Neverthe- less safe 200 mg doxycycline antibiotics quiz, the docking and scoring could still be used to prioritize in silico screening hits of a chemical database purchase 100 mg doxycycline with visa bacterial joint pain. Although the individual programs only showed mediocre per- formance, pooling and rescoring of all solutions improved the prediction accuracy significantly. Binding mode predictions were strongly improved by including either crystal or predicted water, and even with higher deviation from the reference crystal structure, correct prediction of the site of catalysis was still possible. Because of limited timescales of simulations, results can remain dependent on the starting conformations. The state of the art is to solvate the simulated system in explicit water in a periodic box, which although computationally more expensive than continuum solvent or limited solvation schemes, avoids many of the possible pitfalls associated with them. Furthermore, several methodological develop- ments to increase the efficiency of simulations of proteins (and ligand) in water are coming available (103,104). Various analysis methods are available to estimate statistics of ligand binding and orientation and energies of ligand-pro- tein interactions or free energies of binding (105). The experimentally known preference for subterminal, distal hydroxylation of octane, octanoic acid, and lauric acid are thus reproduced. As shown in Table 1, applications for homology model optimization and vali- dation of model stability and the prediction of sites of catalysis in substrates are becoming common practice. For a proper description of ligand dynamics and conformational changes in the enzyme, simulation times exceeding hundreds of nanoseconds may well be needed. Apart from the application of in vitro tools, this necessitates the application of in silico tools that can accurately rationalize and predict metabolic properties and prod- ucts of drug candidates already in early stages of the lead finding and opti- mization process. Generally speaking, it is clear that computational approaches in parallel with high(er) throughput experimental technologies are among the newer and fastest developing approaches in drug discovery, drug metabolism, and toxi- cology. New links with other current developments, such as in neural network computing, genomics, proteomics, and bioinformatics, are within reach, and successful exploitation of these links will allow significant progress toward in silico prediction of drug activity, drug metabolism, and toxicity. Furthermore, in general, a better understanding of the key issues in drug activity should be developed. Indications of substrate selectivity can be obtained qual- itatively on the basis of homology models, although these predictions should always be experimentally verified and critically considered as well. Moreover, addition of water bound at specific (experimentally derived or predicted) loca- tions in the active sites is the topic of current investigations (71,99) and is expected to significantly improve the quality of docking results. Another important factor is the existence of substrate-bound crystal structures where the substrate apparently is not in a catalytically active position with respect to the heme iron. This indicates the importance of the kinetics and dynamics of sub- strate binding and oxygen binding and reduction. This makes statistical considerations like relative weights of different binding modes crucial and in addition increases the flexibility of ligands within each binding mode. Energetic consideration of detailed ligand-protein interactions gives insight in the (relative) importance of different sites of interaction between the ligand and the protein. Finally, the inclusion of explicit water molecules into the active site allows the elucidation of the (mediating) role of water in ligand binding. Furthermore, the use of homology modeling methods to enrich X-ray crystallographical structures with other experimental data, e. Recent development and application of virtual screening in drug discovery: an overview. Common and uncommon cytochrome P450 reactions related to metabolism and chemical toxicity. Structure and function of cytochromes P450: a comparative analysis of three crystal structures. Enantioselective substrate binding in a monooxygenase protein model by molecular dynamics and docking. Crystal structure of cytochrome P-450cam complexed with the (1S)-camphor enantiomer. Crystal structures of ligand complexes of P450eryF exhibiting homotropic cooperativity. Automated multiple analysis of protein structures: application to homology modeling of cytochromes P450. A preliminary 3D model for cytochrome P450 2D6 constructed by homology model building. A three-dimensional protein model for human cytochrome P450 2D6 based on the crystal structures of P450 101, P450 102, and P450 108. Evidence that aspartic acid 301 is a critical substrate-contact residue in the active site of cytochrome P450 2D6. Mutations that alter aggregation, phospholipid dependence of catalysis, and membrane binding. Impact of incorporating the 2C5 crystal structure into comparative models of cytochrome P450 2D6. Residues glutamate 216 and aspartate 301 are key determinants of substrate specificity and product regiose- lectivity in cytochrome P450 2D6. Phe120 contributes to the regiospecificity of cytochrome P450 2D6: mutation leads to the formation of a novel dextro- methorphan metabolite. Influence of phenylalanine 120 on cytochrome P450 2D6 catalytic selectivity and regiospecificity: crucial role in 7-methoxy-4-(aminomethyl)-coumarin metabolism. Mammalian microsomal cytochrome P450 monooxygenase: structural adaptations for membrane binding and functional diversity. Ketoconazole-induced conforma- tional changes in the active site of cytochrome P450eryF. Automated docking using a Lamarckian genetic algorithm and an empirical binding free energy function. ConsDock: a new program for the consensus analysis of protein- ligand interactions. Binding mode prediction of cytochrome p450 and thymidine kinase protein-ligand complexes by consideration of water and rescoring in automated docking. Multiple hydrogen-bonding features of water molecules in mediating protein-ligand interactions. Principles of docking: an overview of search algorithms and a guide to scoring functions. Enhanced docking with the mining minima optimizer: acceleration and side-chain flexibility. Sensitivity of molecular docking to induced fit effects in influenza virus neuraminidase. Combined three-dimensional quantitative structure-activity relationship analysis of cytochrome P450 2B6 substrates and protein homology modeling. Computer-assisted, structure-based prediction of substrates for cytochrome P450 (Cam). Substrate docking algorithms and pre- diction of the substrate specificity of cytochrome P450(cam) and its L244A mutant.

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No increase in mal- formations in offspring of rats treated with this agent in doses up to 12 times that used in humans was found by another group of investigators (Maren and Ellison purchase doxycycline in india infection diarrhea, 1972) doxycycline 200 mg line treatment for uti of dogs. Birth defects were not increased in frequency among offspring of more than 200 women who received this diuretic in early pregnancy (Heinonen et al. Neonatal throm- bocytopenia was observed with hydrochlorothiazide, as with other thiazide diuretics (Rodriguez et al. Hydrochlorothiazide was not teratogenic in the offspring of rats who received this agent in doses many times that of the human adult dose (George et al. It is reasonable to assume that the potential risks of this diuretic are similar to those of other thiazides. For example, the Collaborative Perinatal Project database included only three women treated with methyclothiazide (Aquatensen, Enduran), 10 women treated with polythi- azide (Renese), and only two women treated with trichlormethiazide (Metahydrin, Naqua, Trichlorex) in the first 4 months of pregnancy (Heinonen et al. There are no available animal teratology studies with these three thiazide diuretics. Nonetheless, based upon information for a closely related and better-studied drug, chlorothiazide, it is reasonable to state that the risk of birth defects with these drugs is low, if it exceeds background risk. Other thiazide-like diuretics Chlorthalidone (Hygroton, Thalitone), metolazone (Diulo, Zaroxolyn), and quinetha- zone (Hydromox) are not true thiazide diuretics from the standpoint of chemical struc- ture, although their mode of action is very similar to the thiazide group. There is little available information regarding the use of chlorthalidone in women in the first trimester of pregnancy. Over 1300 women who used thiazide diuretics were included in the Collaborative Perinatal Project database, but only 20 used chlorthalidone during the first trimester (Heinonen et al. Although there was an increased frequency of congenital dislocation of the hip in this latter group, it is difficult if not impossible to draw valid conclusions from such numbers. Tervila and Vartianen (1971) reported no significant differences in offspring of mothers exposed to chlorthalidone after 15 weeks gestation, compared to controls. Only eight pregnant women were exposed to quinethi- azone in the Collaborative Perinatal Project database, and none who received metola- zone (Heinonen et al. No published reports are available on congenital anom- alies in the offspring of women who took either of these two diuretics during pregnancy. Nifedipine Nifedipine was used ‘off-label’ as a tocolytic agent and an antihypertensive medication. Nifedipine was teratogenic in rats given 30 times the usual human dose (data from the manufacturer’s insert). No adverse maternal or fetal effects were reported for the use of nifedip- ine to treat preeclapmsia or hypertension, respectively (Sibai et al. The frequency 66 Cardiovascular drugs during pregnancy of congenital anomlies was not increased among 64 infants born to women treated with nifedipine (or a related calcium channel blocker) (Magee et al. Nifedipine use during pregnancy is probably safe with ‘little teratogenic or fetotoxic potential’ (Childress and Katz, 1994). Nicardipine Treatment of hypertension in pregnancy with nicardipine was more effective than meto- prolol in decreasing blood pressure, and neonatal outcomes were not different (Jannet et al. One study of 40 pregnant women with hypertension reported that intra- venous nicardipine ‘seems to be safe’ (Carbonne et al. Nicardipine was not teratogenic in rats given an oral dose many times the recommended human dose (Sato et al. Isradipine Isradipine, a dihydropyridine calcium channel blocker, is used as an antihypertensive agent. Isradipine was not teratogenic in rats given several times the human dose (data from the manufacturer’s insert). This calcium channel blocker was evaluated for the treatment of hypertension in pregnancy and reported to be effective for the treatment of nonproteinuric hypertension. Diltiazem, nimodipine, and amlodipine There is little information regarding the use of these calcium channel blockers during pregnancy. First trimester exposures do not seem to present a significant risk for congenital anomalies, but this is an unknown area. No epi- demiological studies of this antihypertensive agent in pregnant women have been pub- lished. There were no malformations among 22 infants born to mothers who received captopril during the first trimester (Kreft-Jais and Boutroy, 1988), but no controlled stud- ies have addressed whether or not captopril is a potent human teratogen. Of 29 infants with neonatal renal failure, nine were born to women who had used captopril throughout pregnancy (Rosa and Bosco, 1991). These antihypertensives are, therefore, contraindicated for use during pregnancy, and should be avoided if possible. No animal teratology studies have been published for captopril, but an increased frequency of fetal deaths was reported in two animal studies (Pipkin et al. Of 29 cases of perinatal renal failure, 18 occurred follow- ing maternal therapy with enalapril during pregnancy (Rosa and Bosco, 1991). Among 29 infants with neonatal renal failure, two were born to women who used lisinopril during pregnancy (Rosa and Bosco, 1991). The risk of congen- ital anomalies following use during the first trimester is unknown, but use during the Special considerations 69 second and third trimesters is associated with a significant risk of fetal-neonatal compli- cations. The complications include: oligohydramnios, fetal/neonatal renal failure, and decreased calcification of the cranium (Friedman and Polifka, 2006). Cardiac arrhythmias Fortunately, life-threatening cardiac arrhythmias are uncommon during pregnancy. However, certain less serious arrhythmias may actually be increased in frequency during pregnancy (Brown and Wendel, 1989). Paroxysomal supraventricular tachycardia Paroxysmal supraventricular tachycardia occurs among 1–2 per 500 young women, and frequently occurs in those without overt heart disease (Brown and Wendel, 1989). Pregnancy may increase risk for this type of arrhythmia (Meller and Goldman, 1982; Szekely and Snaith, 1953). If vagal stim- ulation is unsuccessful, verapamil at 5–10 mg intravenously will prove successful in most cases in pregnant women. Recently adenosine, in a dose of 6 mg given as a rapid intravenous bolus, has been recommended for the treatment of supraventricular tachycardia. As previously mentioned, there is little information regarding the safety of this agent during pregnancy. However, there are several reports regarding its efficacy in pregnant women (Afridi et al. Electrical cardioversion should be reserved for patients with cardiac decompensation in whom medical therapy has failed. Patients with frequent recurrences of this arrhythmia can usually be treated with dig- italis and/or verapamil, quinidine, and propranolol as needed (Brown and Wendel, 1989; Zipes, 1988). Atrial fibrillation Atrial fibrillation is uncommon in pregnant women, and this event points to underlying cardiac or thyroid disease. Mitral valve disease, secondary to rheumatic heart disease, is the most commonly encountered underlying cause of atrial fibrillation in the pregnant patient.

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As an external application discount doxycycline 200mg visa antibiotics safe for dogs, to cuts generic doxycycline 100mg with amex virus going around now, bruises, lacerations, and sores, arnica has long been a popular domestic remedy. It undoubtedly assists in carrying off the broken down tissue, which results from the traumatism, and promotes rapid repair. I have observed its influence to be greatly facilitated by combining it with a nutritional substance. In cases where the muscles beneath the skin were severely lacerated, torn and bruised, I have applied one part of arnica with five parts of warm fresh sweet milk, keeping the application warm, covered with a protective dressing, and renewed every two or three hours. It is incredible how rapidly the restoration will take place under these circumstances. In debilitated conditions, where there are old sores of long standing or cold abscesses, this agent may be applied in conjunction with bovinine and will accomplish excellent results. It is desirable that the agent should be studied more thoroughly, in the line of its internal use, in surgical fevers with shock, and in conjunction with external applications after general bruising and laceration, and in extreme cases of adynamia. When there are circumscribed sore spots in the muscular structures of the body—hyperesthetic areas—without apparent cause, this agent is indicated. Nearly soluble in cold water, soluble in 250 parts of boiling water, and in forty parts of alcohol. Physiological Action—Five grains of santonine given to a child caused pain in the stomach, convulsions, insensibility and death. Various phenomena are produced by even smaller doses, as everything appearing yellow or red throughout the field of vision; urine stained deep yellow; a punctiform rash or an eruption like that in measles; amaurosis, flushed face, hot head, twitching of the eyeballs, dilatation of the pupils, foaming at the mouth, clenching of the teeth, jerking of the arms, stertorous breathing. Generally, recovery takes place after these symptoms, but occasionally death follows. Specific Symptomatology—The following indications, seldom all present at the same time, point to the presence of lumbricoid worms in the alimentary canal. They may also be present in part, induced by various other causes of intestinal irritation. There may be intense itching of the nose in children, the child rubbing or boring the nostrils, with bloated abdomen, restless sleep, crying out in affright, grinding of the teeth at night, groaning in sleep, complete loss of appetite, tongue deep red without coating, deficient saliva, nausea, vomiting, fetid breath depraved, erratic appetite with longings, great thirst, aversion to food, abdomen enlarged and hard, diarrhea with whitish, slimy stools, or bowels constipated followed by looseness, colicky pains in the bowels, vomiting and purging after meals, worms discharged with the stools, cramps in the Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 52 bowels at night, itching at the arms, limbs wasted, face pale, skin sallow and unhealthy looking, constant urging to urinate, wetting the bed, urine whitish and cloudy, scalding, dry, hacking, constant cough, tickling in the larynx and trachea, convulsive movements of the hands and arms, sensitiveness to the touch over the whole body, twitching of the muscles, lividity of the face, arrested breath, severe choking sensations, convulsive contraction of the fingers, general convulsions with violent agitation of the limbs, chorea, haziness of sight, loss of consciousness, restlessness, not satisfied with anything, will not sleep, fever occurring daily, usually in the afternoon. Therapy—The generally accepted influence of santonine is in the line of its anthelmintic properties. In the above symptomatology, however, I have named a long list of symptoms, which are due to intestinal or gastro- intestinal irritation. Many of these symptoms should be treated with santonin, without regard to the presence of worms. In fact, if we properly study this remedy, we must put aside entirely the idea of its anthelmintic properties, and consider it as a nerve sedative, as an antispasmodic and as a positive and reliable agent with which to relieve, nerve irritations, especially those of a reflex character. I have made some very conclusive observations in the past fifteen years that convince me that this remedy is the best remedy we have with which to relieve reflex irritation, when the cause of the irritation cannot be at once determined. I was once treating a child who suffered from all the symptoms of nerve irritation which are present with worms. Santonin relieved the nervous irritation in a most satisfactory manner, but subsequent observation proved that there were no worms present, but that the irritation was due to faulty digestion and decomposition of food. I was at once impressed that the agent had relieved the irritation by its influence upon the nervous system, independent of any action it might have had upon the worms. From this observation, I began at once to administer it in all cases where there was reflex irritation. I was consulted concerning a child seven months old, who had a persistent hacking cough from its birth, which resisted all treatment. I allayed the cough in twenty-four hours with half grain doses of santonin, and the cure was permanent. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 53 I was consulted concerning an irritable heart in an old lady, who was so enfeebled from the violent and irregular action of the organ that she had not been able to do anything whatever for over two years. The heart disorder did not seem to be sufficient to cause the extreme weakness, and I treated it with santonin, as a case of reflex irritation. The patient was around the house and assisting with the work within less than a week. A physician reported a case to me that was suffering from persistent protracted fever, with nervous phenomena, that showed it to be of reflex origin, as all other causes were excluded in the examination. After all known methods had failed, three doses of santonine, one grain each, reduced the temperature almost to normal, and that agent alone caused the permanent abatement of the fever. I advise with full assurance of satisfactory results, that this remedy be used freely in the treatment of reflex irritations. From one-half a grain to a grain and a half in an extreme case, will, I think, be sufficient. I would suggest that it be carefully used in the reflex irritations of pregnancy, especially when there is scanty urine, or when there is deficiency of renal action, with much local irritation. I am confident that it will do much towards preventing puerperal convulsions if given early. I think there are some cases of the vomiting of pregnancy that will be quickly allayed by it. I advise that it be given in hysterical conditions, and in those difficulties where there is irritation of the ovaries and irritation at the menstrual epoch, especially if accompanied with some pain. Lydston advised the use of this remedy in large doses in the treatment of epilepsy. Its antispasmodic properties would suggest that it be used in cases where the spasms are due to reflex irritation; whether it possesses sufficient antispasmodic properties to control spasm, as gelsemium, chloral and other agents of that character do, remains to be proven. Santonine at times is a positive remedy with which to increase the secretion of urine in children. It gently stimulates the functional action of the organs, promotes normal secretion and relieves irritation. It is without doubt, our best remedy with which to restore the secretion in post Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 54 scarlatinal or post diphtheritic nephritis. In conjunction with a persistent application of heat, it will be found useful in post puerperal nephritis, of an acute character, and probably in other cases, where sudden suppression has resulted from profound sepsis. Where we find colic with loose, slimy stools, it points to intestinal disorders, while convulsive movements are reflex symptoms, consequent upon the intestinal disease. Santonine influences these conditions by stimulating the great sympathetic and giving tone to the functions of digestion and nutrition. It has been employed with advantage in nervous failure of sight, nervous vomiting and nervous diarrhea; but it is doubtful whether it has ever improved the sight in amaurosis or cataract, as has been claimed. Santonine causes yellow vision and yellow urine, Where worms are demonstrated to exist in the bowels, it is a common practice to give santonine with a cathartic of podophyllin, or follow it with castor oil. The agent is toxic, as stated, and should not be given in material doses for the special purpose of destroying worms, when the child is constipated or suffering from fever. He gives it alone when he needs to restore the menses, and says he needs nothing with it. For young girls with their early menstruation and in cases of painful menstruation, he uses an infusion of the fresh root and expects to get satisfactory results. He takes one ounce of the root and lets it steep slowly for one hour in a pint of water and sweetens it. He takes from five to ten drops of the fluid extract to a cupful of hot sweetened water and gives this every half hour or every one or two hours as the patient needs.

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Such methods will be necessary doxycycline 100mg line antibiotics for sinus infection while breastfeeding, however generic doxycycline 100mg on line antibiotic prescribing guidelines, if it is required to 315 predict one measurement from the other - this is nearer to calibration and is not the problem we have been addressing in this paper. The majority of medical method comparison studies seem to be carried out without the benefit of professional statistical expertise. Because virtually all introductory courses and textbooks in statistics are method-based rather than problem-based, the non-statistician will search in vain for a description of how to proceed with studies of this nature. It may be that, as a consequence, textbooks are scanned for the most similar-looking problem, which is undoubtedly correlation. Correlation is the most commonly used method, which may be one reason for so few studies involving replication, since simple correlation cannot cope with replicated data. A further reason for poor methodology is the tendency for researchers to imitate what they see in other published papers. So many papers are published in which the same incorrect methods are used that researchers can perhaps be forgiven for assuming that they are doing the right thing. It is to be hoped that journals will become enlightened and return papers using inappropriate techniques for reanalysis. Another factor is that some statisticians are not as aware of this problem as they might be. As an illustration of this, the blood pressure data shown in Figures 1 and 2 were taken from the book Biostatistics by Daniel (1978), where they were used as the example of the calculation of the correlation coefficient. A counter-example is the whole chapter devoted to method comparison (by regression) by Strike (1981). More statisticians should be aware of this problem, and should use their influence to similarly increase the awareness of their non- statistical colleagues of the fallacies behind many common methods. A simple approach to the analysis may be the most revealing way of looking at the data. There needs to be a greater understanding of the nature of this problem, by statisticians, non-statisticians and journal referees. Acknowledgements We would like to thank Dr David Robson for helpful discussions during the preparation of this paper, and Professor D. Appendix Covariance of two methods of measurement in the presence of measurement errors We have two methods A and B of measuring a true quantity T. They are related T by A = T + εA and B =T+ εB, where εA and εB are experimental errors. Precision of test methods, part 1: guide for the determination of repeatability and reproducibility for a standard test method. Principal component analysis: an alternative to “referee” methods in method comparison studies. Measurement of left ventricular ejection fraction by mechanical cross-sectional echocardiography. Confirmation of gestational age by external physical characteristics (total maturity score). A multivariate approach for the biometric comparison of analytical methods in clinical chemistry. Measurement of the lecithin/sphingomyelin ratio and phosphatidylglycerol in amniotic fluid: an accurate method for the assessment of fetal lung maturity. Comparison of performance of various sphygmomanometers with intra-arterial blood-pressure readings. Comparison of clinic and home blood-pressure levels in essential hypertension and variables associated with clinic-home differences. Statistical comparison of multiple analytic procedures: application to clinical chemistry. Comparison of the new miniature Wright peak flow meter with the standard Wright peak flow meter. To add to these problems, many recent news reports indicate that racial and ethnic minorities receive lower quality healthcare than whites, even when they are insured to the same degree and when other healthcare access-related factors, such as the ability to pay for care, are the same. Many of these studies also controlled for other potential confounding factors, majority indicated that such as racial differences in the severity or stage of disease progression, the presence of minorities are less co-morbid illnesses, where care is received (e. Some studies receive needed ser- that employed more rigorous research designs followed patients prospectively, using vices, including clini- clinical data abstracted from patients’ charts, rather than administrative data used for in- cally necessary proce- surance claims. Many factors may contribute to the health care disparities observed in these studies. Some researchers suggest that there may be subtle differences in the way that members of different racial and ethnic groups respond to treatment, particularly with regard to some pharmaceutical interventions, suggesting that variations in some forms of treatment may be justified on the basis of patient race or ethnicity. In addition, patients vary in help- seeking behavior, and some racial and ethnic minorities may be more likely than whites to avoid or delay seeking care. However, the majority of studies find disparities in clini- cal services that are equally effective for all racial and ethnic groups. A small number of studies, for example, find that African suggest that racial dif- Americans are slightly more likely to reject medical recommendations for some treat- ferences in patients’ ments, but these differences in refusal rates are generally small (African Americans are attitudes, such as their only 3-6% more likely to reject recommended treatments, according to these studies). It preferences for treat- remains unclear why African-American patients are more likely to reject treatment rec- ommendations. Are they refusing treatment because of a general mistrust of health care ment, do not vary providers? Or do some decline treatment because of negative experiences in the clinical greatly and cannot encounter or a perception that their doctor is not invested in their care? More research is fully explain racial and needed to fully understand treatment refusal because the reasons for refusal may lead to ethnic disparities in different strategies to help patients make informed treatment decisions. If minority patients’ attitudes toward healthcare and preferences for treatment are not likely to be a major source of health care disparities, what other factors may contribute to these disparities? The first set of factors are those related to the operation of healthcare systems and the legal and regulatory climate in which they operate. Differences, Disparities, and Discrimination: Populations with Equal Access to Healthcare. Three mechanisms might be operative in healthcare disparities from the provider’s side of the exchange: bias (or prejudice) against minorities; greater clinical uncertainty when interacting with minority patients; and beliefs (or stereotypes) held by the provider about the behavior or health of minorities. Patients might also react to providers’ behavior associated with these practices in a way that also contributes to disparities. Research on how patient race or ethnicity may influence physician decision-making and the quality of care for minorities is still developing, and as yet there is no direct evidence to illustrate how prejudice, stereotypes, or bias may influence care. In the absence of such research, the study com- mittee drew upon a mix of theory and relevant research to understand how these proc- esses might operate in the clinical encounter. Clinical Uncertainty Any degree of uncertainty a physician may have relative to the condition of a patient Any degree of uncer- can contribute to disparities in treatment. Doctors must depend on inferences about sever- tainty a physician may ity based on what they can see about the illness and on what else they observe about the have relative to the patient (e. The doctor can therefore be viewed as operating with prior beliefs condition of a patient about the likelihood of patients’ conditions, “priors” that will be different according to can contribute to dis- age, gender, socioeconomic status, and race or ethnicity. Doctors must balance new information gained from the patient (sometimes with vary- ing levels of accuracy) and their prior expectations about the patient to make a diagnosis and determine a course of treatment. If the physician has difficulty accurately understand- ing the symptoms or is less sure of the “signal” – the set of clues and indications that 3 physicians rely upon to make diagnostic decisions – then he or she is likely to place greater weight on “priors. The Implicit Nature of Stereotypes …there is considerable A large body of research in psychology has explored how stereotypes evolve, persist, empirical evidence that shape expectations, and affect interpersonal interactions.

G. Orknarok. The Baptist College of Florida. 2019.

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