Foothill Family Clinic

Foot drop, leg pain, changes in gait, and the appearance of a new rash signaled unusual and alarming side effects of a medication the patient had been taking for a decade.

In the development of pediatric A/H1N1 influenza vaccines, this study was performed to identify antigen and adjuvant doses providing optimal immunogenicity and antibody persistence to ensure long-term immunity after immunization with an adjuvanted A/H1N1 vaccine in children 3 to <9 years of age.Healthy children (N = 1357) were immunized with 1 of 8 investigational vaccine formulations ranging in antigen (3.75-30 µg) and MF59 adjuvant (Novartis Vaccines, Marburg, Germany; 0, 50 and 100% of standard dose). Each participant received 2 vaccine doses given 3 weeks apart. Immunogenicity was analyzed by hemagglutination inhibition assay in sera drawn 3, 4 and 6 weeks after first vaccination. Long-term antibody persistence was assessed 6 and 12 months after immunization. Vaccine safety was monitored throughout the study.All MF59-adjuvanted vaccines were well tolerated and highly immunogenic, with adjuvanted formulations inducing antibody titers statistically superior to those of the nonadjuvanted vaccines. Each MF59-adjuvanted vaccine met all the US and European licensure criteria for influenza vaccines 3 weeks after the administration of a single dose; all nonadjuvanted formulations failed to meet licensure criteria at this time point. Antibody titers in response to a single vaccination with 7.5 µg antigen and a full dose of MF59 continued to meet all US and European licensure criteria up to 1 year after immunization.A single dose of vaccine containing 7.5 µg A/California/7/2009 (H1N1) antigen and a full dose of MF59 adjuvant was found to be optimal for children 3 to <9 years of age.

Attitudes toward exercise during pregnancy have changed dramatically over the past 20 years. Recent studies show that, in most cases, exercise is safe for both the mother and fetus during pregnancy, and support the recommendation to initiate or continue exercise in most pregnancies. This report discusses the rationale behind the changes, and offers educational tools that may be employed to initiate behavioral change. We also propose exercise prescriptions for pregnant women who are sedentary, physically active, and competitive athletes. Armed with this information, the practitioner will be better equipped to counsel patients and incorporate a discussion on physical activity into prenatal visits.

Objective and Study Design: This multicentre, randomised, double-blind clinical trial compared the clinical and bacteriological efficacy and safety of cefuroxime axetil and amoxicillin/clavulanic acid in the treatment of secondary bacterial infections of acute bronchitis (SBIAB).

ABSTRACT Fracture control of high toughness steels requires both crack initiation and propagation control. In ductile materials, crack propagation resistance plays a key role, but this quality is not readily definable by any of the existing testing standards. Liebowitz, Eftis et a1 proposed a comprehensive theoretical treatment applicable to ductile fracture. This was applied to a set of COD test data obtained from welds in high strength pipeline steels. Although more experimental work is required, the correlation between the COD results and the L-E analysis is excellent. This type of analysis may provide a basis for significant insight into ductile fracture toughness evaluation. INTRODUCTION Fracture control is a vital design consideration in offshore structural engineering. The high toughness steels now available for the construction of critical engineering components are significantly safer against a catastrophic or unexpected failure than the strong, but brittle, steels of the past. Nevertheless, the basic criteria embodied in a "leak-before break" concept of fracture control are not yet a practical reality available to design engineers. This is because of the lack of a quantitative ductile fracture control parameter equivalent to KIC ' a toughness parameter from the theory of linear elastic fracture mechanics. The complete fracture process in ductile materials involves two separate stages; crack initiation and slow stable growth before point of instability is reached. Therefore, It is insufficient to characterize fracture behaviour in terms of a single parameter such as KIC which relates primarily to crack initiation resistance. What is required is an analytical method to characterize resistance of materials to a slowly advancing crack. However, studies in this field are generally limited to the analysis of the elastic-plastic stress fields around a crack, which are difficult to apply to practical testing requirements. Presently, there are two recognized testing standards fore ductile fracture toughness evaluation the J IC Test(1) and the Crack (Tip) Opening Displacement Test2. Both of them, however, attempt to characterize ductile fracture events under static loading by simple parameters which are related primarily to crack initiation resistance. Conceptually and analytically, neither method is capable of incorporating the subcritica1 crack growth in the measured fracture toughness parameter. In this paper, evidence is presented to show that the existing fracture toughness testing methodology and the results obtained there from, can be analyzed to obtain more pertinent information regarding the ductile fracture behaviour of welded joints. This analysis is accomplished by applying a theory proposed by Liebowitz and Eftis(3-7) which includes a fracture parameter to account for the energy contribution resulting from subcritical crack growth. MATERIALS AND TEST PROCEDURES Spiral welded samples of the X-70 grade linepipe steel were subjected to weld toughness evaluation by COD testing. The chemical composition and the mechanical properties of the six test pipes are listed in Tables 1 and 2. Rough cut sections containing the weld seam were flame cut from each of the six test pipes, straightened, machined and ground flat.