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The NHS Bowel cancer screening programme (NHSBCSP) aims to reduce colorectal cancer (CRC) cumulative mortality by up to 23 per cent; long-term outcomes at national level are not yet known. The purpose of this paper is to examine a local population of CRC patients of screening age for their characteristics and long-term survival in relation to their presentation, including through the NHSBCSP.

Retrospective analysis of a prospectively maintained CRC database for the years 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services.

Of 528 CRC patients diagnosed in the screening age range, 144(27.3 per cent) presented through NHSBCSP, 308(58.3 per cent) electively with symptoms and 76(14.4 per cent) as emergency. NHSBCSP-diagnosed patients were younger (median 66 vs 68 and 69 years, respectively, p=0.001), had more often left-sided cancers (59(41.0 per cent) vs 82(26.6 per cent) and 24(31.6 per cent), respectively, p=0.001), more UICC-stage I (42(29.2 per cent) vs 49(15.9 per cent) and 2(2.6 per cent)), stage III (59(41.0 per cent) vs 106(34.4 per cent) and 20(26.3 per cent)) and less stage IV disease (8(5.6 per cent) vs 61(19.8 per cent) and 34 (44.7 per cent), respectively, p<0.001). Three-year overall survival was best for NHSBCSP and worst for emergency patients (87.5 per cent vs 69.0 per cent and 35.3 per cent, respectively, LogRank p<0.001).

Patients diagnosed within the NHSBCSP have improved outcome compared to both symptomatic elective and emergency presentations. A reduction in overall cumulative mortality in order of 25 per cent may well be achieved, but continuing high levels of emergency presentations and undetected right-sided disease emphasise need for further improvement in public participation in the NHSBCSP and research into more sensitive and acceptable alternative screening methods.

Higher caseloads are associated with better outcomes for many conditions treated in secondary and tertiary care settings, including colorectal cancer (CRC). There is little known whether such volume-outcome relationship exist in primary care settings. The purpose of this paper is to examine general practitioner (GP) CRC-specific caseload for possible associations with referral pathways, disease stage and CRC patients’ overall survival.

The paper retrospectively analyses a prospectively maintained CRC database for 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services.

Of 1,145 CRC patients, 937 (81.8 per cent) were diagnosed as symptomatic cancers. In total, 210 GPs from 44 practices were stratified according to their CRC caseload over the study period into low volume (LV, 1-4); medium volume (MV, 5-7); and high volume (HV, 8-21 cases). Emergency presentation (LV: 49/287 (17.1 per cent); MV: 75/264 (28.4 per cent); HV: 105/386 (27.2 per cent); p=0.007) and advanced disease at presentation (LV: 84/287 (29.3 per cent); MV: 94/264 (35.6 per cent); HV: 144/386 (37.3 per cent); p=0.034) was more common amongst HV GPs. Three-year mortality risk was significantly higher for HV GPs (MV: (hazard ratio) HR 1.185 (confidence interval=0.897-1.566), p=0.231, and HV: HR 1.366 (CI=1.061-1.759), p=0.016), but adjustment for emergency presentation and advanced disease largely accounted for this difference. There was some evidence that HV GPs used elective cancer pathways less frequently (LV: 166/287 (57.8 per cent); MV: 130/264 (49.2 per cent); HV: 182/386 (47.2 per cent); p=0.007) and more selectively (CRC/referrals: LV: 166/2,743 (6.1 per cent); MV: 130/2,321 (5.6 per cent); HV: 182/2,508 (7.3 per cent); p=0.048).

Higher GP CRC caseload in primary care may be associated with advanced disease and poorer survival; more work is required to determine the reasons and to develop targeted intervention at local level to improve elective referral rates.

This chapter expresses the need for an increase or reforestation of Black scholarship and examines the complexity of race in a White privileged institution of higher education. It is written with an understanding of Critical Race Theory's counter-narrative benefits and models the power of voice in the classroom of a Black student and a White teacher and their roles in creating a “safe space for race talk” in the classroom.

This study aims to examining how tourists’ activities condition the relationship between destination image, satisfaction and loyalty.

This study used a constructive replication design (CRD) to investigate the alleged critical role of tourism activities in impacting the tourism experience dimensions of image, satisfaction and loyalty. The CRD approach does not include new concepts or original relationships. However, what is new in the established relationship between image, satisfaction and loyalty is discerning the role of tourism activities as a moderator conditioning the relationship between the three dimensions. The purpose is to establish the external validity of previous studies’ findings through a more stringent test of the findings’ replicability. The analysis used partial least square modeling to examine the relationship between activities, dimensions and multigroup analysis to estimate potential significant differences in group-specific parameters, which are not often used in destination analysis, ensuring rigor in the data analysis and model. The number and type of activities practiced moderate the relationships between these constructs.

The results indicate that tourists’ type and several destination activities moderate the relationship between tourists’ satisfaction, perceived image and loyalty. The results also suggest that the more destination activities tourists practice, the greater is their satisfaction. These two theoretical propositions put activities at the center of destination management and marketing and identify potential experiential consumption spheres. The analysis of activities’ central role is a productive research field.

This study made several recommendations to destination managers to increase activities participation such as strategic marketing opportunities, expansion of the activities portfolio with sports, wellness, nature based and life observation wildlife, voluntary and educational activities, revamping of the UNESCO heritage site and festivals. This study also recommended a strategic use of technology for information dissemination, the design of a daily activity agenda based on the identified segments’ activity patterns and a destination one-stop online travel shopping.

To the best of the authors’ knowledge, this study is the first to apply the tourism activity-based approach to examine actual tourist behavior regarding their engaged activities instead of their experience or perceptions with those activities in a small island destination. Another contribution lies in examining if tourists’ type and activity engagement moderate the relationship between tourists’ satisfaction, perceived image and loyalty. This paper requires researchers to consider tourism activities’ impact on tourists’ image, satisfaction and loyalty.

小型海岛旅游目的地的旅游活动, 形象, 和旅客的满意度和忠诚度

本案例研究考察了旅游活动如何影响目的地形象、游客满意度和忠诚度之间的关系。

本研究采用建设性复制设计 (CRD) 来分析旅游活动在影响目的地形象、游客满意度和忠诚度等三个旅游体验维度起到的关键作用。 CRD 方法并没有引进新概念或关系。然而, 本研究新颖的地方在于认证旅游活动在目的地形象、游客满意度和忠诚度三个维度之间建立的调节关系。该研究通过严格测试研究结果的可复制来建立先前研究的外部有效性。该分析使用 PLS建模 和多组分析（MGA）来检验旅游活动和旅游体验的多维度之间的关系和估计特定组参数的潜在显著差异。 这些参数在目的地研究中不常使用, 从而确保我们数据分析和模型的严谨性。该研究结果表明旅游活动的数量和类型调节了这些旅游体验维度的关系。

研究结果表明游客的类型和某些旅游活动调节了游客满意度、目的地形象和忠诚度之间的关系。结果还表明, 游客参与的活动越多, 他们的满意度就越高。这两个研究结果确定了旅游活动在目的地管理和营销的中心地位, 同时也指出了潜在体验消费的范围。研究目的地活动的核心作用将会是一个富有成效的领域。

本研究首次应用基于旅游活动的理论方法 (TAB) 来检查旅客在小型海岛旅游目的地的实际行为, 而不是他们的体验或看法。本研究的另一个贡献在于检验游客的类型和活动参与是否会调节他们满意度、感知目的地形象和忠诚度之间的关系。该论文结果表明未来的研究需要考虑旅游活动对目的地形象、游客满意度和忠诚度的影响。

本研究向目的地管理人员提出了几项建议以提高旅游活动的参与度, 例如战略营销机会、扩大运动、康养、大自然和野生动物观摩的活动组合、志愿和教育活动、和改善联合国教科文组织遗产地和节日。该研究还建议战略性地使用技术进行信息传播, 根据确定的细分市场活动模式设计游客日常活动议程, 以及目的地一站式在线旅游购物。

Este caso de estudio examina cómo las actividades de los turistas condicionan la relación existente entre la imagen del destino, la satisfacción y la fidelidad.

El estudio empleó una replicación constructiva para investigar el supuesto papel crítico de las actividades turísticas en el efecto de la imagen, satisfacción y lealtad de los turistas en su experiencia turística. El enfoque usado no incluye nuevos conceptos ni relaciones originales. Sin embargo, lo novedoso de la relación establecida entre imagen, satisfacción y fidelidad es discernir el papel de las actividades turísticas como moderadoras condicionando la relación entre las tres dimensiones. El propósito es establecer la validez externa de los resultados de estudios previos a través de una prueba más estricta sobre la replicabilidad de dichos resultados. El análisis utilizó un modelo PLS para examinar la relación entre las actividades, las dimensiones mencionadas y el análisis multigrupo con el objetivo de estimar las posibles diferencias significativas entre los parámetros de cada grupo, método no se utiliza con frecuencia en el análisis de destinos turísticos, lo que garantiza el rigor de nuestro análisis y del modelo. El número y tipo de actividades practicadas moderan las relaciones entre los constructos.

Los resultados indican que el tipo de turistas y las diversas actividades del destino moderan la relación entre la satisfacción, la imagen percibida y la lealtad de los turistas. Los resultados también sugieren que cuantas más actividades del destino sean practicadas por los turistas, mayor es su satisfacción. Estas dos propuestas teóricas sitúan las actividades en el centro de la gestión y el marketing de destinos e identifican esferas potenciales de consumo experiencial. El análisis del papel central de las actividades es un campo de investigación en auge.

Este estudio es el primero en aplicar el enfoque basado en actividades turísticas para analizar el comportamiento del turista con respecto a las actividades realizadas en relación con su experiencia o percepciones con esas actividades en un destino insular pequeño. Otra contribución radica en estudiar si el tipo de turista y su compromiso con la actividad moderan la relación entre la satisfacción de los turistas, la imagen percibida y la fidelidad. El estudio sugiere que los investigadores deben considerar el impacto de las actividades turísticas en la imagen, satisfacción y fidelidad de los turistas.

El estudio realiza varias recomendaciones a los administradores de destinos para aumentar la participación en actividades, como oportunidades de marketing estratégico, expansión de la cartera de actividades con deportes, bienestar, observación de la vida y la naturaleza basada en la naturaleza, actividades voluntarias y educativas, renovación del sitio del patrimonio de la UNESCO y festivales. El estudio también recomendó un uso estratégico de la tecnología para la difusión de información, el diseño de una agenda de actividades diarias basada en los patrones de actividad de los segmentos identificados y una ventanilla única de viajes en línea.

The purpose of this paper is to explore how cohesive/diverse networks affect entrepreneurial activities. In particular, an interest is shown in how cohesion and diversity may affect entrepreneurial outcomes like survival, profitability, innovation and efficiency.

The paper organizes the literature and presents conclusions about the effects of cohesion and diversity using three stages of entrepreneurial activity: opportunity development, technology and organizational creation, and exchange.

At the opportunity stage, strong ties with entrepreneurs increase the likelihood of becoming one, but are associated with lower levels of innovation. Diverse ties increase self‐efficacy and innovation. At the technology and organizational creation stage, most entrepreneurial teams are homogeneous whereas team diversity is associated with better organizational outcomes. Using strong ties to recruit potential employees provides price and commitment advantages, but may interfere with efficiency. At the exchange stage, entrepreneurs must strike a balance between weak (market based) and stronger (embedded) ties to gain preferential access to resources and customers, while maintaining diverse sources for information and market opportunities. Overall, cohesion through strong ties provides entrepreneurs with hard to find resources very early in the development of new ventures, but those resources are limited in scope and have a high cost. By contrast, diversity is more common and more important later in a venture's life cycle.

Guidelines are suggested regarding the best networking strategies at the different stages and in different instrumental areas, offering an overall evaluation of the evidence in the cohesion v. diversity debate. Directions for future research on the effects of networks on entrepreneurial outcomes are also provided.

Managing severe sepsis early has several benefits. Correct early management includes delivering an appropriate fluid challenge. The purpose of this paper is to assess whether junior doctors prescribe adequate fluid challenges to severely septic patients.

A questionnaire outlining three scenarios, each involving a patient with severe sepsis, but with varying weights (50/75/100 kg), was distributed to junior doctors, working in two UK hospitals, managing surgical patients. Participants were asked the fluid volume challenge that they would prescribe for each patient. Responses were compared with the Surviving Sepsis Campaign's recommended volume during the study (20 ml/kg).

Totally, 77 questionnaires were completed. There were 15/231 (6.5 per cent) correct responses. The median volume chosen in each scenario was 500 ml, equating to 5-10 ml/kg. There was no significant difference between doctor grades (FY1 and SHO) in any scenario. With most junior doctors (FY1), there was no difference in responses according to weight; for SHOs the only significant difference was between the 75 and 100 kg scenarios.

Junior doctors are not following guidelines when prescribing fluid challenges to severely septic patients, giving too little and not adjusting volume according to body weight. This implies that high-prevalence, high-mortality conditions are not being treated appropriately by those most likely to treat these patients. More teaching, training and reassessment is required to improve care.

This, the first case-based survey the authors could find, highlights an issue requiring significant improvement. The implications are likely to be relevant to clinicians in all UK hospitals.

Sparta Glass Products has been losing significant market share over the last several quarters in the non-glare-glass market, with a price 10% above the competition. Lowering the price is under consideration. Unfortunately, fully allocated costs are such that the lower price results in a loss. Issues to be discussed and analyses to be conducted include the relevant costs for the decision and the reactions from competitors.

The purpose of this study is to examine the effect of family business exposure on individuals' entrepreneurial intentions (EIs). By applying the institutional framework at the micro level, this study proposed the mediation of three types of institutional forces (coercive, normative and mimetic) between the relationship of family business exposure and EIs.

Data were collected from 367 university students in Pakistan. The survey design was used for the data collection. The measurement and hypothesized models were tested using the structural equation modeling technique in Mplus 7.0.

The findings of this study revealed that family business exposure positively influenced the institutional forces (coercive, normative and mimetic) which further developed the individuals' EIs. However, family business exposure did not affect the EIs directly that showed the full mediation of institutional forces between the relationship of family business exposure and EIs.

This is the first study in its nature which applied institutional theory from the macro level to the micro level within the context of family business. The results revealed the institutional forces as the underpinning mechanism which explains the relationship between family business exposure and EIs.