Shock chemistry in the molecular clouds associated with SNR IC 443.

Several interstellar molecules have been detected toward the highly perturbed B and G clouds associated with the supernova remnant IC 443 via their 3 mm transitions, including N2H+, SiO, SO, CN, HNC, and H13CO+. The (J, K) = (1, 1) and (2, 2) inversion lines of metastable ammonia have also been observed, as well as the J = 3-2 transition of HCO+ at 1.2 mm. Analysis of the (1, 1) and (2, 2) inversion lines of NH3 indicates minimum gas kinetic temperatures of TK = 70 K toward cloud B, and TK = 33 K in cloud G. Modeling of the J = 1-0 and J = 3-2 transitions of HCO+ implies densities greater than 10(5) cm-3 toward both positions. These data clearly show that hot and dense material is present in IC 443, and they suggest the presence of shocks in both regions. A careful analysis of the HCO+ lines indicates that the HCO+ abundance is at most enhanced by factors of a few over that found in cold, quiescent gas. This conclusion contradicts past claims of HCO+ abundance enhancements of several orders of magnitude in the perturbed regions. The N2H+ abundance was also found to be similar to that in cold gas, suggesting that there is no increase in ionization in the clouds. The abundances of SO and CS, as well as CN and NH3, do not appear to differ significantly from those found in cold dark clouds, although chemistry models predict sulfur-containing species to undergo high-temperature enhancements. SiO, however, is found to have an abundance in the perturbed gas 100 times larger than the upper limits observed in the dark cloud TMC 1, a result in agreement with high temperature chemistry models. In addition, the HNC/HCN ratio in both IC 443 B and G was found to be approximately 0.1--far from the ratio of 1 predicted by low-temperature ion-molecule chemistry, but similar to the values observed in clouds where elevated temperatures are present.

The frequency of sexual problems among family practice patients.

Two hundred-twelve patients attending a family practice center participated in a questionnaire study of their sexual identity and function. Using conservative definitions of problems, 75% were identified as having at least one specific sexual problem area. Most of these problems were functional in nature and involved desire, arousal, or orgasm. While the frequency of sexual problems was high in both sexes among all age groups, identity problems were primarily seen among the young, and desire problems among older adults. The prevalence rate of reporting sexual problems did not differ significantly by sex. However, females reported more specific sexual problems than males. Only 26% of the subjects summarized their overall sexual lives as problematic and the vast majority of patients thought their family physicians were able to help with such problems. This study reaffirms the high prevalence of sexual disorders in the population. Given adequate training, family physicians may be the ideal providers of assistance for these problems.

Search for molecular oxygen in dense interstellar clouds.

We have carried out a search for the 234 GHz N = 2 --> 0, J = 1 --> 1 transition of 16O18O using the 13.7 m FCRAO radio telescope. No emission was detected toward six giant molecular clouds. Observations of the 220 GHz J = 2 --> 1 transition of C18O yield column densities for this species 1-3 x 10(16) cm-2; the resulting limits on the [O2]/[CO] ratio lie between <0.5 and <4. According to various chemical models, the ratio of molecular oxygen to carbon monoxide is primarily sensitive to the age of a cloud and to its carbon to oxygen ratio. For ages exceeding 3 x 10(6) yr and total carbon-to-oxygen ratio < 1, [O2]/[CO] can approach unity. Our best limits can be interpreted as indicating that the observed clouds are not chemically "mature" or that [carbon]/[oxygen] > 1. However, significant exploitation of molecular oxygen as a tracer of cloud structure and evolution will require more sensitive observations, which may be best carried out from above Earth's atmosphere.

Epidemiology and ethics of coronary artery bypass surgery in an eastern county.

Despite an extensive literature on coronary artery bypass grafting (CABG) surgery in the last decade, relatively little has been written on the demographic or socioeconomic characteristics of patients who receive this limited medical resource. In the present study data were collected on all patients (N = 539) who received this procedure over a one-year period (July 1977 to June 1978) within Erie County in western New York. Using available census tract data, age-sex adjusted surgery rates by socioeconomic status are developed for defined geographic areas. Patients residing in the city of Buffalo and those from census tracts in the lowest quartile of median family income have dramatically lower surgery rates than do others in the county (P less than .001). Although these discrepancies in CABG surgery rates may be partially explained by differing incidence rates of the medical indications for CABG surgery, problems of access to the service may be operative. Three different principles of distributive justice (equality, liberty, and utility) are discussed in an attempt to see how they might be applicable to the pattern documented.

Medical students from natural science and nonscience undergraduate backgrounds. Similar academic performance and residency selection.

The majority of matriculating US medical students continue to major in the natural sciences as college undergraduates in the belief that this will enhance their chances of admission to and their performance in medical school. The present study compared the academic performance and residency selection of natural science and nonscience majors in three separate medical school classes at the State University of New York at Buffalo. Statistical analysis of grades in the first two years of medical school, clinical performance in the third year, and part I and part II National Board Medical Examination scores revealed no significant differences across three class replications. Residency selection among graduating seniors was also independent of undergraduate major. It is suggested that admissions committees, premedical advisors, and students reconsider their attitudes about the necessity of concentration in the natural sciences before entering medical school.

Family medicine and medical ethics--a natural and necessary union.

Since many ethical dilemmas in the practice of medicine involve cases associated with tertiary care, primary care providers may feel removed from these kinds of problems. Family medicine, committed to an intellectual synergism with a variety of non-biomedical disciplines as well as being a "specialty in breadth" should develop a strong bond with medical ethics. Because of their ongoing relationships with patients and subsequent knowledge of their value systems, family physicians can provide leadership in guiding ethical decision making in intensive care settings. In addition, since a significant number of ethical dilemmas in medicine involve common problems, family physicians may be more sensitive to and feel more comfortable with this aspect of medical practice. Some family practice residency programs have begun to provide educational experiences in medical ethics for their trainees. Although the evaluation methodology for this aspect of training is not fully developed, it seems clear that residency programs should give additional attention to these areas in planning their curricula.

Alternatives to defensive medicine.

The ethics of defensive medicine, as distinguished from unnecessary testing for reasons other than fear of malpractice suits, and the usefulness its practice affords the physician in court are sharply questioned. Physicians, patients, and society are all adversely affected by its practice. Alternatives are recommended that physicians and organized medicine can employ to minimize malpractice problems.

Managing the options of informed consent.

The principle of informed consent involves the changing nature of the physician-patient relationship, decisions as to the amount of information that should be given to a patient, and analysis of the meaning of the term "freely given consent". Discussion of these issues leads into practical suggestions for developing manageable office and hospital policies that allow physicians to take advantage of new cooperative relationships.