabetes compared with healthy control subjects. RESEARCH DESIGN AND METHODS In a population-based study of 61-year-old Caucasian men (n = 271) with established diabetes (n = 50) and newly diagnosed diabetes (n = 24) and healthy control subjects (n = 197), standard risk factors and highly sensitive (hs) C-reactive protein (CRP) were measured. Ultrasound measurements of intima-media thickness (IMT) were performed bilaterally in the common carotid artery, and a composite measure was calculated from common carotid and carotid bulb IMT (composite IMT). The plaque status was assessed. RESULTS Composite IMT and carotid plaque size increased gradually among the healthy control subjects, newly diagnosed diabetic patients, and established diabetic patients (P for trend < or =0.001, respectively). CRP was higher in newly and established diabetes (NS between diabetes groups) compared with healthy control subjects (P < 0.001). Total cholesterol levels were lower in newly diagnosed diabetes (5.51 +/- 1.13 mmol/l, P < 0.05) and established diabetes (5.45 +/- 1.15 mmol/l, P < 0.01) compared with those of healthy control subjects (5.77 +/- 1.03 mmol/l). In men with diabetes (n = 74), diabetes onset status (newly diagnosed versus established), waist-to-hip ratio (WHR), and serum triglycerides, but not CRP, explained 16% of the variance in composite IMT. CONCLUSIONS This is the first study to show increased preclinical atherosclerotic changes (IMT and plaque size) and increased inflammation (hs-CRP) in men with newly diagnosed diabetes as well as in patients with established diabetes compared with healthy control subjects. WHR, diabetes onset status (newly diagnosed versus established), and triglycerides, but not CRP, were independent correlates of carotid artery IMT in men with diabetes.

Professionalisation of sports federations – A multi-level framework for analysing forms, causes and consequences

Introduction: International and national sports federations as well as their member organisations (usually sports clubs) are key actors within the sports system and have a wide range of relationships outside the sports system (e.g. with the state, sponsors, and the media). They are currently facing major challenges such as growing competition in top-­‐level sports, democratisation of sports with “sports for all” and sports as the answer to social problems (integration, education, health, unemployment, etc.). In this context, professionalising sports organisations seems to be an appropriate strategy to face these challenges and solve current problems. This has led to a profound organisational change, particularly within sports federations, characterised by the strengthening of institutional management (managerialism) and the implementation of efficiency-­‐based management instruments and paid staff. In this context the questions arise how sports organisations professionalise and what consequences this may have. Theoretical framework: The goal of our presentation is to review the international literature and develop an appropriate concept of professionalisation in sport federations. Our multi-­‐level approach based on social theory of action integrates the current concepts and perspectives for analysing professionalisation in sports federations. We specify the framework for the following research perspectives: (1) forms, (2) causes and mechanisms, (3) consequences and (4) dynamics, and discuss the reciprocal relations between sports federations and their member organisations in this context. When analysing these different research perspectives, it is important to select or elaborate appropriate theoretical concepts to match the general multi-­‐level framework Discussion: The elaborated multi-­‐level framework for analysing professionalisation in sports federations is able to integrate most of the existing theoretical concepts and therefore, the broad range of endogenous as well as exogenous factors that might influence the professionalisation of sports organisations. Based on the theoretical framework, we can identify several consequences for the methodological design of studies intending to analyse the different perspectives of professionalisation in sports organisations: Data have to be collected on the different levels. Not only the forms of professionalisation and relevant structures of the organisations should be taken into account but also important characteristics of the environment (macro level) as well as members or member organisations, particularly key actors who might play a crucial role in gaining an understanding of professionalisation processes in sports organisations. In order to carry out a complex organisational research design, it seems necessary to focus on case studies – an approach that has become increasingly important in organisational research. Different strategies and methods of data collection have to be used within the case studies (e.g. interviews with experts within the organisations, questionnaire for selected people in the organisation, document analysis). Therefore, qualitative and quantitative research strategies have to be combined.

Causes, forms and consequences of the professionalization of international sport federa-tions in Switzerland: Conceptual framework and first results

Synopsis: Sport organisations are facing multiple challenges originating from an increasingly complex and dynamic environment in general, and from internal changes in particular. Our study seeks to reveal and analyse the causes for professionalization processes in international sport federations, the forms resulting from it, as well as related consequences. Abstract: AIM OF ABSTRACT/PAPER - RESEARCH QUESTION Sport organisations are facing multiple challenges originating from an increasingly complex and dynamic environment in general, and from internal changes in particular. In this context, professionalization seems to have been adopted by sport organisations as an appropriate strategy to respond to pressures such as becoming more “business-like”. The ongoing study seeks to reveal and analyse the internal and external causes for professionalization processes in international sport federations, the forms resulting from it (e.g. organisational, managerial, economic) as well as related consequences on objectives, values, governance methods, performance management or again rationalisation. THEORETICAL BACKGROUND/LITERATURE REVIEW Studies on sport as specific non-profit sector mainly focus on the prospect of the “professionalization of individuals” (Thibault, Slack & Hinings, 1991), often within sport clubs (Thiel, Meier & Cachay, 2006) and national sport federations (Seippel, 2002) or on organisational change (Griginov & Sandanski, 2008; Slack & Hinings, 1987, 1992; Slack, 1985, 2001), thus leaving broader analysis on governance, management and professionalization in sport organisations an unaccomplished task. In order to further current research on above-mentioned topics, our intention is to analyse causes, forms and consequences of professionalisation processes in international sport federations. The social theory of action (Coleman, 1986; Esser, 1993) has been defined as appropriate theoretical framework, deriving in the following a multi-level framework for the analysis of sport organisations (Nagel, 2007). In light of the multi-level framework, sport federations are conceptualised as corporative actors whose objectives are defined and implemented with regard to the interests of member organisations (Heinemann, 2004) and/or other pressure groups. In order to understand social acting and social structures (Giddens 1984) of sport federations, two levels are in the focus of our analysis: the macro level examining the environment at large (political, social, economic systems etc.) and the meso level (Esser, 1999) examining organisational structures, actions and decisions of the federation’s headquarter as well as member organisations. METHODOLOGY, RESEARCH DESIGN AND DATA ANALYSIS The multi-level framework mentioned seeks to gather and analyse information on causes, forms and consequences of professionalization processes in sport federations. It is applied in a twofold approach: first an exploratory study based on nine semi-structured interviews with experts from umbrella sport organisations (IOC, WADA, ASOIF, AIOWF, etc.) as well as the analysis of related documents, relevant reports (IOC report 2000 on governance reform, Agenda 2020, etc.) and important moments of change in the Olympic Movement (Olympic revenue share, IOC evaluation criteria, etc.); and secondly several case studies. Whereas the exploratory study seeks more the causes for professionalization on an external, internal and headquarter level as depicted in the literature, the case studies rather focus on forms and consequences. Applying our conceptual framework, the analysis of forms is built around three dimensions: 1) Individuals (persons and positions), 2) Processes, structures (formalisation, specialisation), 3) Activities (strategic planning). With regard to consequences, we centre our attention on expectations of and relationships with stakeholders (e.g. cooperation with business partners), structure, culture and processes (e.g. governance models, performance), and expectations of and relationships with member organisations (e.g. centralisation vs. regionalisation). For the case studies, a mixed-method approach is applied to collect relevant data: questionnaires for rather quantitative data, interviews for rather qualitative data, as well as document and observatory analysis. RESULTS, DISCUSSION AND IMPLICATIONS/CONCLUSIONS With regard to causes of professionalization processes, we analyse the content of three different levels: 1. the external level, where the main pressure derives from financial resources (stakeholders, benefactors) and important turning points (scandals, media pressure, IOC requirements for Olympic sports); 2. the internal level, where pressure from member organisations turned out to be less decisive than assumed (little involvement of member organisations in decision-making); 3. the headquarter level, where specific economic models (World Cups, other international circuits, World Championships), and organisational structures (decision-making procedures, values, leadership) trigger or hinder a federation’s professionalization process. Based on our first analysis, an outline for an economic model is suggested, distinguishing four categories of IFs: “money-generating IFs” being rather based on commercialisation and strategic alliances; “classical Olympic IFs” being rather reactive and dependent on Olympic revenue; “classical non-Olympic IFs” being rather independent of the Olympic Movement; and “money-receiving IFs” being dependent on benefactors and having strong traditions and values. The results regarding forms and consequences will be outlined in the presentation. The first results from the two pilot studies will allow us to refine our conceptual framework for subsequent case studies, thus extending our data collection and developing fundamental conclusions. References: Bayle, E., & Robinson, L. (2007). A framework for understanding the performance of national governing bodies of sport. European Sport Management Quarterly, 7, 249–268 Chantelat, P. (2001). La professionnalisation des organisations sportives: Nouveaux débats, nouveaux enjeux [Professionalisation of sport organisations]. Paris: L’Harmattan. Dowling, M., Edwards, J., & Washington, M. (2014). Understanding the concept of professionalization in sport management research. Sport Management Review. Advance online publication. doi: 10.1016/j.smr.2014.02.003 Ferkins, L. & Shilbury, D. (2012). Good Boards Are Strategic: What Does That Mean for Sport Governance? Journal of Sport Management, 26, 67-80. Thibault, L., Slack, T., & Hinings, B. (1991). Professionalism, structures and systems: The impact of professional staff on voluntary sport organizations. International Review for the Sociology of Sport, 26, 83–97.

Lessons from Ellen: A Case Study Investigation of Comprehension Strategy Instruction in Action

In the past ten years, reading comprehension instruction has received significant attention from educational researchers. Drawing on studies from cognitive psychology, reader response theory, and language arts research, current best practice in reading comprehension instruction is characterized by a strategies approach in which students are taught to think like proficient readers who visualize, infer, activate schema, question, and summarize as they read. Studies investigating the impact of comprehension strategy instruction on student achievement in reading suggest that when implemented consistently the intervention has a positive effect on achievement. Research also shows, however, that few teachers embrace this approach to reading instruction despite its effectiveness, even when the conditions for substantive professional development (i.e. prolonged engagement, support, resources, time) are present. The interpretive case study reported in this dissertation examined the year-long experience of one fourth grade teacher, Ellen, as she leanled about comprehension strategy instruction and attempted to integrate the approach in her reading program. The goal of the study was to extend current understanding of the factors that support or inhibit an individual teacher's instructional decision making. The research explored how Ellen's academic preparation, beliefs about reading comprehension instruction, and attitudes toward teacher-student interaction influenced her efforts to employ comprehension strategy instruction. Qualitative methods were the basis of this study's research design. The primary methods for collecting data included pre- and post-interviews, field notes from classroom observations and staff development sessions, infonnal interviews, e-mail correspondence, and artifacts such as reading assignments, professional writing, school newsletters, and photographs of the classroom. Transcripts from interviews, as well as field notes, e-mail, and artifacts, were analyzed according to grounded theory's constant-comparative method. The results of the study suggest that three factors were pivotal in Ellen's successful implementation of reading strategy instruction: Pedagogical beliefs, classroom relationships, and professional community. Research on instructional change generally focuses on issues of time, resources, feedback, and follow-through. The research reported here recognizes the importance of these components, but expands contemporary thinking by showing how, in Ellen's case, a teacher's existing theories, her relationship with her students, and her professional interaction with peers impact instructional decisions.

The Relationship Among Resilience, Forgiveness, and Anger Expression in Adolescents

This study was designed to investigate and describe the relationship among resilience, forgiveness and anger expression in adolescents. The purpose of the study was to explore whether certain adolescent resiliencies significantly related to positive or negative affective, behavioral, or cognitive levels of forgiveness and certain types of anger expression in adolescents. This study also investigated whether there were certain adolescent resiliencies and types of forgiveness that can predict lower levels of negative anger expression in adolescents. This research was built on two conceptual models: Wolin and Wolin's (1993) Challenge Model and the Forgiveness Process Model (Enright & Human Development Study Group, 1991). It was based on a quantitative, single-subject correlational research design. A multiple regression analysis was also used to explore possible effects of resilience and forgiveness on anger expression in adolescents. In addition, two demographic variables, Age and Gender, were examined for possible effects on anger expression. Data were gathered from a convenience sample sample of 70 students in three Maine public high schools using three separate assessment instruments: the Adolescent Resiliency Attitudes Scale (ARAS), the Adolescent Version of the Enright Forgiveness Inventory (EFI), and the Adolescent Anger Rating Scale (AARS). Correlational analyses were done on the scales and subscales of these surveys. Significant relationships were found between several adolescent resiliencies and forms of forgiveness as well as between some adolescent resiliencies and types of anger expression. The data indicated that Total Resiliency significantly correlated with Total Forgiveness as well as Total Anger. The findings also identified particular adolescent resiliencies that significantly predicted types of anger expression, while forgiveness did not predict types of anger expression. The data revealed that Age and Gender had no significant affect on anger expression. These findings suggest that the constructs of adolescent resilience and forgiveness have commonalities that can influence how adolescents express anger, and further suggest that intervention and prevention programs expand their focus to incorporate forgiveness skills. The findings from this study can provide critical information to counselors, therapists, and other helping professionals working with adolescents, on approaches to designing and implementing therapy modalities or developmental school guidance programs for adolescents.

Quality of care for uninsured type 2 diabetic patients in a financial assistance medical home model

The medically uninsured population in the United States is 16% or 42 million people and consists of a significant number of Type 2 diabetic patients which is the predominant form of diabetes with 798,000 new cases diagnosed each year. There is limited health services research on uninsured populations concerning health system measures or specific disease conditions. ^ The purpose of this investigation was to determine the impact a newly implemented health care program had on the quality of care provided to patients with Type 2 diabetes. The primary study objective was to compare the quality of care while controlling for utilization, and health status of patients in the new program to their status during the previous financial assistance program. The research design was a retrospective matched-pairs design. The study population consisted of 225 patients who received medical care during 1996 and 1997 at the University Health System in San Antonio, Texas. ^ Six quality of care measures individually failed to demonstrate a statistically significant difference when compared between the two periods. However, an index measure reflecting the number of patients who received all six of the quality of care measures demonstrated a statistically significant increase in 1997 (p-value < 0.05). In 1996, 8 patients (2.6%) received all six medical management components. In 1997, 38 patients (16.8%) received all six medical management components. Four regression models were analyzed; two out of the four models demonstrated inconsistent results based on the program membership variable. ^ It is concluded that there has been a small effect of the Carelink program demonstrated by an increase from 8 to 38 patients receiving all quality of care components for Type 2 diabetics at the UHS. It is recommended that additional research be conducted in order to evaluate the quality of care provided to Type 2 diabetic patients. ^

Outcomes and cost effectiveness of treating type 2 diabetes with a nurse case manager following treatment algorithms versus primary care physicians

Background. Diabetes places a significant burden on the health care system. Reduction in blood glucose levels (HbA1c) reduces the risk of complications; however, little is known about the impact of disease management programs on medical costs for patients with diabetes. In 2001, economic costs associated with diabetes totaled $100 billion, and indirect costs totaled $54 billion. ^ Objective. To compare outcomes of nurse case management by treatment algorithms with conventional primary care for glycemic control and cardiovascular risk factors in type 2 diabetic patients in a low-income Mexican American community-based setting, and to compare the cost effectiveness of the two programs. Patient compliance was also assessed. ^ Research design and methods. An observational group-comparison to evaluate a treatment intervention for type 2 diabetes management was implemented at three out-patient health facilities in San Antonio, Texas. All eligible type 2 diabetic patients attending the clinics during 1994–1996 became part of the study. Data were obtained from the study database, medical records, hospital accounting, and pharmacy cost lists, and entered into a computerized database. Three groups were compared: a Community Clinic Nurse Case Manager (CC-TA) following treatment algorithms, a University Clinic Nurse Case Manager (UC-TA) following treatment algorithms, and Primary Care Physicians (PCP) following conventional care practices at a Family Practice Clinic. The algorithms provided a disease management model specifically for hyperglycemia, dyslipidemia, hypertension, and microalbuminuria that progressively moved the patient toward ideal goals through adjustments in medication, self-monitoring of blood glucose, meal planning, and reinforcement of diet and exercise. Cost effectiveness of hemoglobin AI, final endpoints was compared. ^ Results. There were 358 patients analyzed: 106 patients in CC-TA, 170 patients in UC-TA, and 82 patients in PCP groups. Change in hemoglobin A1c (HbA1c) was the primary outcome measured. HbA1c results were presented at baseline, 6 and 12 months for CC-TA (10.4%, 7.1%, 7.3%), UC-TA (10.5%, 7.1%, 7.2%), and PCP (10.0%, 8.5%, 8.7%). Mean patient compliance was 81%. Levels of cost effectiveness were significantly different between clinics. ^ Conclusion. Nurse case management with treatment algorithms significantly improved glycemic control in patients with type 2 diabetes, and was more cost effective. ^

The Relationship of Student Demographics to 10th Grade MCAS Test Anxiety

The intensification of consequential testing situations is associated with an increase in anxiety among American students (Casbarro, 2005). Test anxiety can have negative effects on student test performance (Everson, Millsap, & Rodriguez, 1991). If test anxiety has the potential to decrease students’ test scores, it becomes a factor that can threaten the validity of any inferences drawn between test scores and student progress (Cizek & Burg, 2006). There are several factors that relate closely to test anxiety (Cizek & Burg, 2006). Variables of key influence include gender, socioeconomic status, and teacher-manifested anxiety (Hembree, 1988). Another influence upon test anxiety is students’ participation in academic support programs to prepare them for exit examinations. The purpose of this study was to examine the relationship between 10th grade high school student gender, socioeconomic status, perceived teacher anxiety, and student preparedness with levels of the Massachusetts Comprehensive Assessment System (MCAS) test anxiety. It appears that few studies have examined levels of high school test anxiety in regards to this specific high-stakes MCAS exit exam required for high school graduation. A two-phase sequential mixed-methods research design was used to survey (N=156) 10th grade students represented by a sampling of (n=80) students with low socioeconomic status and (n=76) students with high socioeconomic status regarding their levels of test anxiety in relation to upcoming MCAS testing. A multiple regression analysis was used to measure the relationship between the predictor variables (gender, socioeconomic status, perceived teacher anxiety, and student preparedness) with the criterion variable of student test anxiety using the Test Anxiety Inventory (TAI). Personal interviews with (n=20) volunteer students provided rich explanations of students’ academic self-efficacy, their perceptions of their performance on the upcoming MCAS exam, and their use of strategies to reduce their levels of test anxiety. Personal interviews with (n=12) volunteer school administrators and teachers provided descriptions of their perceptions of how test anxiety affected their students’ performance. A major quantitative finding of this study was that the variables of student socioeconomic status and student ratings of teacher anxiety accounted for the variance in students’ levels of surveyed test anxiety (R2 = .06, p = .033, small to medium effect size). These results indicate that different student populations vary in their readiness skills to successfully participate in consequential testing situations. Consequently, high-test anxious students would require emotional preparation as well as academic preparation when confronting high-stakes testing. The results have the potential to re-shape the format of schools’ MCAS test preparation efforts.

Place of Work and Place of Residence: Informal Hiring Networks and Labor Market Outcomes

We use a novel dataset and research design to empirically detect the effect of social interactions among neighbors on labor market outcomes. Specifically, using Census data that characterize residential and employment locations down to the city block, we examine whether individuals residing in the same block are more likely to work together than individuals in nearby but not identical blocks. We find significant evidence of social interactions operating at the block level: residing on the same versus nearby blocks increases the probability of working together by over 33 percent. The results also indicate that this referral effect is stronger when individuals are similar in sociodemographic characteristics (e.g., both have children of similar ages) and when at least one individual is well attached to the labor market. These findings are robust across various specifications intended to address concerns related to sorting and reverse causation. Further, having determined the characteristics of a pair of individuals that lead to an especially strong referral effect, we provide evidence that the increased availability of neighborhood referrals has a significant impact on a wide range of labor market outcomes including employment and wages.

Minority preferences and disease types for non-emergent emergency department usage in a CHIP population

Background. Of the over five million annual pediatric visits to U.S. emergency departments, one-third to one-half are for non-emergent conditions. Minorities are more likely to utilize the emergency department (ED) for non-emergent conditions. Very little research has analyzed the role of illness type, perceived need, or family preferences in explaining this disparity. ^ Objectives. This study examined racial-ethnic differences in preferences for care among non-emergent users of the ED. ^ Research design. A random selection of pediatric non-emergent ED users within a single CHIP managed care plan were surveyed regarding attitudes and health care preferences. Preferences for ED utilization were analyzed by racial-ethnic category, controlling for illness type, child and guardian age, education level, language, and perceived need. ^ Results. A total of 250 families were surveyed. Most respondents reported having a regular doctor, satisfaction with their physician, and ready access to their physician. Fifteen percent of White, 39% of Hispanic, and 38% of Black families reported they preferred the emergency department for ill care. In multivariate analysis, Whites families were significantly less likely to prefer the emergency department for ill visits (odds ratio, 0.12; 95% confidence interval 0.03-0.55) compared to Blacks and Hispanics. ^ Conclusions. Racial-ethnic disparities in non-emergent ED utilization may be partially explained by different preferences for care. ^ Key words: children, emergency department, preferences for care, disparities ^

The impact of a child's unexpected hospitalization upon Taiwanese parents' situational anxiety

Background. The parents of a sick child likely experience situational anxiety due to their young child being unexpectedly hospitalized. The emotional upheaval may be great enough that their anxiety inhibits them in providing positive support to their hospitalized child. Because anxiety affects psychological distress as well as behavioral distress, identifying parental distress helps parents improving their coping mechanisms. ^ Purpose. The study compared situational anxiety levels between Taiwanese fathers and mothers and focused on differences between parental anxiety levels at the beginning of the child's unplanned hospitalization and at time of discharge. The study also identified factors related to the parents' distress and use of coping mechanisms. ^ Methods. A descriptive, comparative research design was used to determine the difference between the anxiety levels of 62 Taiwanese father-mother dyads during the situational crisis of their child's unexpected hospitalization. The Mandarin version (M) of Visual Analog Scale (VAS-M), State-Trait Anxiety Inventory (STAI-M), and the Index of Parent Participation/Hospitalized Child (IPP/HC-M) were used to differentiate maternal and paternal anxiety levels and identify factors related to the parents' distress. Questionnaires were completed by parents within 24-36 hours of the child's hospital admission and within 24 hours prior to discharge. A paired t-test, two sample t-test, and linear mixed regression model were used to test and support the study hypothesis. ^ Results. The findings reveal that the mothers' anxiety levels did not significantly differ from the fathers' anxiety level when their child had a sudden admission to the hospital. In particular, parental state anxiety levels did not decrease during the child's hospital stay and subsequent discharge. Moreover, anxiety levels did not differ between parents regardless of whether the child's disease was acute or chronic. The most effective factor related to parental situational anxiety was parental perception of the severity of the child's illness. ^ Conclusions. Parental anxiety was found to be significantly related to changes in their perception of the severity of their child's illness. However, the study was not able to illustrate how parental involvement in the child's hospital care was related to parental perception of the severity of their child's illness. Future studies, using a qualitative approach to gamer more information as to what variables influence parental anxiety during a situational crisis, may provide a richer database from which to modify key variables as well as the instruments used to improve the quality of the data obtained. ^