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Playing with Purpose shows how a facilitator, coach, manager, people developer or trainer can invent or reinvigorate an artificial learning experience and make it so much more than a game. The authors look at a range of dilemmas, challenges and problems faced by anyone wanting to run memorable training sessions, classes and project meetings and then demonstrate how to get powerful lessons from the simplest of household and office objects and situations. The exercises and ideas outlined provide a focused examination of a range of training aims and outcomes including leadership, teamwork, communications, equality and diversity, feedback and personal effectiveness; as well as general energisers, closers and problems to be solved. Steve Hutchinson and Helen Lawrence believe that seeing their sustainable, creative approach to experiential learning explicitly laid out, will give you the confidence to develop your own solutions. Contents: Preface: why read this book and how to use it; Part I The Concept of Experiential Learning: Optimizing artificial experiential learning. Part II The Skills of Facilitation: Extracting the lesson: how to review, capture and amplify the learning. Part III The Developer's Toolbox - Specific Issues and Tactics; Helping teams work; Facilitating leadership development; Building personal effectiveness; Dealing with change; Producing creative and critical thinkers; Understanding organizational quality; Getting people talking: building productive relationships; Exploring diversity issues; Final thoughts and last words; Bibliography. After completing his PhD in Behavioural Ecology and working in academia, Dr Steve Hutchinson led development programmes at the Universities of York and Leeds. He now owns and runs his own development consultancy and has designed and led acclaimed courses and events for a huge range of organisations and institutions, both in the UK and abroad. A highly skilled facilitator and trainer, he is both a Vitae GRADschool national course director and a programme director for the Leadership Foundation for Higher Education. He is a qualified trainer, coach and practitioner of Neuro-Linguistic Programming. He writes articles and chapters on a range of topics from creativity to leadership and motivation. Playing With Purpose is his second book. Dr Helen Lawrence completed a PhD in Sociolinguistic Variation and worked in the academic sector for a number of years, publishing, teaching and lecturing. Discovering a passion for helping people realize their potential she moved into the field of training and development. For five years she worked at the University of York, taking a lead role in developing and delivering training programmes for staff and students. In 2008 she set up her own training and development business, and works with individuals, teams and institutions in the research, educational and not-for-profit sectors. Helen is also a local and national Vitae GRADschool tutor; an accredited Myers Briggs Type Indicator practitioner; and a trained Coactive Coach.

Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed in units of metabolic equivalents of tasks by the responsible anaesthesiologists in the preoperative assessment clinic, graded as poor (<4), moderate (4–10), or good (>10). All participants also completed the DASI questionnaire, underwent CPET to measure peak oxygen consumption, and had blood tests for measurement of NT pro-BNP concentrations. After surgery, patients had daily electrocardiograms and blood tests to measure troponin and creatinine concentrations until the third postoperative day or hospital discharge. The primary outcome was death or myocardial infarction within 30 days after surgery, assessed in all participants who underwent both CPET and surgery. Prognostic accuracy was assessed using logistic regression, receiver-operating-characteristic curves, and net risk reclassification. Between March 1, 2013, and March 25, 2016, we included 1401 patients in the study. 28 (2%) of 1401 patients died or had a myocardial infarction within 30 days of surgery. Subjective assessment had 19·2% sensitivity (95% CI 14·2–25) and 94·7% specificity (93·2–95·9) for identifying the inability to attain four metabolic equivalents during CPET. Only DASI scores were associated with predicting the primary outcome (adjusted odds ratio 0·96, 95% CI 0·83–0·99; p=0·03). Subjectively assessed functional capacity should not be used for preoperative risk evaluation. Clinicians could instead consider a measure such as DASI for cardiac risk assessment. Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University.

Combining authoritative, exciting text and bold images, The World War I Book explores the historical background of the war, its causes, all of the key events across the major theatres of conflict, and its aftermath. Using the original, graphic-led approach of the series, entries profile more than 90 of the key events during and surrounding the conflict -- from the growing tensions between Europe's major powers to the assassination of Archduke Franz Ferdinand, the German invasion of Belgium, the endless slaughter in the trenches, the American entry into the war, the Russian Revolution, the Armistice, and the creation of the League of Nations.

Purpose Radiofrequency ablation (RFA) is a curative treatment option for small lung metastases, which conventionally involves multiple freehand manipulations until the treating electrode is satisfactorily positioned. Stereotactic and robotic guidance has been gaining popularity for liver ablation, although has not been established in lung ablation. The purpose of this study is to determine the feasibility, safety, and accuracy of robotic RFA for pulmonary metastases, and compare procedures with a conventional freehand cohort. Methods A single center study with prospective robotic cohort, and retrospective freehand cohort. RFA was performed under general anesthesia using high frequency jet ventilation and CT guidance. Main outcomes were (i) feasibility/technical success (ii) safety using Common Terminology Criteria for Adverse Events (iii) targeting accuracy (iv) number of needle manipulations for satisfactory ablation. Robotic and freehand cohorts were compared using Mann–Whitney U tests for continuous variables, and Fisher’s exact for categorical variables. Results Thirty-nine patients (mean age 65 ± 13 years, 20 men) underwent ablation of 44 pulmonary metastases at single specialist cancer center between July 2019 and August 2022. 20 consecutive participants underwent robotic ablation, and 20 consecutive patients underwent freehand ablation. All 20/20 (100%) robotic procedures were technically successful, and none were converted to freehand procedures. There were 6/20 (30%) adverse events in the robotic cohort, and 15/20 (75%) in the freehand cohort ( P  = 0.01). Robotic placement was highly accurate with 6 mm tip-to-target distance (range 0–14 mm) despite out-of-plane approaches, with fewer manipulations than freehand placement (median 0 vs. 4.5 manipulations, P  < 0.001 and 7/22, 32% vs. 22/22, 100%, P  < 0.001). Conclusions Robotic radiofrequency ablation of pulmonary metastases with general anesthesia and high frequency jet ventilation is feasible and safe. Targeting accuracy is high, and fewer needle/electrode manipulations are required to achieve a satisfactory position for ablation than freehand placement, with early indications of reduced complications.

Nickel ions can specifically activate human toll-like receptor 4 (TLR4), a crucial component of the innate immune system which is normally activated by bacterial lipopolysaccharides (LPS) leading to the secretion of pro-inflammatory cytokines. 6 While this may explain contact hypersensitivity to nickel, this metal is only present in trace amounts in MoM alloys and is unlikely to be pathogenic following joint replacement.

Thomas Archer (c.1668–1743) is now given appropriate recognition as a key architect of the the English Baroque after years in the shadow of Christopher Wren, John Vanbrugh and Nicholas Hawksmoor. As he was responsible for some of the most architecturally eccentric country houses in England, this accolade of Archer is long overdue. However, despite having been known to have designed several of the country's most important garden buildings, there has been no detailed attempt to analyse such structures within their corresponding landscapes, nor to consider his wider involvement in garden design. This paper explores Archer's involvement at several estates, considering his patrons, the political climate of the time and newly discovered details of his travels abroad. These findings show that he was conducting the same Grand Tour as his noble patrons, and provide revealing insights into his knowledge of Williamite gardens. This evidence suggests that he was a capable aesthete and speculates that he was a crucial and overlooked player in this period of landscape design.

Hip replacement is the main therapeutic intervention for end-stage osteoarthritis (OA). Metal-on-metal (MoM) hip implants were introduced to provide a durable alternative to ceramic and polyethylene devices, particularly in a younger patient population. However they are associated with the development of adverse reactions to metal debris (ARMD) which includes osteolysis, soft tissues necrosis, and inflammatory pseudotumours. MoM implants are usually fabricated from a cobalt-chrome alloy. Cobalt activates human Toll-like receptor 4 (TLR4), an innate immune receptor also activated by bacterial lipopolysaccharide (LPS). This study set out to investigate the inflammatory consequences of cobalt-mediated TLR4 activation through a series of in vitro assays developed throughout this work. In human MonoMac 6 macrophages cobalt was found to increase secretion and expression of pro-inflammatory cytokines including IL-8, IL-6 and CCL20. Using IL-8 as a marker of TLR4 activation a small molecule TLR4 antagonist, CLI-095, was shown to inhibit these effects, indicating that they are TLR4-dependent. Similar responses were observed in endothelial cells and osteoblasts. A monoclonal anti-TLR4 neutralising antibody inhibited cobalt-mediated IL-8 expression and secretion, while a polyclonal anti-TLR4 neutralising antibody did not. Further investigation showed that cobalt-mediated TLR4 activation increases expression of intercellular adhesion molecule 1 (ICAM1) and its soluble form sICAM-1. It also promotes primary monocyte and neutrophil migration. A TLR4 mutation did not prevent inflammatory responses to cobalt, although further assay optimisation is required. Co-stimulation of MonoMac 6 cells with cobalt and LPS or nickel caused downregulation of IL6, CCL2 and IL8 expression. Finally, unlike cobalt, chromium and strontium ions did not activate TLR4 and did not induce IL-6 or IL-8 secretion in macrophages. In summary, this study has shown that TLR4 activation by cobalt ions from MoM hip implants results in increased cellular inflammatory responses. The use of TLR4 inhibitors in this study suggests that TLR4 is a potential therapeutic target in ARMD. Overall, the TLR4 signalling pathway is an interesting avenue for further investigation into factors underlying MoM implant failure.