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Immune checkpoint inhibitors (ICIs) have revolutionised the field of oncology. While most ICIs are well-tolerated, severe and fatal immune-related adverse events (irAEs) have been documented, likely related to the strengthened immunity harnessed by ICIs against tumours. Endocrinopathies are some of the most common irAEs, with both hypothyroidism and hyperthyroidism encountered after ICI use. As such, patients with pre-existing autoimmune conditions, such as Graves' disease (GD) with clinically active thyroid eye disease (TED), are excluded from most clinical trials studying ICIs due to concerns of exacerbating pre-existing autoimmune conditions or of increasing the potential for irAE development. The limited information currently available on the safety and efficacy of ICIs in this population poses a clinical challenge for oncologists. The objective of this commentary is to highlight these challenges and provide treatment recommendations pertaining to two specific cohorts of patients with GD, namely GD patients with minimal eye complications and GD patients with previous TED who underwent radiotherapy, surgery or pulse methylprednisolone and whose disease is now quiescent, and to patients with subclinical autoimmune thyroid disease.

Despite advances in ophthalmic diagnostics, the direct ophthalmoscope remains a key clinical skill taught to medical students and is the tool of choice for retina examination among non-ophthalmic physicians. However, in recent years viable alternatives have become available. The coronavirus disease 2019 (COVID-19) pandemic has forced a major re-thinking in medical education worldwide. In this commentary, we examined the current merits and limitations of the direct ophthalmoscope in both the clinical sense and in the context of infection control. Furthermore, we compared the direct ophthalmoscope with alternatives, including commercially available portable non-mydriatic fundus cameras, that would allow a change in focus during ophthalmic teaching. We concluded that the latter will better prepare our medical students for the age of telemedicine and deep-learning systems. While the COVID-19 pandemic will not be the sole reason for the ‘death’ of the direct ophthalmoscope, the global situation will inevitably serve to expedite long overdue changes in our teaching of ophthalmic skills to non-ophthalmic physicians.

Residual current devices (RCDs) are commonly used in low voltage electric power systems, including our households, as protective devices against electric shock. They monitor the balancing current b...

Project selection is a crucial decision-making process in many organizations. By adopting a project-based learning perspective, this study sets out to develop a framework to integrate organizational knowledge development with project selection. We utilize various knowledge management models to create a structured evaluation metric to measure project contribution to organizational knowledge. A project selection model, which involves project knowledge contribution as one of the evaluation perspectives, is proposed. Results of a focus group study effectively validate the proposed evaluation metric. The article concludes with an empirical implementation of the model in an electronic component manufacturing company.

External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

In preparing a PAL driven OL, various activities and preparations are needed to be done, starting by assessing the readiness towards the Learning organization, then to check whether the supportive policy and resources are being put in place. Steps for realizing the PAL supporting pillars would also be addressed.

Purpose This paper aims to present the result of the pilot run of a research project which aims at evaluating the applicability of project-based action learning (PAL) to shop floor organizational learning (OL) component in a manufacturing company in Dongguan, China. How the PAL framework was introduced and implemented is described. The factors that influence PAL implementation are examined in this pilot implementation. The implications and effectiveness are discussed. The findings shed light on the modifications needed in the PAL framework for shop floor implementation. Design/methodology/approach This is a longitudinal case research which is conducted in a case company (APT) located in Dongguan, China. PAL framework was introduced and implemented in APT. A wave-like approach was used to repeat launching PAL projects in cycles. Data of learning and work performances were collected for review during each phase and each cycle of the project. The result presented here is from the early round of the pilot PAL implementation. Findings Result indicated that the PAL framework is applicable in the shop floor level OL. Learning and performance have been found to have improved in all the PAL groups participating in the pilot run. Result also shows that the PAL implementation framework needs some fine tuning to meet the needs of the unique shop floor environment particularly with regard to performance measure and evaluation. Originality/value No such case study has been conducted in shop floor level before. The research study will be valuable experience and example for other organizations to implement OL in shop floor level.

External ventricular drainage (EVD) may be used for therapeutic cerebrospinal fluid (CSF) drainage to control intracranial pressure (ICP) after traumatic brain injury (TBI). However, there is currently uncertainty regarding the optimal timing for EVD insertion. This study aims to compare patient outcomes for patients with early and late EVD insertion. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, MEDLINE/EMBASE/Scopus/Web of Science/Cochrane Central Register of Controlled Trials were searched for published literature involving at least 10 severe TBI (sTBI) patients from their inception date to December 2019. Outcomes assessed were mortality, functional outcome, ICP control, length of stay, therapy intensity level, and complications. Twenty-one studies comprising 4542 sTBI patients with an EVD were included; 19 of the studies included patients with an early EVD, and two studies had late EVD placements. The limited number of studies, small sample sizes, imbalance in baseline characteristics between the groups and poor methodological quality have limited the scope of our analysis. We present the descriptive statistics highlighting the current conflicting data and the overall lack of reliable research into the optimal timing of EVD. There is a clear need for high quality comparisons of early vs. late EVD insertion on patient outcomes in sTBI.

An automated system has been developed at SCL for the calibration of low level dc current sources and meters, including electrometers and femtoammeters, from 100 picoamperes (pA) down to 100 femtoamperes (fA). The system is comprised of in-house developed control software, ramping voltage generation circuitry, and a set of precision air capacitors. For measurement at the 100 pA level, expanded measurement uncertainties of 0.1 % and 0.3 % for generating test currents and calibrating meters, respectively, can be achieved by this system.

PurposeThis paper addresses the importance of a more proactive role of organizational learning (OL) facilitators, learning motivation reinforcer, through a two‐part longitudinal study in a case company. The first part of this study aims to investigate and analyze some unexpected challenges in the project action learning‐driven (PAL) OL implementation in the case company, and the second part seeks to discuss an enhanced role of OL facilitators to cope with the new challenges.Design/methodology/approachA longitudinal case study supplemented with a series of carefully choreographed field research activities, e.g. interviews, on‐site observations, survey tests, was conducted to achieve the research purpose. In the first part of this study, the feedbacks regarding PAL implementation were collected from different PAL stakeholders to identify the problems and barriers that undermined the effectiveness of PAL implementation. In its second part, the proposed facilitator's interventions were introduced in the case company. The results were examined through a controlled group experiment conducted with an on‐going round of PAL implementation.FindingsThe study found that adverse changes in business circumstances and organizational restructurings could dampen staff's motivation toward organization's OL initiatives which would further reduce the OL effectiveness. To redress the situation, a set of facilitator's interventions was developed to reinforce OL members' learning motivation. Study results indicate that the proposed interventions can positively influence the learning motivation of the PAL members in the case company.Practical implicationsThis paper describes the difficulties encountered in a real life OL journey and the role OL facilitators could take on to help overcome them. It provides empirical evidence of how the learning motivation and commitment of OL members can be positively influenced by OL facilitation.Originality/valueThe authors believe such longitudinal case based OL research is rare and valuable to OL theorists and practitioners.

This chapter presents the project action learning (PAL) implementation experience as real-life cases. PAL uses real-life projects to align individual and team learning with organizational learning (OL). The case company adopted a wavelike approach in its PAL implementation. PAL became the OL vehicle of the case company. An enabling IT-based infrastructure was developed to provide a platform for easy communication, knowledge sharing, and information interchange. The knowledge gained or generated throughout the PAL-driven OL processes could be captured and retained as retrievable organization knowledge. OL facilitation is another vital pillar for PAL implementation, which provides cognitive coaching and coordination to guide the PAL teams, especially their new members through the established PAL process.