A Scenario Analysis of the 2030 German Spa Tourist and Tourism

Tourism is affected by growing transformations of social change, globalisation and wealth creation. Uncertainty surrounding the development of the factors makes it difficult to predict and provide contingency for the future. This is especially so for the spa tourism industry given its enormous figures in revenue growth over the past two decades. Given the growth of the spa industry and the key uncertainties that will shape its future, it is important to understand how the landscape of the spa industry might change in the next few decades. Although there has been research done on the future of spa tourism, for example by the Global Spa and Wellness Summit, their work requires more development and is not country-specific. In response, this study is of value as it explores the future of spa tourism in terms of creating multiple potential pathways. It does this from the perspective of the German spa industry, and addresses the interrelationships of these uncertainties. By following the specific methodology of scenario planning, this study develops a scenario analysis of the future of the German spa industry and answers the questions “What will the German spa tourist and spa tourism industry look like in 2030?” The study consisted of 22 semi-structured interviews with a diverse expert panel in Germany. Interview participants identified twelve key drivers which were discussed in light of existing literature. The two most significant key drivers identified in the interviews were then positioned along a two- key matrix with the demanding consumer on the horizontal axis and new distribution of wealth on the vertical axis. Based on these drivers the study presents four plausible yet challenging and completely different scenarios for the development of the German spa tourist and tourism in 2030. The scenarios include prosperous society, highlighting a positive future for German spas due to the growth of the middle class and thus increasing demands and a multifaceted spa clientele; the power elite, concentrating on the super rich spa consumer and their extravagant consumer behaviour; middle class on the brink, presenting a squeezed middle class and a gradient decline of the spa industry; and the welfare state, a gloomy scenario with almost no spa tourism left. Through examination of significant questions and strategic implications, the study concludes that the spa industry needs to challenge its current linear ways of thinking by adopting new insights and perspectives of the future. Furthermore, the industry needs to establish standardised criteria for accreditation and operation of spa facilities. This needs to include a focus on staff training in order to continue to attract the German spa tourist and thus remain profitable in the future

GENDER DIFFERENCES IN CAREERS AND SALARY FOR AGRIBUSINESS GRADUATES: A CASE STUDY

This research shows that differences exist in careers and salaries based on gender for the graduates of the California Polytechnic State University Agribusiness Department, although the graduates acquire the same education level. This research is based on data that was collected through the use of a survey instrument with a sample size of 1151.Labor and Human Capital,

The experience of the older leisure traveller at an airport: the case of Frankfurt airport

This thesis is about the experience of older people who travel through an airport. The research reported took place at the interface of population ageing, tourism travel and airport management. Although air transport is influenced by population ageing, older people’s experiences within this specific environment are largely untold. This is surprising, as flying is the preferred form of travel for much of international tourism and airports represent key infrastructure for the provision of dependable services. Thus, there are gaps in knowledge on older travellers at an airport and the airport’s role in this part of leisure travel. In particular, a holistic examination of older travellers’ experiences within the airport environment is missing. This research uses different approaches to the experience concept to explore the expectations, needs and demands of older travellers. It investigates the airport experience of older travellers, in light of the changing roles of airports in society. In the form of a qualitative single-case study, it examines the situation of the older leisure traveller at Frankfurt Airport in Germany. Data was collected through 66 interviews with older leisure travellers, frontline employees and managers, complemented by 50 observations. This provides a comprehensive perspective of the older travellers’ airport experience and represents a novel approach. The thesis makes several contributions to experience, travel and tourism literature. On the demand side, the findings allow for a better understanding of the experience of the older passengers. The effect of ageing on an airport’s customer base is investigated. It is discussed whether this group needs special treatment within the regular passenger process. On the supply side, the emerging role of the airport as part of the overall holiday journey is explored. Furthermore, the findings show how airport management deals with this particular passenger group

Constitutional Confidentiality

Federal Certificates of Confidentiality (“Certificates”) protect sensitive information about human research subjects from disclosure and use in judicial, administrative, and legislative proceedings at both the state and federal levels. When they were first authorized by Congress in the 1970s, Certificates covered sensitive information collected in research about drug addiction use. Today, however, they extend to virtually all personal information gathered by biomedical research studies. The broad reach of Certificates, coupled with their power to override state subpoenas and warrants issued in the context of law enforcement, abortion regulation, and other police powers typically under state control, beg the question whether Certificates are constitutional. This Article, for the first time, examines the fundamental constitutional underpinnings of Certificates and situates them within the context of federal statutory privilege law. In so doing, it makes several contributions to the existing literature. First, after a brief background about Certificates and other congressional action relating to biomedical research, this Article argues that the Certificate statute creates a federal statutory privilege. To date, the language of privilege has been wholly absent from discussions of Certificates and their reach. Yet understanding the Certificate as a privilege provides well understood nomenclature and legal principles for applying the Certificate statute. Second, this Article locates the primary constitutional authority undergirding the Certificate statute in the Commerce Clause. Third, this Article argues that Congress’s power to tax and spend provides further constitutional grounding for Certificates, at least with respect to federally-funded researchers and institutions. For both bases of constitutional authority, this Article maps new territory, yielding clarity where there has previously been uncertainty. Fourth, this Article brings together constitutional doctrines limiting both congressional power and evidentiary privileges to illuminate how these doctrines may require Certificate protections to give way in exceptional cases. In so doing, it bridges traditional constitutional law and evidence law, reaping insights from their intersection from which scholars in both fields may benefit. Finally, this Article considers the implications of this constitutional analysis not only on Certificates, but also on congressional action aimed at regulating human subjects research more generally and on the law surrounding federal statutory privileges

Therapeutic Massage to Enhance Family Caregivers’ Well-being in a Rehabilitation Hospital

Background and purpose: A massage therapy program was implemented to address the psychological well-being of family caregivers to patients in a rehabilitation hospital. The impact of massage “dosage” on caregiver stress and psychological well-being was examined in this study. Participants’ perspectives on the program were also explored. Materials and methods: Thirty-eight family caregivers were randomized to receive either one massage per week or three massages per week for two weeks. Caregivers reported psychological symptoms and stress pre- and postprogram. Program acceptability was assessed via responses on an exit survey. Results: Overall, 79% of massages were received (89% among program completers). Post-program symptom scores were lower than baseline scores for both groups (F (1, 31) = 8.74 – 24.50, P \u3c 0.01). Exit surveys indicated high program acceptability and perceived benefits. Conclusion: Findings suggest that massage services would be welcomed, utilized, and beneficial for improving the psychological well-being of family caregivers in a rehabilitation hospital

Subtoxic Alterations in Hepatocyte-Derived Exosomes: An Early Step in Drug-Induced Liver Injury?

Drug-induced liver injury (DILI) is a significant clinical and economic problem in the United States, yet the mechanisms that underlie DILI remain poorly understood. Recent evidence suggests that signaling molecules released by stressed hepatocytes can trigger immune responses that may be common across DILI mechanisms. Extracellular vesicles released by hepatocytes, principally hepatocyte-derived exosomes (HDEs), may constitute one such signal. To examine HDE alterations as a function of drug-induced stress, this work utilized prototypical hepatotoxicant acetaminophen (APAP) in male Sprague-Dawley (SD) rats, SD rat hepatocytes, and primary human hepatocytes. HDE were isolated using ExoQuick precipitation reagent and analyzed by quantification of the liver-specific RNAs albumin and microRNA-122 (miR-122). In vivo, significant elevations in circulating exosomal albumin mRNA were observed at subtoxic APAP exposures. Significant increases in exosomal albumin mRNA were also observed in primary rat hepatocytes at subtoxic APAP concentrations. In primary human hepatocytes, APAP elicited increases in both exosomal albumin mRNA and exosomal miR-122 without overt cytotoxicity. However, the number of HDE produced in vitro in response to APAP did not increase with exosomal RNA quantity. We conclude that significant drug-induced alterations in the liver-specific RNA content of HDE occur at subtoxic APAP exposures in vivo and in vitro, and that these changes appear to reflect selective packaging rather than changes in exosome number. The current findings demonstrate that translationally relevant HDE alterations occur in the absence of overt hepatocellular toxicity, and support the hypothesis that HDE released by stressed hepatocytes may mediate early immune responses in DILI

The effect of perceived appearance judgements on psychological and biological stress processes across adulthood

Social self-preservation theory posits that stress is experienced when an aspect of an individual's identity has the potential to be negatively evaluated. Appearance is a central part of identity; however, little research has examined whether perceived appearance judgements are a source of social-evaluative stress. In addition, stress may be an explanatory link in the association between appearance perceptions and depressive symptoms. This study examined whether perceived appearance judgements were associated with increased stress and greater depressive symptoms among adults. Study 1 examined the associations between self-reported appearance judgements and cortisol stress responses in response to a laboratory stressor (Trier Social Stress Test) among 71 individuals aged 18–65. Study 2 assessed self-reported appearance judgements and depressive symptoms among 498 adults ages 18–65 via an online survey data collection. Appearance judgement was associated with a stronger cortisol response, higher self-reported stress, and greater depressive symptoms. Stress mediated all associations between appearance judgements and depressive symptoms and neither age nor gender moderated these associations. The findings suggest that appearance judgements contribute to psychological and biological stress processes and demonstrated that stress mediated the association between appearance judgements and depressive symptoms

Performance of the PROMIS After Operative Interventions for Shoulder Instability

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to capture patient-reported outcomes (PROs) in an efficient manner. Few studies have assessed this instrument postoperatively. Purpose: To compare the PROMIS Physical Function computer adaptive test (PROMIS PF CAT) and Upper Extremity (PROMIS UE) item bank to other previously validated PRO instruments and to evaluate ceiling and floor effects and construct validity responsiveness in patients who underwent operative interventions for shoulder instability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 72 patients who underwent operative interventions for shoulder instability completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx shoulder activity scale (Marx), 36-Item Short Form Health Survey physical function (SF-36 PF) and general health (SF-36 GH), Western Ontario Shoulder Instability Index (WOSI), PROMIS PF CAT, and PROMIS UE before surgery and then at 6 weeks and 6 months postoperatively. Correlation coefficients were calculated among these tools. The effect size of change was also calculated for each tool at each time point. A total of 91 patients who had also undergone surgery for shoulder instability completed these PRO instruments 2 years postoperatively. The percentage of patients hitting the ceiling and floor effects of each of the PRO instruments was calculated at all time points. Results: The PROMIS PF CAT demonstrated excellent-good correlation with the SF-36 PF at all postoperative time points (0.61 at 6 weeks, 0.68 at 6 months, and 0.64 at 2 years; P \u3c .01 for all). The PROMIS UE showed excellent correlation with the ASES at 6 weeks postoperatively (0.73, P \u3c .01). Both the PROMIS PF CAT and PROMIS UE demonstrated the ability to detect change after surgical interventions with a medium to large effect size. The PROMIS UE demonstrated a ceiling effect at 6 months (68.1%) and 2 years (67.0%) postoperatively. The PROMIS PF CAT demonstrated no ceiling effect at any time point. Conclusion: The PROMIS PF CAT demonstrated good to excellent correlation with other previously validated PRO instruments that assess physical function in patients with shoulder instability postoperatively. The PROMIS UE demonstrated good correlation with other PRO tools but had a significant ceiling effect and is not recommended for this patient population. Both tools demonstrated an ability to detect change after surgical interventions with a good effect size

Error detection and error memory in spatial navigation as reflected by electrodermal activity

The study investigated spatial navigation by means of electrodermal activity (EDA). Two groups of healthy subjects (group 1, age <38; group 2, age ≥38) were recorded during navigation through two 3-D virtual mazes differing in difficulty, that is, Maze Simple (MazeS) and Maze Complex (MazeC). Our results show (1) an effect of difficulty, that is, larger skin conductance responses (SCRs) and slower velocity profiles while navigating through MazeC as compared to MazeS. (2) An effect of age, that is, larger SCRs and faster velocity profiles in younger subjects (group 1) compared to older subjects (group 2). (3) An effect of maze region, that is, SCRs increased when subjects entered dead ends with group 1 (young group) decreasing in velocity, whereas group 2 (old group) increased in velocity. (4) And an error memory effect, that is, subjects who remembered an error at a given decision point (crossroads preceding dead ends in MazeC) from previous trials, and then if they did not repeat that error, elicited decreased SCRs as compared to subjects who did not remember and subsequently repeated an error. The latter aspect is the most impactful as it shows that EDA is able to reflect error detection and memory during spatial navigation. Our data designate EDA as suitable monitoring tool for identification and differentiation of the affective correlates underlying spatial navigation, which has recently attracted researchers' attention due to its increased use in 3-D virtual environment