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People are more attracted to faces that are more symmetrical than they are to those that are less symmetrical keppra 500 mg free shipping, and this may be due in part to the [6] perception that symmetrical faces are perceived as healthier (Rhodes et al buy discount keppra 250 mg on-line. Although you might think that we would prefer faces that are unusual or unique cheap 250 mg keppra with visa, in fact the [7] opposite is true. The researchers found that the more faces that were averaged into the stimulus, the more attractive it was judged. Although preferences for youthful, symmetrical, and average faces have been observed cross- culturally, and thus appear to be common human preferences, different cultures may also have unique beliefs about what is attractive. In modern Western cultures, “thin is in,‖ and people [8] prefer those who have little excess fat (Crandall, Merman, & Hebl, 2009). The need to be thin to be attractive is particularly strong for women in contemporary society, and the desire to maintain a low body weight can lead to low self-esteem, eating disorders, and other unhealthy Attributed to Charles Stangor Saylor. However, the norm of thinness has not always been in place; the preference for women with slender, masculine, and athletic looks has become stronger over the past 50 years. In contrast to the relatively universal preferences for youth, symmetry, and averageness, other [9] cultures do not show such a strong propensity for thinness (Sugiyama, 2005). Forming Judgments on the Basis of Appearance: Stereotyping, Prejudice, and Discrimination We frequently use people‘s appearances to form our judgments about them and to determine our responses to them. The tendency to attribute personality characteristics to people on the basis of their external appearance or their social group memberships is known as stereotyping. Our stereotypes about physically attractive people lead us to see them as more dominant, sexually warm, mentally healthy, intelligent, and socially skilled than we perceive physically unattractive [10] people (Langlois et al. And our stereotypes lead us to treat people differently—the physically attractive are given better grades on essay exams, are more successful on job interviews, and receive lighter sentences in court judgments than their less attractive counterparts [11] (Hosoda, Stone-Romero, & Coats, 2003; Zebrowitz & McDonald, 1991). In addition to stereotypes about physical attractiveness, we also regularly stereotype people on the basis of their sex, race, age, religion, and many other characteristics, and these stereotypes [12] are frequently negative (Schneider, 2004). Stereotyping is unfair to the people we judge because stereotypes are based on our preconceptions and negative emotions about the members of the group. Stereotyping is closely related to prejudice, the tendency to dislike people because of their appearance or group memberships, and discrimination, negative behaviors toward others based on prejudice. We may not vote for a gay person for public office because of our negative stereotypes about gays, and we may avoid people from other religions or those with mental illness because of our prejudices. Research has found, for instance, that attractive people are actually more sociable, more popular, and less lonely than less attractive individuals Attributed to Charles Stangor Saylor. And, consistent with the stereotype that women are “emotional,‖ women are, on average, more empathic and attuned to the emotions of others than are men (Hall [14] & Schmid Mast, 2008). Group differences in personality traits may occur in part because people act toward others on the basis of their stereotypes, creating a self-fulfilling prophecy. A self-fulfilling prophecyoccurs when our expectations about the personality characteristics of others lead us to behave toward those others in ways that make those beliefs come true. If I have a stereotype that attractive people are friendly, then I may act in a friendly way toward people who are attractive. This friendly behavior may be reciprocated by the attractive person, and if many other people also engage in the same positive behaviors with the person, in the long run he or she may actually become friendlier. But even if attractive people are on average friendlier than unattractive people, not all attractive people are friendlier than all unattractive people. And even if women are, on average, more emotional than men, not all men are less emotional than all women. Social psychologists believe that it is better to treat people as individuals rather than rely on our stereotypes and prejudices, because stereotyping and prejudice are always unfair and often inaccurate (Fiske, 1989; Stangor, [15] 1995). Furthermore, many of our stereotypes and prejudices occur out of our awareness, such that we do not even know that we are using them. Implicit Association Test You might want to test your own stereotypes and prejudices by completing the Implicit Association Test, a measure of unconscious stereotyping. Because our primitive ancestors needed to accurately separate members of their own kin group from those of others, categorizing people into “us‖ (the ingroup) and “them‖ (the outgroup) was useful and even necessary (Neuberg, [16] Kenrick, & Schaller, 2010). And the positive emotions that we experience as a result of our Attributed to Charles Stangor Saylor.

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These changes in renal function influence elimination buy 500 mg keppra visa, and the reduced plasma Key points levels of digoxin correlate closely with the increased creatinine Disease profoundly influences the response to many drugs clearance in thyrotoxicosis 250 mg keppra with amex. Other factors including enhanced by altering pharmacokinetics and/or pharmacodynamics buy keppra 250mg low price. There is no widely measured biochemical marker heart disease which would be exacerbated if an excessive (analogous to serum creatinine in chronic renal failure) steady-state thyroxine level were achieved. His liver and spleen are not palpable in the presence of ical nephrology, 3rd edn. Comment It is a mistake to try to eliminate ascites too rapidly in patients with cirrhosis. In this case, in addition to prerenal renal fail- ure, the patient has developed profound hypokalaemia, which is commonly caused by furosemide in a patient with secondary hyperaldosteronism with a poor diet. It would have been better to have initiated treatment with spironolactone to inhibit his endogenous aldosterone. Low doses of furosemide could be added to this if increasing doses of spironolactone up to the maximum had not pro- duced adequate fluid/weight loss. Great caution will be needed in starting such treatment now that the patient’s renal function has deteriorated, and serum potassium levels must be monitored closely. There is a direct relationship between plasma ability results from two main sources: concentration and pharmacological or toxic effect, i. Inter-individual variability in plasma drug concentrations passes both kinds of variability. Several drugs are being given concurrently and serious really wants to achieve is to reduce the risk of a clinical event, interactions are anticipated. Replacement treatment (for example, of thyroxine) is to be For example, antihypertensive drugs are monitored by their optimized. Apparent ‘resistance’ to the action of a drug needs an on serum cholesterol (Chapter 27), oral anticoagulants by explanation, when non-compliance is suspected. Another indication, distinct from therapeutic drug monitor- In some circumstances, however, there is no good continu- ing, for measuring drug concentrations in plasma is in clinical ous variable to monitor, especially for diseases with an unpre- toxicology. Measuring drug concentrations specific intervention is contemplated in treating a poisoned in plasma or serum identifies only pharmacokinetic variabil- patient (e. Drug distribution and the location (tissue and cell) of the drug’s target influence the relationship between plasma drug concentration and effect. Earlier in the dose interval, the plasma concentra- tion does not reflect the concentration in the extracellular tis- Measurement of drug concentrations is sometimes a useful sue space accurately. Digoxin: measuring the plasma concentration can help optimize therapy, especially for patients in sinus rhythm have occurred. Greater care is therefore required in the timing where there is no easy pharmacodynamic surrogate and labelling of specimens for drug concentration determina- marker of efficacy, and is also useful in suspected toxicity tion than is the case for ‘routine’ chemical pathology speci- or poor compliance. Lithium: plasma concentrations are measured 12 hours before the next dose to assess the ‘trough’ concentration, and a after dosing. Aminoglycoside antibiotics – for gentamicin, peak (depending on the drug) to determine the ‘peak’ concentration. Advice on the interpretation of organisms, and trough levels, measured immediately this information is sometimes available from a local therapeutic before a dose, of 1–2mg/L reduce the risk of toxicity; for drug-monitoring service, such as is provided by some clinical amikacin, the desirable peak concentration is 4–12mg/L, pharmacology and/or clinical pharmacy departments. With extended interval eral, the cost of measuring drug concentrations is greater than aminoglycoside dosing (a single daily dose of 5–7mg/kg), for routine clinical chemical estimations, and to use expensive a single drug concentration determined at a time after the facilities to produce ‘numbers’ resulting from analysis of sam- completion of the distribution phase is used to define ples taken at random from patients described only by name or further dosing intervals using validated nomograms. Therapeutic drug monitoring tandem mass spectroscopy or radioimmunoassay) avoid the is also widely used for some other anticonvulsants, pitfalls of less specific methods which may detect related com- such as carbamazepine and sodium valproate. There are few prospective studies of the impact of thera- Measurement of plasma theophylline concentration can peutic drug-monitoring services on the quality of patient care. General Hospital showed that before the use of digoxin (Plasma concentrations 15mg/L are, however, associated monitoring, 13. The clinical utility of predicting toxicity by measuring a metabolite (desethyl Life-threatening toxicity possible Coma amiodarone) is under evaluation.

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Joseph Warren—Paul Revere In Boston in 1776 purchase 500mg keppra fast delivery, at the battle for Breed’s Hill (often misidentified as Bunker Hill) discount keppra 250 mg line, Dr purchase keppra 250mg overnight delivery. His face was unrecogniz- able as he suffered a fatal head wound, a rifle ball to the left side of his face. Pattison Te earliest known use of a dentist as an expert witness in court occurred in 1814 in the case of a Janet McAlister in Scotland. Te night afer her burial, the trio was alleged to have moved her body to the nearby College Street Medical School. James Alexander, who was able to ft the dentures into 14 Forensic dentistry the skull. Te defense testimony stated the dentures could be “ftted to any skull” and, therefore, did not ft just this skull. Guerin’s identifcation was accomplished by the abrasions caused by clay pipes he had a habit of using when smoking. Te abrasive marks in the dentition were unique and were similarly described by multiple witnesses. Later, the son of the married couple accused them of murder, stating that he saw his mother leave the home with some- thing heavy and large in a bag. A woman ftting the description of the missing woman was found on the streets in a “squalid” condition and stated her name was Caroline Walsh. It was pointed out in the trial that the missing Caroline Walsh had perfect teeth. In 1816, a plan to erect a monument to the young prince generated rumors that he was still alive, now thirty-one years of age, and that another child had been buried in his place. In 1846, during the reconstruction of a church, a lead cofn containing the skeleton of a child was found near a side entrance. Milicent, a physician, examined the bones and concluded the child had died of bad health and neglect. Recamier, examined the bones and said they were those of an individual, ffeen or sixteen years of age. Recamier’s age assessment was accepted and the body was reinterred in an unmarked place. Based on tooth development, three experts aged the remains at between sixteen years plus and eighteen years plus. George Parkman, a respected professor at Harvard University, failed to return from dinner on November 23, 1849. When he failed to appear as expected, suspicion of foul play fell on his colleague, John White Webster, a professor of chemistry at the same university. Webster had been behaving somewhat irregularly of late, and it was known that he owed Dr. In a nearby assay furnace fragments of a lower jawbone, three blocks of artifcial teeth in porcelain, and melted gold were also found. Nathan Cooley Keep, a dentist, identifed the teeth as part of an upper and lower denture he had made for Dr. He recalled the circumstances of the denture’s construction in exact detail, as Parkman had been anxious about having the dentures ready for the opening of a new medical college at which he was to give a speech. Te day before the event, when some of the bottom teeth collapsed during the baking process, Dr. Keep and his assistant worked through the night and ftted the denture some thirty minutes before the ceremony. Parkman returned in a short time and complained that the lower cramped his tongue. An adjustment was made by grinding away portions of the inside of the lower denture. Keep ft portions of the lower denture to models he had retained in the production of it and showed the court where he had done the grinding adjustment of the lower denture. Te Parkman–Webster case represents the frst case of a dentist giving expert testimony in courts in the United States.

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