British Case Research Articles

OA17 An unusual cause of unilateral retroperitoneal fibrosis

Abstract Background/Aims Retroperitoneal fibrosis (RPF) is a rare condition, with an incidence of around 1 per 200,000 to 500,000 per year. It is distinguished by fibro-inflammatory changes in the retroperitoneum, which typically surrounds the abdominal aorta. Idiopathic RPF is common, whilst secondary causes can result from drug therapies, infection, malignancy, or surgery. Early symptoms include dull, poorly-localised back or flank pain, and lower limb swelling. The classical focal mass of primary retroperitoneal fibrosis is typically situated over the distal aorta, anterior to the L4 and L5 vertebra. External compression of the ureter can result in hydronephrosis due to prevention of normal ureteric urinary peristalsis. Management options are limited, generally involving immunosuppression and urological surgery, often necessitating cross-specialty, multidisciplinary input. Methods We report the case of a young gentleman with no past medical or family history who presented with abdominal pain, vomiting, septic shock and metabolic acidosis. To exclude acute abdominal pathology, computed tomography (CT) abdomen and pelvis was performed. Incidentally, this found chronic inflammatory changes in the descending colon and right retroperitoneal soft tissue thickening causing severe right hydroureteronephrosis. This incidental finding of retroperitoneal fibrosis on CT scan prompted an exploration into infective, inflammatory, and malignant aetiological causes of retroperitoneal fibrosis. Results Following initial stabilisation, urological opinion was sought, which concluded that surgical intervention for ureteric stenting was unnecessary. This decision was supported by the absence of obstruction from fibrosis and the lack of signs indicating infection. No medical explanation was found for the initial presentation in extremis. Rheumatological advice was sought for consideration of biopsy and immunosuppressive therapy for this suspected primary retroperitoneal fibrosis. Upon inquiry, the patient divulged a historical occurrence of retroperitoneal fluid accumulation secondary to a paravertebral mass that mandated laparoscopic drainage four years ago overseas. Histopathological analysis of the mass confirmed the presence of tuberculosis (TB), which was treated. His recovery was complicated at that time by right-sided hydronephrosis and fibrosis necessitating decompression. This sequence of events was deemed by a radiologist to also account for the observed bowel findings in the right flank. Conclusion This case report is the first of its kind to document TB, or any infective aetiology, as being the primary cause of unilateral retroperitoneal fibrosis. Unilateral retroperitoneal fibrosis is incredibly rare, and there are only four English language case reports in the literature. Idiopathic RPF typically presents as bilateral concentric tissue around the abdominal aorta, whilst secondary causes can lead to unconventional imaging patterns, as seen in this case. It was only upon direct inquiry that the patient disclosed a prior diagnosis of TB affecting the lumbar spine. This case highlights the importance of meticulous history taking and systematic exclusion of secondary causes of RPF, prior to contemplating invasive biopsies and steroid therapy. Disclosure D. Li: None. M. Renju: None.

Lenalidomide‐induced posterior reversible encephalopathy syndrome: A case report

AbstractPosterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular dysregulation. To our knowledge, we present the first case of lenalidomide‐induced PRES in English. A 59‐year‐old woman with history of multiple myeloma status post stem cell transplant and induction triple therapy 6 months ago with partial remission and subsequent high‐dose melphalan 1 month ago presented with progressive vision loss for 1 week. Her systolic blood pressure was >180 mmHg, and neurological examination demonstrated decreased vision bilaterally. Brain MRI revealed significant T2 hyperintensity restricted to temporal and occipital lobes and left occipital parenchymal hemorrhage and diffuse leptomeningeal enhancement. She had a witnessed generalized tonic–clonic seizure and EEG that captured an electrographic seizure originating from the occipital lobe. Her vision improved rapidly after discontinuing the lenalidomide. She was discharged to rehab with a normal neurological examination. We report the first English case of presumed lenalidomide induced PRES in a patient undergoing multiple myeloma treatment.

Syntactic variation in Hong Kong English

Kirkpatrick and Lixun (2021) maintain that two significant morphosyntactic processes have been at play in early Englishes. These are simplification and regularization. Simplification refers to the relatively simplified inflectional morphology in English today. Kirkpatrick and Lixun (2021) provide an example for the word stan (i.e., stone in Old English) that showed great differences in the singular and plural form in nominative, accusative, genitive and dative case in Old English. Another process is regularization, through which some of the strong verb forms for past tense in English have changed to take the weak or the regular form. To illustrate, the past tense of work was wrought but over time, it has changed to worked.

Exploring the linkage of higher education and attitudes towards European integration: The British case

AbstractWhile cross‐sectional research has consistently shown graduates are less Eurosceptic than non‐graduates, little is known about the causal role of university study in determining these attitudes, as few longitudinal studies have explored this. This study does so, providing robust causal estimates of higher education's effect on Euroscepticism through applying individual‐ and sibling fixed‐effect modelling techniques to British Household Panel and Understanding Society data from 1999–2022. Both specifications provide consistent results; suggesting university study does little to decrease Euroscepticism in the short‐run but has substantial long‐run effects. This alludes to an ‘allocation’ effect, whereby it is largely not the experience of obtaining a degree itself, but the opportunities afforded by virtue of doing so that shape attitudes towards Europe. Our novel findings not only demonstrate that within‐sibling estimates of higher education's effect can be generalised to the wider British population but also advance our understanding of the mechanisms linking education with Euroscepticism.

English-for-Specific-Purposes Lecturer in English-Medium-Instruction Environment – Maritime English Case Study

In this paper, the Maritime English lecturer's role is considered from the point of view of their ecologically sustainable development. This will be done according to the survey carried out with experienced and novice Maritime English lecturers. The survey examines the current role of a Maritime English lecturer and seeks to envisage the best course of their future development in an English-medium-instruction (EMI) environment. Thus, a questionnaire with appropriate questions for a group of respondent Maritime English lecturers was created and then distributed; next, the responses were analysed and the results’ overview elaborated; last, an attempt was made to model the Maritime English lecturer's optimum development according to the guidelines of ecological sustainability. The essential prerequisite was to consider the idea of an ecologically sustainable development process, its establishment and purpose, and how it can be overlaid onto the professional and pedagogical role of Maritime English lecturers to support their current role, but also to assist in their future development. The latter seems unavoidable due to changes in the maritime industry and requirements from the maritime educational sector.

The Requirements of Managing Phase I Clinical Trials Risks: The British and Italian Case Studies.

Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety of the new compound. To mitigate the possible risks associated with drug administration and treatment, the European Competent Authority issued various guidelines to provide provisions and harmonize risk management processes. In the UK and Italy, particular attention should be paid to the Medicines & Healthcare Products Regulatory Agency (MHRA) phase I accreditation scheme and the specific rules set by the Italian Drug Authority through the AIFA Determination no. 809/2015. Both reference documents are based on the concept of quality risk management while conducting phase I clinical studies. Moreover, the AIFA determination outlines specific requirements for those sites that want to conduct non-profit phase I clinical trials. Indeed, the document reports peculiar activities to the "Clinical Trial Quality Team", which is a team that should support the clinical site researchers in designing, starting, performing, and closing non-profit phase I studies. In this paper, we provide a general overview of the main European guidelines concerning the management of risks during phase I trials, focusing on the main peculiarities of the schemes and rules set by the MHRA and AIFA.

Automated Scoring of Translations with BERT Models: Chinese and English Language Case Study

With the wide application of artificial intelligence represented by deep learning in natural language-processing tasks, the automated scoring of translations has also advanced and improved. This study aims to determine if the BERT-assist system can reliably assess translation quality and identify high-quality translations for potential recognition. It takes the Han Suyin International Translation Contest as a case study, which is a large-scale and influential translation contest in China, with a history of over 30 years. The experimental results show that the BERT-assist system is a reliable second rater for massive translations in terms of translation quality, as it can effectively sift out high-quality translations with a reliability of r = 0.9 or higher. Thus, the automated translation scoring system based on BERT can satisfactorily predict the ranking of translations according to translation quality and sift out high-quality translations potentially shortlisted for prizes.

Analysing sympathy from a contrastive pragmatic angle: a Chinese–English case study

Abstract In this study, we provide a replicable language-anchored framework for capturing expressions of sympathy in interaction, by contrasting Chinese and English sympathising behaviour. Our framework combines interaction ritual and speech acts, and it captures sympathising without associating it with one particular speech act from the outset. Methodologically, we follow a tripartite design: First we identify puzzlements which ritual sympathising can trigger for Chinese expatriates living in the US and American expatriates in China. We then conduct Discourse Completion Tests (DCTs) to identify conventions of sympathising in the two linguacultures. Finally, we interpret our expatriates’ puzzlement through the outcomes of the DCT analysis.

Cholecystectomy clip-induced biliary stone: Case report and literature review

Abstract Migration of cholecystectomy surgical clip into the common bile duct with subsequent stone formation is a rare phenomenon, one which may lead to complications including obstruction, pain, nausea, vomiting and fever. The mechanism of migration is largely unknown but may result from a combination of factors including necrosis, intra-abdominal pressure or poor surgical technique with migrated clip serving as a nidus for stone formation. We present a 55-year-old woman with clip-induced stone impacted at the distal common bile duct 12 years post-cholecystectomy and a review of the literature related to cholecystectomy clip stone formation. In addition, we reviewed relevant English language case reports and literature reviews by searching PubMed using search terms ‘stone’, ‘clip’, ‘cholecystectomy’ and ‘biliary’. There was no limit to the date of publication. Our study found 68 unduplicated cases of clip-induced stones which had a wide range of onset and presenting systems. Further research is needed to identify risk factors, methods of prevention and benefits of early detection screening.

Independence and impartiality: Australia’s arbitrator bias test

Abstract This article examines Australia’s arbitrator bias test to reveal its underlying contradictions and ambiguity and suggests that the legislation is amended to remedy these flaws and ensure Australia stays in line with international best practice. In 2010, section 18A of the International Arbitration Act 1974 (Cth) introduced the arbitrator bias test into Australian statute. The provision failed to specify both limbs of the test and relied on Gough, an outdated English case. This produced two opposing decisions from Australia’s federal judiciary: Sino Dragon and Hui. The uncertainty of Australia’s arbitrator bias test strikes at the heart of the process as the independence and impartiality of arbitrators is a fundamental pillar of international commercial arbitration. After critically analysing the progression of England’s approach to the arbitrator bias test over the past century to date, I conclude that the inherent unclearness of Australia’s approach needs to be remedied by the real possibility test being codified in Australian statute. This test reflects the Australian federal judiciary’s most recent approach. My analysis also reveals it is the most appropriate test. By clarifying Australia’s arbitrator bias test those associating with Australia’s international commercial arbitration system have the requisite certainty and clarity to engage with ease.

Role of the Growth Hormone Receptor (GHR) Gene in Skeletal Class II Malocclusion and Its Significant Influence on the Skeletal Facial Profile in Both the Sagittal and Vertical Dimensions: A Systematic Review.

This systematic review aims to determine the role of the growth hormone receptor (GHR) gene in skeletal malocclusion and its significant influence on the growth of the maxilla and the mandible in both sagittal and vertical dimensions. A search of the electronic databases of PubMed, Google Scholar, and Cochrane up to and including the year 2023 was made. In addition to this, a hand search of orthodontic and dentofacial orthopaedic journals was carried out. This search included randomized control trials. The Mesh terms used were "skeletal class II malocclusion", "mandibular retrognathism", "sagittal malocclusion", "genetic expression", "genetic factors", "genetic study", "genetic polymorphism", and "single nucleotide polymorphism". The inclusion criteria included studies such as clinical trials and orthopaedic appliances in the presurgical phase. The exclusion criteria for the study were studies not in the English language, case reports, case series, and studies with irrelevant data. It has been cited in various literature that polymorphic variations of the GHR gene could cause variations in mandibular morphogenesis affecting both the mandibular body length and ramal height. However, its effects are quite variable and are based on different population groups. Polymorphism of the GHR gene can be considered a reliable indicator predicting variations in affecting the growth of the mandible with greater significance in affecting the vertical ramal height compared to the body length of the mandible. Its effects on the maxillary skeletal base are rather limited comparatively.

The Post-Public Sphere and Neo-Regulation of Digital Platforms

This article discusses the post-public sphere and the regulation of platforms that have had disruptive effects on democracy. Platformisation means that the normative ideals for a political public sphere set out by Jürgen Habermas face a distinctive challenge. “Neo-regulation” is an evolving adaption by states that reflects the urgent need to address platformisation and digitalisation more generally. In conditions of geopolitical competition, notably between the China and US, attempts by various states and the EU to establish a neo-regulatory order has developed a significant national security dimension, which is highly relevant for the regulation of digital communication. Policing borders and content is an ever-present focus in all political regimes, whether characterised as democratic or authoritarian. Applying Pierre Bourdieu’s field theory to internet regulation, the argument is illustrated by reference to current British regulatory practice. At the level of the state, the “regulatory field” is shaped by national and global forces. Although the British case has specific characteristics, the underlying analysis has general relevance for comparative research.

Analysis of the Legitimacy of Directors’ Liability to Company’s Creditors —Drawing on English Case Law

Analysis of the Legitimacy of Directors’ Liability to Company’s Creditors —Drawing on English Case Law

Israel – In Search of Constitutional Common Sense

The Israeli radical judicial overhaul program, aiming to seriously weaken the judiciary, has led the country to the brink of chaos and violence, with hundreds of thousands of demonstrators in the streets, society tearing itself apart and numerous sectors of society, such as medical service or reservists of IDF, announcing a suspension of their service to a nation they fear will no longer be a democracy. Despite the strong social protest, Knesset – representing an extremely right-wing coalition – adopted on the July 24, 2023 the amendment to Basic Law: The Judiciary to bar the judiciary from striking down decisions of the government and its ministers on the grounds of such decisions being unreasonable. The measure known as the reasonableness clause (standard) is rooted in English and American case law and it is frequently used in Israel to control administrative activity. It allows the courts to strike down governmental and administrative decisions and their regulations seen as having not taken into account all the relevant considerations of a particular issue, or not given the correct weight to those considerations – even if they do not violate any particular law or administrative rulings. The current right-wing coalition, led by Benjamin Netanyahu, argues that the clause as it stands gives too much power to the judiciary, especially the Supreme Court sitting as a High Court of Justice, to interfere with the actions of the executive, and that the powers of judges, who are not elected by the public, remain out of control in this procedure. Opponents of the government’s amendment argue that this standard is crucial in helping to protect civil rights that are not fully defined in Israeli law. Eliminating the standard of reasonableness will be another step towards giving the government unlimited power. It violates not only the separation of powers principle and the rule of law but it also harms the right to good administration. Irrespective of the Supreme Court’s decision on the constitutionality of the government’s amendment, the struggle to maintain the democratic principles of the Israeli system will continue.             Despite the strong social protest, Knesset – representing extremely right-wing coalition –adopted on the 24th of July 2023 the amendment to Basic Law: Judiciary to bar the judiciary from striking down decisions of the government and its ministers on the basis of being unreasonable. The measure known as the reasonableness clause (standard) is rooted in English and American case law bless and it is frequently used in Israel to control the administrative activity. It allows the courts to strike down governmental and administrative decisions and their regulations seen as having not taken into account all the relevant considerations of a particular issue, or not given the correct weight to those considerations – even if they do not violate and particular law or administrative rulings. The current right-wing coalition, led by Beniamin Netanyahu, argues that the clause as it stands gives too much scope to the judiciary, especially the Supreme Court sitting as a High Court of Justice, to interfere with the actions of the executive, and that the powers of judges, who are not elected by the public, remain out of control in this procedure.             Opponents to the government’s amendment argue that this standard is crucial in helping to protect civil rights that are not fully defined in Israeli law. Eliminating the standard of reasonableness will be another step towards giving the government unlimited power. It violates not only the separation of powers principle and rule of law but it also harms the right to good administration.             Irrespectively of the Supreme Court's decision on the constitutionality of the government's amendment, the struggle to maintain the democratic principles of the Israeli system will continue.

Unveiling Chinese Approaches to British Case Study Group Discussions: Insights for Global Business Education

In the context of globalization in business education, students from all over the world participate in mixed case study group discussions to enhance their skills in risk forecasting and intercultural communication through collaborative exploration. Learners who possess effective case-based discussion techniques and strategies for success in one cultural context may find them either impactful or ineffective when applied in another learning culture. This study scrutinized the case study group discussion process involving a group of Chinese undergraduate students enrolled in a split-site degree program and their English-speaking partners. Three group discussion approaches—spiral, individual, and cumulative—were identified by analyzing the Chinese students’ strategies for manipulating topics and reacting to others’ opinions. These Chinese approaches illustrate unique autonomous learning strategies of self-reflection and inner dialogue within the study groups. The findings hold implications for the course design of English for Business Purposes (EBP) in business partnership degree programs.

Exploring the Development, Dilemmas and Countermeasures of College English Teaching by Combining the Hierarchical Analysis Approach

Abstract College English teaching has formed a long-term historical persistent problem in the process of higher education expansion, and it is urgent to explore its development dilemma and corresponding countermeasures. This study uses hierarchical analysis to analyze the connection between relevant factors in English teaching activities, constructs a judgment matrix for teaching evaluation, establishes the index ordering through a consistency test, and applies intuitive fuzzy logic to establish the index weights. At the same time, a genetic algorithm was applied to the weight optimization process to iterate the better matrix indicator weights. After verifying the optimization effect through experiments, the comprehensive assessment method was applied to specific teaching cases and analyzed. The comprehensive evaluation results of students, teachers, and experts were obtained respectively, the latter being [0.3459 0.2961 0.1848 0.1086 0.0636]. The final evaluation result of the university English teaching case is [0.3358 0.2790 0.1874 0.1272 0.0695], which corresponds to the grade of “general”. Through the evaluation of university English teaching, the difficulties of current English teaching are fed back, which lays the foundation for the countermeasures to be put forward.

Civil Recourse Against Food Traders Causing Food Poisoning in Malaysia – Proposals for Reforms

Under the current legal regime, the only civil recourse against food traders causing food poisoning to consumers in Malaysia is through civil action under tort of negligence. A civil action is not straightforward and often fraught with difficulties. Hence, the objectives of this paper are twofold. Firstly, to examine the application of the tort of negligence in civil liability cases against food traders who cause food poisoning; and secondly, to explore alternative approaches that could be introduced to safeguard the legal rights to compensation of aggrieved consumers and/or dependants of deceased consumers. This paper employs a pure doctrinal research method where the relevant food safety legislations and relevant English case laws together with the secondary sources such as textbooks, journals articles, statistics reports, press reports, relevant online databases, and websites are referred to. This paper concludes that the only civil recourse available is by commencing a civil action under tort of negligence against food traders. In addition, it is also found that relevant food safety legislations only empower enforcement authorities to take legal action against food traders but they will not act on behalf of aggrieved consumers who suffered from food poisoning and/or dependants of deceased consumers who died from food poisoning. This paper, thus, proposes reforms by way of amendments to the Food Act 1983.

Undifferentiated Small Round Cell Sarcoma of the Hypopharynx in a 7-Month-Old Patient.

Undifferentiated small round cell sarcoma is an extremely rare and highly aggressive tumor touching the soft tissues and bones. Here, we report the case of a 7-month-old girl who presented to our department with respiratory distress due to a hypopharyngeal mass causing airway obstruction. The patient underwent a tracheotomy and had a direct laryngoscopy. Histological examination confirmed the diagnosis of an undifferentiated small round cell sarcoma. The patient received chemotherapy and radiotherapy and underwent neck dissection. One year later, the patient was diagnosed with local recurrence as well as metastatic cervical nodes and liver and pulmonary metastases. The case is original by the tumor's location and the age of onset. To the best of our knowledge, this could be the first case in English and French literature reporting an undifferentiated small round cell sarcoma affecting the hypopharynx among infants. The purpose of this article is to report our case and discuss its clinical and anatomopathological features as well as its prognosis and treatment options.

Synthetic-analytic variation in the formation of Greek comparatives and relative superlatives

Abstract Many adjectives in Modern Greek form both synthetic and analytic comparatives and relative superlatives. To our knowledge, this is the first work to examine the triggers of the Synthetic-Analytic (S-A) variation in this language by means of a corpus study. To date, numerous studies have shown that a series of predictors (phonological, lexical, syntactic) appear to influence the S-A variation in English. The present paper focuses on some factors mentioned in the existing literature (e.g., frequency, number of syllables, syntactic position etc.) alongside Text Type, which is explicitly used as a predictor for the first time. Overall, our results suggest that 1) the S-A variation seems to be influenced by similar predictors cross-linguistically and 2) comparatives and relative superlatives show a partially different picture in Modern Greek, as is also the case in English (Cheung & Zhang 2016).

Transforming the grid for a more environmentally and socially sustainable electricity system in Great Britain is a slow and uneven process.

Electricity system decarbonization is key for environmental sustainability. From a consumption-production perspective, much attention has been paid to changes in how electricity is generated and used, but electricity systems also rely on a grid infrastructure that connects and integrates production and consumption, and which will also need to transform. At the same time, new technologies in the electricity system, including the grid, offer the potential for more socially sustainable ways of producing and consuming energy. However, in practice, change has been slow, uneven, and often dysfunctional. A socio-technical transitions approach offers insights into why this is so, seeing electricity system change not simply in technical and economic terms, but also as the outcomes of interactions between technology and social and political processes. The approach draws attention to the particular challenges of achieving rapid transitions in complex critical infrastructures like electricity with strong institutional logics of security. This article applies this approach to the case of Great Britain, where despite strong commitments to sustainability in the form of high-level climate policy, the electricity grid has often been a constraint on the pace of change. The nature of the British transition is explained partly by weak links between these high-level goals on the one hand and the detailed rules and practices in the electricity system on the other. It is also explained by patterns of ownership and grid regulation in the British case that protect incumbents and make it difficult for new actors to develop the system in more socially sustainable directions.