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This practice report highlights changes made to a first-year unit in an Urban and Regional Planning degree, designed to enhance students' levels of cultural competency. We briefly discuss the history of cultural competency highlighting a lack of application in the field of urban planning. We report on a practical case study where six strategies were developed to enhance students' cultural competency. We reflect on the experience of designing and delivering a unit called Diversity and Cultural Planning. The results from 38 students who completed a cultural competency survey at the start and at the end of term, revealed an increase in overall self-assessment scores of around 12%. As cities become more diverse, this practical case study highlights the need and benefits of enhancing the cultural competency of those who both teach and learn about urban planning.

Operable gastrooesophageal adenocarcinoma (GOA) is treated with multimodality therapy which is curative in

This paper proposes a probabilistic approach for extracting time-varying and irregular time signature information from polyphonic audio extracts, subsequently providing beat and bar line positions given inferred time signature divisions. This is achieved via dynamically evaluating the beat tempo as a function of time through finding an optimal compromise in beat and bar alignment in the time and tempo domains. Time signature divisions are determined based on a new representation, termed the Metrogram, that presents time-varying information regarding rhythmic and metric periodicities in the Tempogram. Our methodology is characterised by its ability to provide a distribution over metric interpretations, offering insights into the diverse ways music can be rhythmically perceived. Results indicate high-level accuracy for a variety of polyphonic extracts containing irregular, complex, irrational, and time-varying time signatures. Accuracy rivalling state-of-the-art methodologies is also reported in a beat tracking task performed on the standard Ballroom Dataset. The paper offers insights into the field of dynamic time signature recognition and beat tracking, offering a valuable and versatile resource for the analysis, composition, and performance of music.

This practice report highlights changes made to a first-year unit in an Urban and Regional Planning degree, designed to enhance students’ levels of cultural competency. We briefly discuss the history of cultural competency highlighting a lack of application in the field of urban planning. We report on a practical case study where six strategies were developed to enhance students’ cultural competency. We reflect on the experience of designing and delivering a unit called Diversity and Cultural Planning. The results from 38 students who completed a cultural competency survey at the start and at the end of term, revealed an increase in overall self-assessment scores of around 12%. As cities become more diverse, this practical case study highlights the need and benefits of enhancing the cultural competency of those who both teach and learn about urban planning.

Abstract Background For patients with oesophagogastric adenocarcinoma, surgery is the only curative option and despite the use of multimodality therapy, which combines it with chemotherapy and/or radiotherapy, more than 50% of patients will relapse and die. Many UK patients present with advanced disease which is already inoperable or metastatic at diagnosis. For these patients, standard care chemotherapy only offers them survival of less than a year. Nivolumab, a checkpoint blockade inhibitor, has been found to work in some advanced cancers. It is proposed, for those where immunotherapy hasn’t worked, that these immunologically evasive tumours need to be sensitized to immunotherapy drugs to allow them to act. Methods ELEVATE is a single arm phase II trial testing the overall response to nivolumab following temozolomide treatment in patients with advanced unresectable previously treated adenocarcinoma which is O6-methylguanine-DNA-methyltransferase (MGMT) methylated. 18 patients are being recruited from UK secondary care sites. To be eligible, participants must have been treated with at least 3 months of platinum and fluoropyrimidine chemotherapy. Participants will receive 50 mg/m2 temozolomide continuously for 3 months. If their disease progresses during the 3 months, they will stop temozolomide and start nivolumab at a dose of 240mg every 2 weeks. If there is no progression after 3 months the participant will continue taking temozolomide in combination with nivolumab. All treatment will stop once the participant progresses on nivolumab. The primary endpoint is the best overall response to nivolumab, using both Response Evaluation Criteria in Solid Tumours version 1.1 and immunotherapy modified Response Evaluation Criteria in Solid Tumours. Secondary endpoints include progression-free survival, overall survival, and quality of life. Discussion ELEVATE will provide evidence for whether giving nivolumab after temozolomide in patients with previously treated advanced oesophagogastric adenocarcinoma is safe and biologically effective prior to future randomised trials. Trial registrations EudraCT Number: 2020-004771-41 (issued 01 October 2020); ISCRTN11398887 (registered 14 July 2021).

Zoological collections are rapidly changing from a place of entertainment to centers of education. Many zoological collections run holiday and weekend clubs with activities aimed at inspiring and enthusing the next generation. The COVID-19 pandemic saw zoological collections across the world closing, leading a need for alternative educational content. Edinburgh Zoo, UK converted their summer school to a virtual provision. This provided a unique opportunity to determine the effectiveness of online zoological education by investigating if engagement levels differ for family groups when education is ‘live’, ‘recorded’ or ‘activity’ based. A total of 235 participants signed up for the Virtual Summer School, which comprised of 46 separate activities. Submissions, comments and polls were coded for content level and activity type. Results show that the overall engagement was higher for the live sessions compared to the recorded content; however, the content level was higher for activities. Content level increased over the week and there was a higher reported nature appreciation at the end of the Virtual Summer School. These findings provided evidence to suggest that online holiday zoo education can engage and inspire and gives insight on how to maximize the engagement and knowledge acquisition when using these online platforms.

Abstract Background Powassan virus (POWV; genus Flavivirus) is the sole North American member of the tick-borne encephalitis sero-complex and an increasing public health threat in the USA. Maintained in nature by Ixodes spp. ticks, POWV has also been isolated from species of other hard tick genera, yet it is unclear if these species can serve as vectors. Dermacentor variabilis and Amblyomma americanum share geographic and ecologic overlap with Ixodes spp. ticks and POWV transmission foci, raising the possibility that POWV could become established in these tick species and leading to range expansion and increased human risk. Therefore, we assessed the competency of Ixodes scapularis, D. variabilis and A. americanum for POWV lineage II (POWV II). Methods Larvae from all three species were co-infested on POWV-infected Balb/c mice. The engorged larvae were allowed to molt to nymphs and screened for the presence of POWV II RNA by reverse transcription-qPCR. Eight infected nymphs from each species were allowed to individually feed on a naïve mouse. Mice were screened for the presence of POWV II RNA to determine infection status. Results The results demonstrated that larvae from all three tick species were able to efficiently acquire POWV II via feeding on viremic mice, maintain infection through molting and successively transmit POWV to naïve mice at the nymphal stage at comparable rates across all three species. Conclusions Our findings reveal that non-Ixodes tick species can serve as competent vectors for POWV and highlight the potential role of these species in the ecology and epidemiology of POWV. Future studies examining the possible implications of these findings on POWV epidemiology and the adaptability of POWV in these new vectors are warranted. Graphical abstract

This paper presents a co-teaching mentor model, which improved the teaching of academics and enhanced student satisfaction and retention. Two research-focused lecturers responsible for first-year units were partnered with a co-teaching mentor to offer guidance on how the content (urban and regional planning) could be delivered more effectively with an emphasis on student engagement and motivation. These two case studies are discussed and the findings demonstrate the effective transfer of teaching awareness and skills through this process. Five key educational theories underpin the substantive changes made to the way that classes were delivered. The applied relevance and transfer of these ideas can be demonstrated in the reflections from the participating staff through a pedagogical analysis of the before and after changes in their teaching practices, and in the improved student evaluation and retention results.

Background: Current pathways recommend positron emission tomography–computerised tomography for the characterisation of solitary pulmonary nodules. Dynamic contrast-enhanced computerised tomography may be a more cost-effective approach. Objectives: To determine the diagnostic performances of dynamic contrast-enhanced computerised tomography and positron emission tomography–computerised tomography in the NHS for solitary pulmonary nodules. Systematic reviews and a health economic evaluation contributed to the decision-analytic modelling to assess the likely costs and health outcomes resulting from incorporation of dynamic contrast-enhanced computerised tomography into management strategies. Design: Multicentre comparative accuracy trial. Setting: Secondary or tertiary outpatient settings at 16 hospitals in the UK. Participants: Participants with solitary pulmonary nodules of ≥ 8 mm and of ≤ 30 mm in size with no malignancy in the previous 2 years were included. Interventions: Baseline positron emission tomography–computerised tomography and dynamic contrast-enhanced computer tomography with 2 years’ follow-up. Main outcome measures: Primary outcome measures were sensitivity, specificity and diagnostic accuracy for positron emission tomography–computerised tomography and dynamic contrast-enhanced computerised tomography. Incremental cost-effectiveness ratios compared management strategies that used dynamic contrast-enhanced computerised tomography with management strategies that did not use dynamic contrast-enhanced computerised tomography. Results: A total of 380 patients were recruited (median age 69 years). Of 312 patients with matched dynamic contrast-enhanced computer tomography and positron emission tomography–computerised tomography examinations, 191 (61%) were cancer patients. The sensitivity, specificity and diagnostic accuracy for positron emission tomography–computerised tomography and dynamic contrast-enhanced computer tomography were 72.8% (95% confidence interval 66.1% to 78.6%), 81.8% (95% confidence interval 74.0% to 87.7%), 76.3% (95% confidence interval 71.3% to 80.7%) and 95.3% (95% confidence interval 91.3% to 97.5%), 29.8% (95% confidence interval 22.3% to 38.4%) and 69.9% (95% confidence interval 64.6% to 74.7%), respectively. Exploratory modelling showed that maximum standardised uptake values had the best diagnostic accuracy, with an area under the curve of 0.87, which increased to 0.90 if combined with dynamic contrast-enhanced computerised tomography peak enhancement. The economic analysis showed that, over 24 months, dynamic contrast-enhanced computerised tomography was less costly (£3305, 95% confidence interval £2952 to £3746) than positron emission tomography–computerised tomography (£4013, 95% confidence interval £3673 to £4498) or a strategy combining the two tests (£4058, 95% confidence interval £3702 to £4547). Positron emission tomography–computerised tomography led to more patients with malignant nodules being correctly managed, 0.44 on average (95% confidence interval 0.39 to 0.49), compared with 0.40 (95% confidence interval 0.35 to 0.45); using both tests further increased this (0.47, 95% confidence interval 0.42 to 0.51). Limitations: The high prevalence of malignancy in nodules observed in this trial, compared with that observed in nodules identified within screening programmes, limits the generalisation of the current results to nodules identified by screening. Conclusions: Findings from this research indicate that positron emission tomography–computerised tomography is more accurate than dynamic contrast-enhanced computerised tomography for the characterisation of solitary pulmonary nodules. A combination of maximum standardised uptake value and peak enhancement had the highest accuracy with a small increase in costs. Findings from this research also indicate that a combined positron emission tomography–dynamic contrast-enhanced computerised tomography approach with a slightly higher willingness to pay to avoid missing small cancers or to avoid a ‘watch and wait’ policy may be an approach to consider. Future work: Integration of the dynamic contrast-enhanced component into the positron emission tomography–computerised tomography examination and the feasibility of dynamic contrast-enhanced computerised tomography at lung screening for the characterisation of solitary pulmonary nodules should be explored, together with a lower radiation dose protocol. Study registration: This study is registered as PROSPERO CRD42018112215 and CRD42019124299, and the trial is registered as ISRCTN30784948 and ClinicalTrials.gov NCT02013063. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 17. See the NIHR Journals Library website for further project information.

The aim of this study was to explore how public health policy in the United Kingdom was reflected in community intellectual disability nurses' (CIDNs)' job descriptions and person's specifications. The role of CIDNs has evolved due to policy changes. As these roles evolve, job descriptions and person specifications are important in highlighting employer's expectations staff, priorities, and professional values of their employees. This study involved an exploratory documentary analysis of n = 203 CIDNs' job descriptions and person specifications in the context of role theory. The CIDNs' public health roles identified in this study are health education, health protection, health prevention, health surveillance, and health promotion. Key policies themes were intellectual disability health access, public health strategies, policy evaluation/redesign, and public health policy. There is a lack of public health role clarity and inconsistency in role expectations across organizational boundaries in the United Kingdom.