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Various factors, especially health status and income levels, have been viewed as the major factors impeding and/or promoting health service utilization. This research determined the extent to which a probability sample of Canadian senior citizens were correctly aware of the services provided by relevant health agencies and the extent to which income and health status factors were related to their use of those services. It was determined that awareness of health agencies influenced patterns of use more than other factors. Implications of the findings are discussed.

Health-service researchers, policy analysts, and politicians face several problems in attempting to evaluate health care programs and make relevant policy decisions. The possible rôle of social indicators is discussed in these regards and is applied in an important health care context, the utilization of ancillary health services by the elderly. A Western Canadian research study substantiates the academic and applied value of the social indicators approach with respect to health services planning, research, and policy decision-making.

This research suggests some social indicator candidates for families housed in multiple-family environments. Objective, subjective, and behavioral data sets are all represented in the analysis. This range of social statistics and the utilization of appropriate statistical analysis are viewed as necessary conditions for generating social indicators rather than simply relying on arbitrarily selected social statistics and assume they are indicators. Analysis of 1253 interviews in 88 Alberta subsidized housing projects reveals that subjective data from the tenant category of housing variables rank highest in accounting for present levels of user satisfaction and are viewed therefore as reasonable social indicators with respect to that issue.

The literature indicates the necessity for different levels of health service for various age cohorts among the elderly. The present study concerns the relationship between age cohorts and the use of community‐based ancillary health services in comparison with other enabling, predisposing, and health status factors. In a probability sample of Western Canadian older persons, three enabling variables were found to be most closely associated with the use of such health service, i.e., knowledge of health services, education, and monthly family income. Age differences among the elderly, a predisposing variable, were unrelated. Implications for the delivery of health services are discussed.

Proposed measures of autonomic nervous system functioning within an individual were reviewed. An important factor in the choice of such measures is the recognition that the magnitude response to stimulation is influenced, to a large extent, by the state of the individual prior to stimulation. From the point of view of informational content, there is little difference between the use of the magnitude change score and response level as the basic response datum when used in conjunction with the initial level. Consideration of the concept of the autonomic lability score as well as the mean response score reveals that neither measure adequately corrects nor compensates for the effect of prestimulus level. Several magnitude measures suggested for the comparison of individuals include the slope of the regression of change score on initial level, variability around this line, a measure of discriminability, and a measure of maximal reactivity. The temporal aspects of the autonomic response are discussed and, because of their lack of dependence on prestimulus level, two measures are extracted for each aspect—the mean and variability.

IDENTICAL twins afflicted with arthrogryposis multiplex congenita have never before been described in medical literature to our knowledge. In an excellent review article in 1951, James1 stated that two cases had never been reported in the same family. A recent report cited two sets of probably authentic identical twins, each of which consisted of one normal and one affected infant.2 On the basis of such observations, much speculation as to the etiology has been presented in the past. The knowledge that arthrogryposis multiplex congenita can occur in identical twins is therefore of importance and will be briefly discussed as it relates to etiologic considerations. REPORT OF A CASE Twin girls were born to a multiparous mother on Dec. 29, 1952, terminating an uncomplicated pregnancy. The first infant (R. E. R.) was delivered at 10:25 a. m. after a cephalic presentation. She weighed 2700 gm. and was normal except

IN A PREVIOUS paper1 a description was given of certain physical changes accompanying adolescence in girls. The value of such information to the pediatrician was discussed, with particular reference to the normal range of individual variation in sexual maturation. In the present study a similar report is made for boys.The general literature on adolescent bodily changes and various studies of female adolescence were cited in the earlier publication. In addition, a number of studies have dealt specifically with male adolescent development.2 These range from concise descriptions of developmental processes to broad discussions of the relation of sexual maturation to behavior in adolescence. MATERIALS AND METHODS The 59 boys reported on in this paper are, like the girls in the earlier study,1 regular participants in the long-term study of growth and development under way at the Fels Research Institute for the Study of Human Development.3 The

The human infant was stimulated repetitively with a standardized stimulus, thus setting a complex chain of central and peripheral receptors and effectors into motion.

THE PEDIATRICIAN, in serving his adolescent patients, can profitably employ a knowledge of the individual differences which exist in the processes of sexual maturation.1 A recent editorial in The Journal of the American Medical Association emphasized this fact, concluding, "The pediatrician is in a strategic position to aid developing adolescents in understanding and evaluating their own development."2It is certainly true that many of the psychologic tensions and inadequacies of the adolescent have a physical or physiologic basis, related to differentials which often exist in body size, sexual maturation and social or intellectual maturity.There are widely accepted behavior expectations for children of differing degrees of physical maturity.... The body parts and characteristics and functional properties do not mature evenly.... The appearance of the adolescent, sometimes will not be in harmony with his physiological maturity; a mature appearing adolescent may have a child's tolerance for tobacco or alcohol,

Infants are quieter, sleep more, and have lower heart rates when swaddled under the experimental conditions we employed.

Methodologic techniques described in a previous report were explored in a group of 16 newborn infants. Cardiacrate responses to a standard stimulus provided the data which were analyzed for purposes of differentiation of subjects.

Techniques are described that have been employed in interindividual and intraindividual comparisons of human infants in terms of autonomic nervous system function. With the use of cardiacrate observations as a model, particular emphasis is given to the analysis of data that are patterned and involve time sequences.

Vincristine sulfate and cyclophosphamide were administered concurrently to nine consecutive children with unresectable neuroblastomas. Objective tumor regression was observed in all nine children and complete remission was obtained in seven. The findings of this study indicate that the concurrent use of vincristine sulfate and cyclophosphamide can produce prolonged, symptom-free survival of some children with neuroblastomas. The findings also indicate that some unresectable neuroblastomas will respond to chemotherapy alone or chemotherapy followed by radiation therapy to an extent that allows complete surgical excision.

The relationship between the nonpregnant basal metabolic level and the basal metabolic gain during pregnancy was investigated in 158 women of the Fels Research Institute series.

The infants of a “normal” group of mothers were divided into two groups according to the basal metabolic rates of the mothers during the ninth month of pregnancy. A similar division was made on the basis of the mothers’ B.M.R. gain during pregnancy. In each instance the infants of the high B.M.R. group were compared with the low B.M.R. group in terms of birth weight and length, weight/length cubed index, and number of ossification centers present in the extremities of the left side (at one month), together with the gains in these categories during the first six months of life. Infants of mothers in the high ninth month B.M.R. group were larger and skeletally slightly more mature than infants in the low B.M.R. group. So were infants of mothers with high B.M.R. gains during pregnancy. Infants in both high groups weighed slightly more in relation to their lengths, than did the infants of the low groups. There was some tendency for the infants of the low groups to gain slightly more rapidly in weight, height and ossification during the first six months of life.

THE ANTIBIOTIC, dactinomycin, and the alkaloid, vincristine sulfate, have each produced objective tumor regression in children with a variety of malignant neoplasms.1 The best responses to dactinomycin have occurred in cases of Wilms' tumor and rhabdomyosarcoma, although tumor regression has occasionally been observed in children with lymphoma, neuroblastoma, and other neoplasms. The antitumor spectrum of vincristine sulfate has included lymphomas, Wilms' tumor, rhabdomyosarcoma, neuroblastoma, Ewing's sarcoma, retinoblastoma, and liposarcoma.Dactinomycin acts by binding the guanine moiety of deoxyribonucleic acid and thereby preventing the formation of the enzyme, ribonucleic acid polymerase.2 As a result, ribonucleic acid and protein synthesis are suppressed and cellular damage occurs. Although the specific mechanism of action of vincristine sulfate is unknown, it prevents cell division by interfering in some way with the formation of organization of the spindle tubules of the mitotic apparatus.3Since the limiting toxic effect of dactinomycin therapy is most

Silver nitrate irrigations after cystoscopic evacuation of clots stopped intractable hemorrhage from the bladder in 8 of 9 children who had received cyclophosphamide and/or pelvic irradiation for various malignant diseases. This method of management produces fewer adverse side effects yet : appears to be as effective as the more drastic measures of control, such as cystectomy or colocystoplasty.

Thoracoabdominal ectopia cordis is a rare congenital malformation usually associated with anterior diaphragmatic and pericardial defects, a short or bifid sternum, and intracardiac defects. Several techniques have been attempted for the correction of this anomaly. We report a patient with a large pericardial defect that was repaired with remnants of the omphalocele sac. The method is simple and effective, and should be considered as an alternative for the management of this disease.

TO THE EDITOR: —I have read with some interest the abstract of the article by Loewy and Placzek on this subject (The Journal, July 11, 1914, p. 203). I do not know how much this subject interests the medical profession, but I cannot allow a notice like this to pass without giving my views as a practical aviator.I have repeatedly flown at heights in excess of 4,000 meters (about 21/2 miles). When I won the Tri-State Race going from Boston to Nashua, N. H., to Worcester, Mass., to Providence, R. I., and back to Boston I flew at practically this height during the entire distance.I have always believed in high flying. I am convinced that it is far less dangerous than flying low. In the first place the vertical air-currents which annoy the aviator at low altitudes have no effect at great heights. The horizontal air-currents, corresponding to