The diagnostic criteria of Asperger's syndrome (AS), considered a part of the autistic spectrum disorder, are still unclear. A critical marker, which distinguishes AS from autism, is the presence of language. The ability of a child with AS to acquire and use language early results in the fact that AS usually is diagnosed much later than autism. Autism is not usually diagnosed until around the age of 3, whereas AS usually is not diagnosed until the child is 6 or 7 years of age. In the present article, using Eshkol-Wachman movement notation, we present evidence that abnormal movement patterns can be detected in AS in infancy. This finding suggests that AS can be diagnosed very early, independent of the presence of language. As shown earlier by us, almost all of the movement disturbances in autism can be interpreted as infantile reflexes ''gone astray''; i.e., some reflexes are not inhibited at the appropriate age in development, whereas others fail to appear when they should. This phenomenon appears to apply to AS as well. Based on preliminary results, a simple test using one such reflex is proposed for the early detection of a subgroup of children with AS or autism.

✓ Despite the fact that gout is a common metabolic disorder, because its involvement of the axial skeleton is rare the diagnosis is often delayed, even in patients with long-standing gout who present with neurological deficits. The authors report the case of a woman with a history of extensive gout, emphasizing the clinical, radiological, and pathological features of a lumbar spinal stenosis.

No abstract

This study identified and characterized the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic through a retrospective electronic medical record review of 7422 well-child visits in 2016. Diagnosis and treatment were analyzed by patient's weight diagnosis, sex, age, and provider training level. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietitian or pediatric obesity weight management program. Increased provider training level was associated with a lower adherence to pediatric obesity guidelines. Strategic modifications to electronic medical records that automatically offer body mass index-associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.

The impact of the metal bearing seal on rolling cutter bit performance at high rotary speeds has been dramatic. In the high-cost drilling environment of the North Sea, the metal sealed bit has proven its ability to extend rolling cutter bearing life at high rotary speed and thereby provide significant reductions in drilling costs. Thisimprovement is encouraging more widespread use of these bits with downhole motors and steerable systems.An analysis of recent run data from the Norwegian sector of the North Sea shows metal sealed rolling cutter bits can be used for a much greater number of bit revolutions than their elastomer seal counterparts and, consequently, footage per bit has more than doubled without sacrificing rate of penetration. Cost savings of up to $100,000 per well have been documented. This paper describes the design of the metal sealed bit and its performance in the Ekofisk and Eldfisk fields.

This paper describes an analytical procedure for forecasting the life expectancy of rock-bit journal bearings. Actual performance data and reliability analyses are used to establish empirical relationships and a graphic procedure that relates the risk of bearing failure to operating parameters and drilling cost.

Reliability functions derived from field performance data are used to measure the effectiveness of a new rock bit bearing seal. The new seal is a metal face seal and its performance is compared to the standard O-ring seal. The results show a significant increase in bit life measured in cone revolutions under typical operating conditions. This increase in cone revolutions may be utilized to increase rotating time, rotary speed or both. An example comparing various alternatives is provided. Data are also provided which show a much improved tolerance to high bottom hole temperatures. Introduction Each of the three sections in today's journal bearing "Tricone" rock bit is a four element system consisting of the cutting structure or teeth, the bearing, the bearing seal and the bearing lubrication system. Failure of any one of these elements constitutes a terminal event. As a result, the system is termed a serial system and the overall reliability is the product of the reliabilities of the individual elements. To judge the effectiveness of a change in one of these four elements, it is most desirable to change only the element under consideration, or conduct the comparison so variations in the reliability of the other elements do not influence the outcome. This paper describes such an evaluation for a new bearing seal. Reliability functions with the new seal and its predecessor are derived from field performance data and are used to judge the effectiveness of the new seal in terms of operating parameters and drilling time. Limited data showing the heat tolerance of the new seal are also presented. SEAL DESIGNS The new seal design 3 and its predecessor 4 are illustrated in Figures 1 and 2 and the location of the seal in an assembled bit is shown in Home 3. The predecessor is an O-ring seal which is squeezed between the rotating cone and stationary head bearing. With this arrangement, the O-ring is always experiencing wear at one of the two contact surfaces and the surfaces are being worn as well. Eventually, this either by itself or in combination with bearing wear will allow mud to enter the bearing and cause bearing failure. The new seal is a metal face seal in which two metal rings are supported and held in contact by compressed O-ring energizers. A dynamic seal is maintained between the contacting faces of the metal rings while the energizers form static seals between the rings, cone and journal. The perceived advantages of the new seal were increased wear resistance and higher heat tolerance. These would result in longer bit life or allow the use of higher rotary speeds to achieve faster penetration rates. SEAL LIFE COMPARISON To measure the effectiveness of the new seal under typical service conditions, the performance of bits equipped with two variations of the new seal was compared to the performance of O-ring sealed bits along the Gulf Coast in a region extending from Brazoria County, Texas, to Mobile County, Alabama. All bits were 121/4" diameter API 517 bits produced by a single manufacturer. Bearing dimensions and metallurgy as well as lubricant were essentially identical. The only significant variation between the O-ring and metal seal bits was a slight reduction in bearing length to accommodate the greater length of the metal seal package. The only significant variation between the two metal seal versions was the metallurgy of the metal rings. Because O-ring seals are adversely effected by excessive heat the comparison was limited to bit runs where formation temperatures were between 200deg.F and 300deg.F. Performance data for the three groups of bits are listed in Tables 1, 2 and 3 and summarized in Figure 4. Although Figure 4 implies improved performance with metal face seals, it does not provide a very clear indication of the advantage to be expected for a particular application. Reliability functions derived from the performance data provide a better picture. P. 79^

Recent research from psychological, psychiatric and social viewpoints has emphasized the importance to the whole community of the aged population, and has stressed in particular that the changing proportion of aged to working populations is bringing with it problems of great urgency.