Midterm 2 Flashcards
1
Q
What determines your internal reactions?
A
- intuitive valuation & 2. deliberate evaluation of the situation
2
Q
Describe associative memory
A
- your implicit model of the world
- different components of statistical (typical) regularities across your experiences and lifetime
** the ability to learn and remember the relationship between unrelated items
Ex. the name of someone we have just met or the aroma of a particular perfume.
3
Q
Semantic memory
A
- your explicit model of the world
- general knowledge (facts, ideas, meanings and concepts; can come from experience or culture)
**refer to facts about the world
Ex. knowing that Paris is in France.
4
Q
__________ is a major source of associative learning
A
CULTURE
- Our culture influences what we are exposed to every day
- Repeated exposure strengthens some associations
- Lack of exposure weakens other associations
*culture effects our implicit view of the world without our awareness, and our explicit with OR without awareness
5
Q
What is conditioning?
A
a major way of learning new associations and thus forming associative memories
6
Q
What do System 1 and System 2 associate with?
A
System 1 = INTUITION (intuitive)
System 2 = REASONING (deliberate)
7
Q
What does our associative memory determine?
A
Our intuitive judgments
From there, they are endorsed into our deliberate judgements and accepted
8
Q
Describe some characteristics of System 1
A
Fast
Parallel
Automatic
Effortless
Associative
Slow-learning
Emotional
9
Q
Describe some characteristics of System 2
A
Slow
Serial
Controlled
Effortful
Rule-governed
Flexible
Neutral
10
Q
What is the availability heuristic?
A
a mental shortcut that relies on immediate examples that come to a given person’s mind when evaluating a specific topic, concept, method, or decision.
Ex. It’s easy to recall examples of complications arising during childbirth. Therefore, we believe that complications during childbirth must be common.
11
Q
What is processing fluency?
A
A cognitive bias where our opinion of something is influenced by how easily our brain processes it and understands it.
We tend to prefer things that are simple to understand and use, and will even find simple information more believable.
12
Q
What is attribute substitution?
A
It occurs when people make a judgment that requires the use of a target attribute, but make the judgment using a heuristic attribute that comes more readily to mind
Ex. someone who has been thinking about their love life who is then asked about their happiness might substitute how happy they are with their love life rather than answer the question as asked.
13
Q
What are “weasel words”?
A
Vague enough to be meaningless, but can be used to mislead:
Ex.
- It’s possible
- It’s a serious/definite possibility
- It might/could
- there is a chance
etc….
14
Q
What is Words of Estimative Probability (WEP)
A
terms used by intelligence analysts in the production of analytic reports to convey the likelihood of a future event occurring
15
Q
Our judgments about what is “dangerous” or “safe” are….
A
- generally not based on statistical probabilities
- culturally influenced
- based on associative memory and heuristics
WHEN APPLIED TO BIRTH:
“Birth is dangerous, but intervention (technology/control) makes it safe”
16
Q
What are the 2 failures that are attributed to the dual system models of reasoning?
A
- System 1 - the automatic operations that generate a faulty intuition
- System 2 - fails to detect and correct the intuition with it’s controlled operations
17
Q
In general, what can judgemental biases be attributed to?
A
Described as a big focus on some info and little focus/neglecting other info
18
Q
When do framing effects occur?
A
they commonly occur when alternative statements of a decision problem evoke different emotions
Ex. “10% mortality vs 90% survival”
19
Q
Give an example of how assertiveness can be judged differently based on heuistics?
A
When ppl were asked to recall 12 instances in which they behaved assertively judged themselves to be less assertive than those who were asked to recall only 6 instances
**struggling to recall the last dew instances was the heuristic by which assertiveness was judged.
20
Q
Fluency is…..
A
a poor indicator of accuracy
21
Q
What is the general outcome from fearing things we shouldn’t?
A
We put ourselves in MORE danger by fearing unnecessarily for things.
Ex. people didn’t take planes after 9/11 and instead drove, which resulted in more deaths bc driving is a higher risk
22
Q
What are the 2 different strategies our brain has to make sense of a situation?
A
- Conscious Strategy —> think about what we learned and come up with an answer in a logical and guaranteed way.
- Unconscious Strategy (“FAST AND FRUGAL”) —> picks up on problem very easily, operates below unconscious level and not in a logical way (intuition)
**represented in Iowa experiment with the red and blue cards
23
Q
Once a treatment is known as “standard care”, is it easy for the treatment to change when there is new evidence?
A
NO - once a treatment is viewed as the norm it is very hard for it to not pertist
Treatments are usually based on flawed results that end up sneaking their way into standard medicine.
“we adopt things before we know if they actually work because they SHOULD work”
24
Q
What drug is added to the IV post c-section?
A
PITOCIN - it is added to the IV when stitching up the uterus to help the uterus contact and therefore decrease bleeding.
25
What is the ventral amygdalofugal pathway?
It connects to a lot of brain regions but most importantly connects the amygdala to the hypothalamus!
It is important for the associative memory (the ability to learn and remember the relationship between unrelated items - ex. remembering the name of someone you just met)
26
What is stria terminalis?
a major pathway between the amygdala and the hypothalamus that provides reciprocal connections between the two structures.
They project ONLY TO SUB-CORTICAL STRUCTURES
27
What is the basal ganglia?
a group of sub-cortical nucliei in an area of the brain that is very closely involved with VOLUNTARY EMOTIONAL ACTIVITY
Involved with implicit memory
28
What are the automatic bodily responses involved in emotions controlled by?
Controlled by outputs of the AMYGDALA ----> go to the nuclei of the sympathetic nervous system in the brainstem ----> to the HYPOTHALAMUS
29
What does the hypothalamus control?
Its main function is to keep your body in a stable state called homeostasis. It does this by influencing your AUTONOMIC NS or by managing hormones.
**releases hormonal secretions of the pituitary gland
30
What are the 2 pathways once the thalamus is aware it is in danger?
1. Thalamo-amygdala pathway "the SHORT route" = passes straight from thalamus to amygdala. fast, rough impression of situation, no cognition involved
2. Thalomo-cortico-amygdala pathway "the LONG route" = passes from the thalamus to the neocortex and only then to the amygdala
31
What happens when info passes through the thalomo-cortico-amygdala pathway?
It's the "long route" --> the info that has travelled through this long route has been evaluated whether or not the stimulus is a real threat
32
What does the polymodal associative cortex do?
it conceptualizes an object and informs the amygdala about it
33
The hippocampus supports which type of memory?
Explicit memory (type of long-term memory that's concerned with recollection of facts and events)
Explicit memory is required to learn about the dangerousness of an object or situation to begin with.
34
What part of the brain activates when there is possible danger?
The amygdala - and activates the efferent structures that release physical manifestations of fear (ex. increased heart rate, sweaty hands, dry mouth, tense muscles, etc.)
35
In other species, the prefrontal cortex is dedicated to only ________________
VOLUNTARY MOTOR CONTROL
In primates, the prefrontal cortex has developed to be beyond that.
36
Studies have compared the human brain to those of other primates, but not many comparisons to _____________
the great apes
However, in those few studied they found that the prefrontal cortex was found to be about the same in size humans as the great apes (as they are the closest cousins)
37
Humans have larger volume of ________ in the prefrontal cortex
WHITE MATTER
38
What type of memory is linked to an active role of the prefrontal cortex?
working memory (small amount of information that can be held in mind and used in the execution of cognitive tasks)
39
What do the culturally dominant representations of birth tend to AVOID?
- the physiological reality: blood, bodily fluids, body organs, etc
- the vulnerability and dependency of human newborns on their mothers
- the animalism and emotionality of birth
40
What are the 2 ways reasoning can be motivated?
1. ACCURACY MOTIVE: motivation to arrive at an accurate, thorough explanation
- Leads us to expend more cognitive effort
- process information more deeply
- use more complex thinking strategies
2. DIRECTIONAL MOTIVE: motivation to arrive at a particular, directional explanation
- leads us to try to justify a particular conclusion in rational, convincing manner
- undertake a biased memory search for particular beliefs and rules
- access only a subset of our relevant knowledge
41
When is the self serving bias most likely to occur?
when we formulate explanations about positive or
negative events or outcomes
42
How are positive outcomes explained in the context of self-serving bias? How are the negative outcomes explained?
- positive evens or outcomes tend to be explained through internal causes (“it was me”)
^^ attributed to dominant cultural values
- negative events or outcomes tend to be explained through external causes (“it wasn’t me”)
^^attributed to non-dominant cultural values
43
Do people with depression show less or more self-serving bias than someone who is not depressed?
They show less self-serving bias and are more realistic
44
Define "due date"
Expected date of birth: 280 days (40 weeks) from the first day of the last menstrual period
45
Term pregnancy
Between 37 and 42 weeks (“window”)
46
What is pre-term and post-term pregnancy?
- Pre-term: before full 37 weeks of pregnancy
- Post-term: after 42 weeks of pregnancy
47
At how many weeks is membrane sweeping offered according to medical guidelines?
It's offered at 38 to 41 weeks
48
When is induction offered according to medical guidelines, why is it offered at this time?
offer induction at 41+0 to 42+0 weeks
***BECAUSE... present evidence reveals a decrease in PERINATAL MORTALITY with induction
49
Formal induction is performed by _____ weeks + _____ days of pregnancy if labour hasn’t started yet on its own
41 weeks + 3 days
50
What is membrane sweeping?
a clinician inserts 1 or 2 fingers into the cervix and using a continuous circular sweeping motion detaches the interior pole of the membranes from the lower uterine segment.
51
What is the rationale behind membrane sweeping?
- presumed to cause the release of endogenous prostaglandins from the adjacent membranes and
cervix
^^ prostaglandins are hormone-like lipid compounds that are known to play a partial role in the initiation of labour
52
What are some pros and cons of membrane sweeping?
Pros:
- may decrease the length of pregnancy
- may reduce the rate of formal medical induction (**but only 1/8 avoids formal medical induction who receive membrane sweeping)
Cons:
- can be very painful
- can cause bleeding or irregular contractions
- in 1/10 women leads to rupture of the amniotic sac (“water breaking”), which then leads to formal induction within 24 hours according to current medical guidelines
- sometimes done without consent, during a vaginal/cervical exam at the end of pregnancy
53
At least ____ of women have their labour induced currently
20-30%
54
Describe the artificial oxytocin method of labour induction
- given through IV drip
- Currently recommended and most commonly used method
- Involves continuous oxytocin administration throughout labour and after delivery
55
Describe the prostaglandins method of labour induction
- are inserted into the vagina as a gel or a pessary (a soft, flexible device)
- more effective than oxytocin in bringing about vaginal delivery within 24 hours
- more likely than oxytocin to cause uterine hyperstimulation
56
Describe the mechanical methods of labour induction
- reduced uterine hyperstimulation compared to prostaglandins
- increased maternal and neonatal infections compared to prostaglandins and artificial oxytocin
(ex. balloon catheters, intentional rupture of amnionic sac)
57
What is the reasoning for performing induction after 41 weeks?
there is a very increased risk of stillbirth at 41 weeks compared to 40 weeks.
58
What is base rate neglect?
When presented with specific information (conditional
probabilities, specific risks), we tend to ignore the relevant general information (unconditioned probabilities, background risks)
"I misjudge the probability of something by ignoring important background information"
59
How does base rate neglect apply to birth?
Can be applied to the probabilities of stillbirths
Risk being considered = the probability of stillbirth >= 41+0 weeks
Risk being neglected = the probability of stillbirth in general
60
What is the representativeness heuristic?
based on automatic attribute substitution:
representativeness = likelihood of occurrence
(i.e., more representative = more likely to occur
61
What can the representativeness heuristic result in neglecting?
Can result in neglect of relevant BASE RATES (accurate stats/probabilities)
- a prototype or mental model is activated by the representative individual or event
- alternative mental models are not activated or are suppressed
62
What are the representative outcomes that serve as prototypes of events during childbirth?
- lack of modern medical intervention leads to a dead baby/mother
- modern medical interventions lead to a healthy baby being born to a healthy mother
Therefore, the representativeness heuristic leads us to:
- overestimate the risk of not intervening
- underestimate the risk of intervening
63
What's the difference between anti-cautionary and precautionary?
Precautionary: Assumed UNSAFE until proven otherwise
Anti-cautionary: Assumed SAFE until proven otherwise
64
What is the prelevence of the anti-cautionary principle?
Within medicine, it is linked to MEDICAL REVERSALS.
Not always not unique to birth or medicine, it applies to:
- new medical technologies and interventions in medicine as a whole
- new technologies in society as a whole
65
What are some medical reversals from modern obstetrics?
- routine X-rays for pregnant women (found to cause
cancer)
- thalidomide for pregnancy nausea (found to cause
severe birth defects)
- routine pubic area shaving (found to cause infection
rather than prevent it)
- routine episiotomy - cutting area between vagina and anus (found to cause tearing rather than
prevent it)
66
What are some things in from the childbirth circa in 1960
* Heavy sedation
* Routine enema & shave prep
* “Sterile” environment
* “Prophylactic” forceps
* Routine episiotomy
* Delivery in operating room
* Litothomy position (supine, legs in stirrups)
67
What are some things in from the childbirth circa in 2017 (essentially today?
- Epidural analgesia
* Episiotomy
* Forceps or Vacuum
* Cesarean Section
* Legs in stirrups
* "Flat lying position”
* Induction of labour
* Augmentation of labour
* Routine artificial oxytocin after birth of baby
68
When animals give birth they do not cut the cord and let it naturally detach, what does this mean for the offspring?
*baby stays connected to the placenta
*continues to receive blood and oxygen
*enables the gradual transition to breathing
69
What is Wharton’s Jelly? What's it's purpose?
It's a gelatinous substance within the umbilical cord
PURPOSE/WHAT IT DOES:
- it protects and insulates umbilical blood vessels
- changes its structure with cooler temperature
- provides a physiological clamping action, slowing the flow of blood
- contains stem cells and may have yet unknown benefits
It can also be used to:
- create adult stem cells including neural cells in rats
- treat brain damage in mice effectively
70
What is placental transfusion? What is an example of this?
It refers to the transfer of residual placental blood to the baby during the first few minutes of age
Common example of this is DELAYED CORD CLAMPING (1 - 3 mins later rather than immediate)
This.....
* increase in blood volume of the newborn
* increase in red cell volume
* higher birth weight
* fewer infants iron deficient
***not delayed by gravity, even when baby is held above placenta, transfusion still occurs
71
Historically with midwives, what was the original way of cutting the cord?
Historically, midwives would wait until the cord stops
pulsating until they do anything to it.
Aristotle and Hippocrates wrote approvingly of
midwives’ practice of waiting until the cord
stops pulsating.
72
When are the first records from of immediate cord clamping?
First records date from the late 1600s
73
What are the early explanations for immediate cord clamping?
* to avoid blood loss from the baby before physiological closure of the umbilical vessels
* to “spare the bed linen” from being soiled by placental blood leaking from the cut end of the cord
However, in 1733 Charles White say cutting the cord immediately was not beneficial at all it just grew to be the standard.
74
What did Erasmus Darwin have to say about immediate cord clamping?
“a very injurious thing” left babies “much weaker than
[they] ought to be”
Said this in the 1800s, father of Charles
75
When was chloroform introduced into the birthing process?
In the early 1900s
- chloroform put into general anesthesia during childbirth (Stage 2)
76
Is chloroform dangerous when given to the person giving birth?
Yes if chloroform passed through the umbilical cord to the baby, with the potential to cause profound
RESPRITORY DEPRESSION
The cord immediately clamped and cut to prevent the
baby from receiving any more of the chloroform
77
In the 1960s, what was the reason given for immediate cord clamping become the standard practice?
Promoted as a tool to prevent postpartum hemorrhage - which is when a woman has heavy bleeding after giving birth.
78
What are the doctors goal for the third stage of labour (post birth)?
its overall goal is to limit postpartum hemorrhage
79
What is the triad of interventions during the third stage of labour?
1. administration of Pitocin to induce contractility of the uterus and make the placenta separate from the uterine wall quicker
2. early cord clamping and cutting
3. controlled traction of the umbilical cord pulling on the cord while applying counter pressure to help deliver the placenta
(ALL have preventing postpartum hemorrhage in mind)
80
What is the best intervention from stage 3 triad of interventions that reduces hemorrage?
Giving uterotonic drugs (pitocin) might be the only intervention in the active management of stage 3 that is associated with reduced hemorrhage but:
* the quality of the evidence is generally low
* more data/research are needed
81
What are the risks of cutting the cord too early?
- can lead to iron deficiency anemia in babies
- in premature infants, can lead to intraventricular hemorrhage ( bleeding into the fluid-filled areas, or ventricles, surrounded by the brain)
82
What is the WHO's Recommendation for cord clamping?
Delay of umbilical cord clamping for 1–3 minutes
83
What are the UK guidelines for cord clamping?
Delay clamping the umbilical cord earlier than necessary
(unless exigent circumstances such as heavy maternal blood loss or the need for immediate neonatal resuscitation take priority)
84
What are the Canadian guidelines for cord clamping?
The risk of jaundice is weighed against the physiological
benefits of delayed cord clamping.
85
What changes with delayed cord clamping (1-3 minutes) vs immediate (<60 sec)?
When cord clamping is delayed, there is a slightly higher risk the baby will develop jaundice.
86
What type of memory is medical knowledge?
- Mostly procedural
- Some semantic
- Semantic knowledge serves the procedural
knowledge (explains why certain practices are adopted and others are not)
87
What type of memory is scientific knowledge?
- Mostly semantic
- Some procedural
- Procedural knowledge serves the semantic knowledge (prescribes what we should do to update and improve the semantic knowledge)
88
What is the evidence-practice gap?
Taking a long time for science to influence medical practice and it only does so partially
89
Who is Archie Cochrane? What did he do?
A scottish doctor.
- criticized the lack of reliable evidence behind many of the commonly accepted healthcare interventions
* advocated for the use of randomized control trials to
make medicine more effective and efficient
* led to the development of the Cochrane Library database of systematic reviews
* HELPED LAY THE FOUNDATION FOR EVIDENCE-BASED MEDICINE
90
Many Cochrane Systematic Review articles conclude that _______________?
there is not enough evidence to support and endorse the interventions they examine
(think about the levels of evidence pyramid)
91
What 3 components make up Evidence-Based Medicine (EBM)?
- Clinical Judgement
- Relevant Scientific Evidence
- Patient's values and preferences
92
How do changes happen within semantic knowledge?
Changes based on the ‘evidence’ we are exposed to
(the evidence could be biased or faulty)
93
How do changes happen within procedural knowledge?
Changes based on
- what we frequently do (habits)
- the system of incentives and disincentives (rewards and punishments) that are part of our environment
94
What are the systems of incentives and disincentives that influence the practice of obstetrics
- Personal
- Professional
- Duty of care (an obligation to benefit one’s patients medically)
- Financial
- Medico-legal (litigation pressures/insurance policies)
95
What is the leading primary allegation for obstetric claims when suing?
“neurologically impaired infant” (29% of all obstetric claims)
96
Is the risk of an obstitrition loosing a lawsuit filed against them high?
Overall, the risk of ‘losing’ the lawsuit are very small (~5%) for the doctor
However, most lawsuits don’t go to trial in the first place
97
More than half of Ob/Gyns say that their thinking and actions are continuously affected by _____________
the threat of lawsuits
- More than half describe being sued as an extremely negative experience
- More than a third agreed that “I no longer trust patients, I treat them different” and in some cases also lost trust in their colleagues and organizations
98
The stronger the emotional salience, the _________ active the amygdala
MORE
99
What is emotional salience? What part of the brain detects it?
The emotional significance of percepts, thoughts, or other elements of mental experience, which can draw and sustain attention through mechanisms outside of cognitive control
Basically a biologically adaptive cue that can influence how an event is remembered and possibly how it is integrated in memory
The amygdala detects emotional salience, not threat
100
Do positive or negative experiences evoke more emotional salience?
Negative experiences quickly and easily reach very strong emotional salience
101
What is cognitive control?
The deliberate guidance of current thoughts, perceptions or actions.
This control is imposed in a goal-directed manner by currently active top-down executive processes
102
According to studies, what is the #1 emotion that evokes amygdala activation?
DISGUST, followed by fear.
103
What is the typical hospital delivery sequence of steps?
After the baby is born:
* Cut the cord
* Wipe the baby with a towel
* Wrap the baby in another towel
* Put a hat on the baby’s head
* (Finally) give the baby to mother
104
What are the 3 different types of disgust and their functions?
- Distaste --> to avoid toxins (ex. eating spoiled foods)
- Disgust --> to avoid infection (ex. seeing injuries, seeing vomit, etc.)
- Moral disgust ---> to avoid “unsuitable” interaction partners (ex. violation of social norms/morals)
105
How was the UK’s Department of Health campaign so motivating?
They evoked feelings of fear and disgust which are both very motivating, specifically when combined with eachother.
“Gen Unhooked” campaign of anti-smoking ads
^^The campaign received hundreds of complaints about the advertisements, describing them as “offensive”, “disturbing”, or “violent”
106
What is the function of the insula?
One of its functions is to control food preferences (taste identification and intensity) independently of taste receptor signaling
- Located in the primary gustatory cortex
- damage can lead to inability to identify taste experiences
107
If the insula is damaged, what can happen?
It can lead to an inability to identify taste experiences
108
What cortex is the insula located?
Located in the primary gustatory cortex
109
What is the function of the Orbitofrontal Cortex (OFC)?
Has many functions but plays an important role in representing taste, flavor, and food reward.
Involved with the motivational value (approach/avoid) of taste experience in the brain
110
Where is the Orbitofrontal cortex located?
secondary gustatory cortex
111
What is the Ventromedial Prefrontal Cortex
(VMPFC)?
a region for binding together the big brain parts that involve emotional processing, decision-making, memory, self-perception, and social cognition in general.
**the region where different somatic markers created by different stimuli are integrated in
112
What are somatic markers?
- physiological affective states associated with
particular stimuli (aka feelings in body that are associated with emotions)
^^ex. rapid heartrate from anxiety, or nausea from disgust.
*STRONGLY INFLUENCE SUBSEQUENT DECISION-MAKING
- different somatic markers created by different stimuli are integrated in VMPFC to produce a net somatic state
- a mechanism by which emotional processes
can guide or bias reasoning
113
What happens when we are in conflict with our domanent values?
- we need to recruit cognitive control and the
Lateral PreFrontal Cortex (LPFC - responsible for the implementation of cognitive control, which requires multiple cognitive processes, such as working memory, attentional selection and planning.)
- increased cognitive difficulty
114
What happens when we are considering doing something that aligns with our dominant values?
- we recruit the ventromedial PFC (VMPFC - a key brain region supporting decision-making processes)
- relatively high processing fluency
115
Legally speaking, the fetus does not become
a person until ______________
it is fully born, separated from the mother and living independently
*But obstetricians currently regard the fetus as a separate entity from the mother, or their "second patient"
116
What are some issues with treating the fetus as a second patient?
Health care providers become responsible for negative
fetal/newborn outcomes — and therefore vulnerable to lawsuits
It creates a conflict between health care providers and pregnant women who decide to refuse medical treatment
* providers see themselves as the advocate for the baby
* can resort to court orders to force invasive interventions on pregnant women for the perceived benefit of the fetus
117
In the Georgia Case, when the emergency hearing was conducted at the hospital what was found in the ultrasound scan?
That she had complete placenta previa (the placenta completely or partially covers the opening of the cervix)
This caused predictions that:
* there was a 99% chance that the fetus would die during a vaginal delivery
* there was a 50% chance the mother would die too
118
What was the final outcome of the Georgia case?
Mrs. Jefferson uneventfully delivered a healthy baby without surgical intervention
A second ultrasound scan after the emergency hearings found that her placenta had moved so that cesarean delivery was no longer indicated
Doctors had testified at the emergency hearings that it was “highly and virtually impossible” for the condition to reverse itself
**meaning that likely the first ultrasound was innacurate and did not complete placenta previa
119
What did the court decide regarding the Georgia case?
The court denied the parents appeal stating:
“...we weighed the right of the mother to practice her religion and to refuse surgery on herself, against her unborn child’s right to live. WE FOUND IN FAVOUR OF THE CHILDS RIGHT TO LIVE.”
120
How do ultrasounds work?
- uses sound waves with frequencies higher than those audible to humans (>20,000 Hz)
- sends pulses of ultrasound into tissue using a probe
- when a sound wave encounters a material with a different density, part of the sound wave is reflected back to the probe and is detected as an echo
**the greater the difference in density, the greater the echo
- seeing deep into the body with sonography is very difficult: most of the signal is lost from acoustic absorption
- can produce false positives, as well as misses
