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Background: The primary aim of Community Pharmacists’ participation in immunization is to contribute towards mitigating deaths associated with vaccine preventable diseases as well as expanding access to immunisation services. However, with the increasing Nigerian population, the global targets of reducing child mortality can significantly be achieved by periodically reviewing health systems performance to identify and address existing gaps. Objective: The general objective of the study is to identify the challenges encountered by Community Pharmacists in providing immunisation services in Calabar Metropolis of Cross River State. Method: A descriptive cross sectional study design was adopted for the study. Data were collected using a pre-tested semi-structured questionnaire from 68 community pharmacists which were selected using the purposive sampling technique. Data generated were synthesised and analysed using SPSS (version 20.0) and results were presented in frequency tables and charts. Fisher Exact test was used to test for association between variables at 0.05 alpha level. Results: Results showed that most community pharmacies have the resources to participate in immunization, only a few however had immunization administration record sheets 7(11.3%) and immunization record cards for patients 4 (6.5%). The finding also showed that lack of training 55 (88.7%); low awareness by the public of immunization services provided by the community pharmacist 44 (70.9%) and storage of vaccines 39 (62.9%) were the prominent perceived challenges to providing immunization in the community pharmacy. The association between lack of time (p =1.000, Fisher’s Exact test) and provision of immunization services was statistically not significant. Conclusion: Addressing identified challenges is pivotal to increasing and expanding accessibility and utilisation of immunisation services especially amongst the populace in resource limited settings.

To identify clinical parameters that are prognostic for improved overall survival (OS) after yttrium-90 radioembolization (RE) in patients with liver metastases from colorectal cancer (CRC).A total of 131 patients who underwent RE for liver metastases from CRC, treated at 2 academic centers, were reviewed. Twenty-one baseline pretreatment clinical factors were analyzed in relation to OS by the Kaplan-Meier method along with log-rank tests and univariate and multivariate Cox regression analyses.The median OS from first RE procedure was 10.7 months (95% confidence interval [CI], 9.4-12.7 months). Several pretreatment factors, including lower carcinoembryonic antigen (CEA; ≤20 ng/mL), lower aspartate transaminase (AST; ≤40 IU/L), neutrophil-lymphocyte ratio (NLR)5, and absence of extrahepatic disease at baseline were associated with significantly improved OS after RE, compared with high CEA (20 ng/mL), high AST (40 IU/L), NLR ≥5, and extrahepatic metastases (P values of.001,.001, .0001, and .04, respectively). On multivariate analysis, higher CEA, higher AST, NLR ≥5, extrahepatic disease, and larger volume of liver metastases remained independently associated with risk of death (hazard ratios of 1.63, 2.06, 2.22, 1.48, and 1.02, respectively).The prognosis of patients with metastases from CRC is impacted by a complex set of clinical parameters. This analysis of pretreatment factors identified lower AST, lower CEA, lower NLR, and lower tumor burden (intra- or extrahepatic) to be independently associated with higher survival after hepatic RE. Optimal selection of patients with CRC liver metastases may improve survival rates after administration of yttrium-90.

The Canadian supercritical water-cooled nuclear reactor (SCWR) is a 2540 MWth channel-type SCWR concept that employs 336 fuel channels in the reactor core. Each fuel channel includes a pressure tube that is submerged in a heavy water moderator and contains a removable fuel assembly. The fuel assembly is designed so that all in-core components exposed to high radiation fields (other than the pressure tube) are part of the fuel assembly, which is removed from the reactor core as part of the assembly after three operating cycles. This design feature significantly reduces the likelihood of component failures due to radiation damage. To achieve high (>45%) power conversion efficiency, the Canadian SCWR operates at a supercritical water pressure (25 MPa) and high temperatures (350 °C at the inlet, 625 °C at the outlet). These conditions lead to fuel cladding temperatures close to 800 °C. Because of the reduced material strength at this temperature and higher fission gas production of the fuel, collapsible fuel cladding is selected over internally pressurized cladding. To increase heat transfer and to reduce cladding temperatures, turbulence-inducing wire-wraps are employed on fuel elements. Numerical models have been developed to analyze the thermal-structural behavior of Canadian SCWR fuel at normal and accident conditions. It was found that axial ridging, a possible failure mechanism with collapsed fuel cladding, can be avoided if the cladding thickness is larger than 0.4 mm. Detailed numerical analysis showed that the maximum fuel cladding temperature for the worst-case accident scenario is below the melting point by a small margin. This result was obtained with conservative assumptions, suggesting that the actual margin is greater. Hence, one of the design goals, the exclusion of the possibility of melting of the fuel, which is called the “no-core-melt” concept, seems attainable. However, this needs to be demonstrated more rigorously by removing the conservative assumptions in the analysis and performing supporting experimental work. This paper presents a description of the Canadian SCWR fuel assembly concept, its unique features, the rationale used in the concept development and the results of various numerical analyses demonstrating the performance and characteristics of the Canadian SCWR fuel channel.

The January 1994 grounding and discharge of over 800,000 gallons (3,028,000 liters/3,028 m3) of low API gravity No. 6 oil from the tank barge Morris J. Berman at San Juan, Puerto Rico was one of those infrequent but typically major events that set in motion a massive skimming and shoreline cleanup operation. As these actions proceeded effectively along the northern coast of Puerto Rico, it quickly became apparent that significant quantities of oil from the Berman had submerged and continued to recontaminate economic, historic, and environmentally sensitive coastal areas after the leaking barge and floating oil had been removed. Recognizing the unique nature of the problem and general lack of Coast Guard or industry-wide experience in the emerging field of submerged oil recovery, the federal on-scene coordinator (FOSC) formed a group within the overall organization to respond to the situation. The methods implemented by this group recovered approximately 145,000 gallons of oil from the seabed at an estimated cost of $8 million.

Significant inconsistency of boundary lines delineating the jurisdiction of various federal, state, and local agencies unnecessarily complicates oil spill planning and response by increasing the number of stakeholders in these processes. Planning gaps also occur in border areas as agencies concentrate their attention on risks more central to their zones. Compounding these problems is the location of some boundaries that are drawn precisely where the risk of a big spill is highest. More consistent and closer alignment of federal boundary lines and responsibilities is needed nationwide to increase the efficiency and effectiveness of spill planning and response.