Informal acquisition of accounting literacy and the use of accounting information by clinicians at the board of clinical commissioning group

This thesis discusses how clinicians align their logic with the objective of the organisation that they work for, leading to informal acquisition of accounting literacy and the use of accounting information. The study uses institutional logic theory to explain the transformation that takes place as clinicians work alongside accountants. Data were gathered from document analysis, participant observation and semi-structured interviews with GPs, nurses and pharmacists. Drawing on institutional logic theory, the study argues that the objectives that clinicians intend to achieve when they join the management team differ from those of the organisation. However, as they learn about the organisation’s specificities such as its politics, budgetary process, and public expectations, their perceptions of what is possible align with those of the organisation. The alignment of these diverse types of logic manifests in the form of trust, minimal conflict and a shared vision, even though the different groups are not necessarily in agreement about the best way to rationalise services. Consequently, the different groups can work together in harmony and allow some actors to direct certain activities while other actors shape different activities but decisions must be justified with sufficient information. The alignment of logic and teamwork fosters informal learning through three processes: attachment to managers; hearing the same information repeatedly; and participation in goal-driven activities. Interdependency between clinicians and accountants and their shared visions are the two key factors in facilitating the informal learning process. The knowledge acquired is then used in decision-making, to influence behaviour, and for the purposes of education and negotiation

Predictors Hampering Treatment of Offenders in Nigeria’s Custodian Centres

This study examined silent variables that influence the treatment of offenders in Nigerian custodian centres. The research was conducted using both primary and secondary data. Questionnaires were distributed to 400 respondents randomly selected from correctional institutions across the three senatorial districts of Cross River State, while the in-depth interview was conducted on 6 participants each across the selected custodian centres. The presentation of data was done using frequency distribution tables, and relevant narratives. The test of hypotheses was done using Pearson product moment correlation (PPMC) and the qualitative data were analysed using content analysis. The study found that corruption, inadequate rehabilitation equipment and low funding strongly influence the treatment of offenders in custodian centres in Cross River State, Nigeria. The study, therefore, recommends that the government through a special committee constituted should judiciously oversee the execution of the previously suggested prison reforms, which include but are not limited to provision of the needed infrastructures that will cater for the welfare of the inmates, pardoning awaiting trail offenders that have spent reasonable number of years in custody without conviction, this will help solve the challenge of overcrowding in correctional institutions across the country

Intelligence Gathering Imperative: A Tool for Successful Security Outfits’ Operation

This study examines the recent security challenges Nigerians and non-Nigerians encounters in their daily existence to eke a living. These threats are orchestrated by the activities of one of the deadliest terrorist group in the world (Boko Haram), and herdsmen notorious killers, armed banditry, cow rustling by rustlers, incessant kidnapping especially students in schools and unsuspecting Nigerians and non-Nigerians alike; which has made Nigeria federating states unsafe for any meaningful socio-economic development to thrive. To achieve this, two objectives were stated to include, underscore the overarching relevance of intelligent gathering in preventing crime and understand the elaborateness of intelligence gathering that can be utilized to mitigate crimes outcomes. The study found that intelligence gathering is the disconnect that has precipitated this state of affairs in Nigeria. Equally responsible is the people’s loyalty which is first and foremost skewed to ethnoreligious and political considerations instead of the country. It was recommended among other appeals to include: The National Intelligence Agency (NIA) of Nigeria which is the coordinating security agency should be properly funded and personnel trained in modern intelligence gathering techniques, the unnecessary bickering, in-fighting for superiority between and among security agencies in Nigeria should be discouraged because this itself is a big challenge in security equation of Nigeria; and serious effort should be made to stop the politicization of security intelligence gathering matters based on tribe, ethnic group, religious and political affiliations

Isolation and characterization of pyropheophorbide-a from moringa oleifera lam

Moringa oleifera is a plant rich in pharmacologically active compounds. This study investigated the phytochemical constituents of Moringa oleifera leaf extracts. Dried M. oleifera leaves were ground and extracted successively with hexane, ethyl acetate and methanol using a Soxhlet apparatus. Different chromatographic techniques were used to fractionate the ethyl acetate extract. Thin layer chromatography was used to pool similar fractions together. Fractions obtained were purified using sephadex glass column. The structures of isolated compounds were identified using nuclear magnetic resonance (NMR), electrospray ionization mass spectrometry (ESI-MS) and comparison with published data. Phytochemical screening revealed the presence of flavonoids, terpenoids, carbohydrates and phenols. Ethyl acetate extract which was subjected to column chromatography resulted to the isolation of two compounds: mono acetyl glycerol and pyropheophorbide-a, from the leaves of M. oleifera. This is the first report on the isolation of pyropheophorbide-a from the leaves of M. oleifera

Inflammation-based scores in patients with pheochromocytoma

Background: Pheochromocytoma is associated with systemic inflammation, but the underlying mechanisms are unclear. Therefore, we investigated the relationship between plasma metanephrine levels and haematological parameters – as a surrogate of inflammation – in patients with pheochromocytoma and the influence of preoperative α-blockade treatment.Design and Methods: We retrospectively studied 68 patients with pheochromocytoma who underwent adrenalectomy (median age 53 years, 64.7% females) and two control groups matched for age, sex, and body mass index (BMI): 68 patients with non-functioning adrenocortical tumors (NFAT) and 53 with essential hypertension (EAH). The complete blood count (CBC) and several inflammation-based scores [Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), Systemic-Immune-Inflammation Index (SII), Prognostic-Nutrition Index (PNI)] were assessed in all patients and, in a subset of pheochromocytomas, after adrenalectomy (n=26) and before and after preoperative α-blockade treatment (n=29).Results: A higher inflammatory state, as indicated by both CBC and inflammation-based scores, was observed in patients with pheochromocytoma compared to NFAT and EAH. Plasma metanephrine levels showed a positive correlation with NLR (r=0.4631), PLR (r=0.3174), SII (r=0.3709), and a negative correlation with LMR (r=0.4368) and PNI (r=0.3741), even after adjustment for age, sex, ethnicity, BMI and tumor size (except for PLR). After adrenalectomy, we observed a reduction in NLR (p=0.001), PLR (p=0.003), SII (p=0.004) and a concomitant increase in LMR (p=0.0002). Similarly, α-blockade treatment led to a reduction in NLR (p=0.007) and SII (p=0.03).Conclusions: Inflammation-based scores in patients with pheochromocytoma showed pro-inflammatory changes that correlated with plasma metanephrine levels and are ameliorated by adrenalectomy and α-blockade

Pheochromocytomas Most Commonly Present As Adrenal Incidentalomas:A Large Tertiary Center Experience

Context: Pheochromocytomas are increasingly diagnosed in incidentally detected adrenal masses. However, the characteristics of incidental pheochromocytomas are unclear.Objective: We aimed to assess the proportion and clinical, biochemical, radiological, genetic, histopathological, and follow-up characteristics of incidental pheochromocytomas.Methods: A retrospective review was conducted of patients with pheochromocytoma seen between January 2010 and October 2022 at a large UK tertiary care center. The diagnosis was confirmed histologically or by the combined presence of increased plasma and/or urinary metanephrines (MN), indeterminate adrenal mass on cross-sectional imaging, and metaiodobenzylguanidine avidity.Results: We identified 167 patients with pheochromocytoma; 144 (86.2%) underwent adrenalectomy, for 23 (13.8%) surgery was either awaited, deemed unsuitable due to frailty or other metastatic malignancy, or declined by the patients. Excluding pheochromocytomas diagnosed via screening genetically predisposed individuals (N = 20), 37 of 132 (28.0%) presented with adrenergic symptoms and/or uncontrolled hypertension, while 91 of 132 (69.0%) patients presented with an incidentally detected adrenal mass. Incidentally detected patients were older (median age 62 years) than those detected due to clinical suspicion (aged 42 years) or after genetic screening (aged 33 years) (all P < .05). Incidentally detected pheochromocytomas were smaller (median 42 mm) than tumors detected due to adrenergic symptoms/uncontrolled hypertension (60 mm), but larger than tumors identified by genetic screening (30 mm) (all P < .05). Increased MN excretion showed a similar pattern (symptomatic/uncontrolled hypertension > incidental > genetic screening) (all P < .05). Hereditary predisposition was detected in 20.4% of patients (incidental, 15.3%; symptomatic/uncontrolled hypertension, 42.9%).Conclusion: The majority of pheochromocytomas are diagnosed incidentally and have distinct clinical, radiological, biochemical, and genetic features. Their detection at older age but smaller size may point to a different underlying tumor biology

Rathke's Cleft Cyst Abscess with a Very Unusual Course

Infected Rathke's cleft cysts (RCC) are extremely rare with only a few published cases. We report the case of a 31-year-old man who presented with headaches, visual disturbance, and hypopituitarism secondary to an infected RCC with extension of abscesses along the optic tract. Magnetic resonance imaging showed ring enhancing cystic lesions within an expanded sella with suprasellar and intraparenchymal extension. The radiological appearance suggested a high-grade optic glioma, but an endoscopic transsphenoidal biopsy revealed frank pus in the pituitary fossa, which subsequently grew Staphylococcus aureus . Pathological examination of the cyst wall showed an inflamed RCC. Following a prolonged course of intravenous antibiotics, the infection resolved and vision improved. RCC abscesses are rare and the intracranial extension of the infection in our case makes it unique

A rare challenging case of co-existent craniopharyngioma, acromegaly and squamous cell lung cancer

Co-existence of craniopharyngioma and acromegaly has been very rarely reported. A 65-year-old man presented with visual deterioration, fatigue and frontal headaches. Magnetic resonance imaging revealed a suprasellar heterogeneous, mainly cystic, 1.9 × 2 × 1.9 cm mass compressing the optic chiasm and expanding to the third ventricle; the findings were consistent with a craniopharyngioma. Pituitary hormone profile showed hypogonadotropic hypogonadism, mildly elevated prolactin, increased insulin-like growth factor 1 (IGF-1) and normal thyroid function and cortisol reserve. The patient had transsphenoidal surgery and pathology of the specimen was diagnostic of adamantinomatous craniopharyngioma. Post-operatively, he had diabetes insipidus, hypogonadotropic hypogonadism and adrenocorticotropic hormone and thyroid-stimulating hormone deficiency. Despite the hypopituitarism, his IGF-1 levels remained elevated and subsequent oral glucose tolerance test did not show complete growth hormone (GH) suppression. Further review of the pre-operative imaging revealed a 12 × 4 mm pituitary adenoma close to the right carotid artery and no signs of pituitary hyperplasia. At that time, he was also diagnosed with squamous cell carcinoma of the left upper lung lobe finally managed with radical radiotherapy. Treatment with long-acting somatostatin analogue was initiated leading to biochemical control of the acromegaly. Latest imaging has shown no evidence of craniopharyngioma regrowth and stable adenoma. This is a unique case report of co-existence of craniopharyngioma, acromegaly and squamous lung cell carcinoma that highlights diagnostic and management challenges. Potential effects of the GH hypersecretion on the co-existent tumours of this patient are also briefly discussed

Macroprolactinoma causing VI, X, XII cranial nerve palsies nearly 30 years after initial treatment

A 48-year-old man was diagnosed with a large macroprolactinoma in 1982 treated with surgery, adjuvant radiotherapy and bromocriptine. Normal prolactin was achieved in 2005 but in 2009 it started rising. Pituitary MRIs in 2009, 2012, 2014 and 2015 were reported as showing empty pituitary fossa. Prolactin continued to increase (despite increasing bromocriptine dose). Trialling cabergoline had no effect (prolactin 191,380 mU/L). In January 2016, he presented with right facial weakness and CT head was reported as showing no acute intracranial abnormality. In late 2016, he was referred to ENT with hoarse voice; left hypoglossal and recurrent laryngeal nerve palsies were found. At this point, prolactin was 534,176 mU/L. Just before further endocrine review, he had a fall and CT head showed a basal skull mass invading the left petrous temporal bone. Pituitary MRI revealed a large enhancing mass within the sella infiltrating the clivus, extending into the left petrous apex and occipital condyle with involvement of the left Meckel’s cave, internal acoustic meatus, jugular foramen and hypoglossal canal. At that time, left abducens nerve palsy was also present. CT thorax/abdomen/pelvis excluded malignancy. Review of previous images suggested that this lesion had started becoming evident below the fossa in pituitary MRI of 2015. Temozolomide was initiated. After eight cycles, there is significant tumour reduction with prolactin 1565 mU/L and cranial nerve deficits have remained stable. Prolactinomas can manifest aggressive behaviour even decades after initial treatment highlighting the unpredictable clinical course they can demonstrate and the need for careful imaging review