A Brexit last call: The strange practice of pre-Brexit opt-ins

As long as the UK’s membership in the EU lasted, it had a special position within the Union. This could be seen particularly well in a peculiar practice that has largely gone unnoticed in the public, namely a series of opt-in decisions that the UK took prior to Brexit but after the Brexit referendum. This contribution raises the question of whether the UK used the pre-Brexit period as a type of ‘last call’, trying to get everything it could of its membership before it ended. To do so, it studies five opt-in decisions, examining their subject matter, the effects of the opt-ins and the outcome of the Brexit negotiations in order to understand the UK’s reasons for integrating further into the EU before withdrawing from it. Uncovering various political and practical motivations, it comes to the conclusion that the initial impression of a ‘last call behaviour’ is not justified.

A Case of macro-TSH masquerading as subclinical hypothyroidism

A 47-year-old man was commenced on levothyroxine following a diagnosis of subclinical hypothyroidism with nonspecific symptoms. Despite increasing doses of levothyroxine, his thyroid-stimulating hormone (TSH) remained elevated and he was referred for further assessment as he was unable to tolerate further titration. On assessment, his thyroid function demonstrated an elevated TSH and elevated free-T4. The initial impression was of iatrogenic thyrotoxicosis, with possible underlying thyroid hormone resistance, TSHoma or assay interference. After discontinuation of levothyroxine, free-T4 normalised but TSH remained elevated. There was a normal response to thyrotropin-releasing hormone (TRH) testing. T3 suppression testing demonstrated free-T4 reduction but persistently high TSH. THRβ sequencing was normal. TSH measurement by alternative assays revealed discrepant results. Gel filtration chromatography revealed the presence of high-molecular weight TSH variant alongside normal TSH. Macro-TSH is a rare phenomenon with spuriously elevated TSH and which may mimic subclinical hypothyroidism. Recognition of macro-TSH avoids misdiagnosis and prevents inappropriate treatment.

Intravascular Papillary Endothelial Hyperplasia (Masson’s Tumor) of the Submandibular Gland: A Case Report

Intravascular papillary endothelial hyperplasia (IPEH), a rare benign endothelial vascular lesion related to thrombosis, generally develops in fingers, trunk, head, and neck. Nevertheless, it has been rarely reported in the salivary gland. In this article, we report a case of IPEH of the right submandibular gland in a 37-year-old female whose initial impression was sialadenitis secondary to sialolithiasis. To date, our case may be the first well-documented report of IPEH in the submandibular gland. The patient underwent ablation of the submandibular gland, and no evidence of recurrence was found during follow-up.

Canonization, Satire, and Criticism of Avot in Midrash Yelammedenu from the Genizah

In this article, I present a midrashic reference to one mishnah of tractate Avot that would appear to undermine its canonical status. A close reading of the midrash, will show that it makes use of various satirical tools, including exaggeration and ridicule, which appear to be aimed at a mocking of the mishnah. However, further reading of the midrash in light of a more comprehensive look at tractate Avot will show that contrary to this initial impression, the use of satire may not be directed at undermining the canonical status of Avot but rather at strengthening it. According to this reading, the satire is directed at internal criticism that the midrash identifies in the heart of the mishnaic text, with the result that Avot’s status is restored.

A Course Syllabus Design: Initial Steps and Recommendations

The article attempts to highlight the importance of implementing a course syllabus design practices in Uzbek tertiary education. The syllabus is an introductory document that guides students throughout the entire course and functions as an asset to shape the initial impression on the course’s nature and its content. The constituent parts of a course syllabus are a general description and course objectives, topics, preliminary schedule of assignments, materials, grading plan, pre-set rules, and policies of class conduct. Also, the author discusses the basic syllabus sections and presents the guidelines on the points to be considered while designing a syllabus for the course.

Consumers Associate High-Quality (Fine) Wines with Complexity, Persistence, and Unpleasant Emotional Responses

The conventional method for the sensory evaluation of wine is based on visual, olfactory and gustatory perceptions described by a domain-specific language. This is a complex task, requiring extensive training, which is not feasible from a consumer perspective. The objective of this study was to apply a wine tasting sheet, including sensory and emotional responses, to simplify the recognition of fine white wines by consumers. First, a panel of 15 semi-trained judges evaluated eight sensory attributes through Optimized Descriptive Profile (ODP) methodology. Then, a group of 104 consumers evaluated five white wines with different sensory characteristics using an improved emotional wine tasting sheet. The emotions and sensations most frequently associated with white wines were obtained through the Check-All-That-Apply (CATA) approach. The eight sensory attributes were significant (p-value < 0.05) in the distinction of wines by the ODP. Likewise, the distinction of the wines also provided significant differences in all the emotional and sensory attributes (p-value < 0.05). The different wine styles could be distinguished by Principal Component Analysis (PCA) using the semi-trained judges or the consumer responses. The highest score in the “global evaluation” was given to two young, fruity wines characterized by high aromatic “initial impression”. The two fine wines, including a 2004 Burgundy Pouilly-Fuissé, were the lowest rated in “initial impression” and “global evaluation”, although they were considered by the consumers among the most complex and persistent. These wines were also most frequently associated with unpleasant emotions by the CATA test. The recognition of these fine wine attributes and their incongruity with emotional responses can be used in a rapid way by professionals to explain the different wine styles to consumers.

Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis

Miliary shadows on chest imaging have wide differential diagnoses. The most common etiology is infectious, such as miliary tuberculosis (TB) and histoplasmosis, but miliary shadows can be the presentation of sarcoidosis, pneumoconiosis, and secondary metastasis to the lungs from primary cancers of the thyroid, kidney, and trophoblasts as well as sarcomas. Here we present the case of a 35-year-old Indian male who presented with a 2-month history of dry cough and shortness of breath. Chest imaging showed diffuse bilateral miliary nodules. The initial impression was that of miliary pulmonary TB. Subsequent bronchoscopy with a transbronchial biopsy confirmed the diagnosis of pulmonary mucinous adenocarcinoma with brain metastasis, which is a rare and unusual presentation of primary lung cancer. The tumor was positive for ALK5A4 and PD-L1, and the patient was started on tyrosine kinase inhibitor immunotherapy, with a favorable response.