PSYC 207 MIDTERM 2

Internal Reactions

combinations of intuitive valuation (fast & unconscious) + deliberate evaluation (careful, conscious, deliberate) of situation

Associative memory

your implicit model of the world, how you learn to create associations/ relationships between things

-> remembering someone's name
-> not always easy to describe, you just think it
-> culture is a major source of associative learning

Semantic memory

your explicit model of the world, your general knowledge (facts, ideas, meanings, concepts)
- conscious connections & concepts

Exposure

repeated exposure strengthens some associations & lack of exposure weakens others

Implicit & explicit

Implicit= we're unaware - not expressed directly, explicit= we're aware - it's clearly expressed

Culture & intuititive valuations

culture determines our experiences & what we're exposed to which determines our associative memory which determines our intuitive valuations

Conditioning

the process of learning associations between environmental events and behavioural responses

Classical conditioning

a type of learning in which one learns to link two or more stimuli and anticipate events

- repeated pairing of a neutral & physiologically important stimulus

- neutral stimulus begins to elicit response similar to one by the important one

Operant conditioning

repeated pairing of some action or behaviour with reward or punishment
- behaviour + positive / negative outcome

Media eliciting emotions

- words
- dramatic music
- visually creating feels of danger

System 1

the intuitive, automatic, unconscious, and fast way of thinking (associative)

- much more influenced by physiological reactions

System 2

the deliberate, controlled, conscious, and slower way of thinking

How does system 1 & 2 react to "birth is dangeros"

system 1: immediate fear due to previously established connections
system 2: judges this assumption as true as it searches for examples of things that could go wrong during birth

Availability heuristic

estimating the likelihood of events based on their availability in memory; if instances come readily to mind (perhaps because of their vividness), we presume such events are common

-> "it's easy to think of complications during childbirth so it must be common..."

Fluency heuristic

believing something because it is easy for your mind to process it

Processing fluency

the ease with which something is processed or comes to mind

- high fluency (availability) of something to come to mind makes us thing its frequency is also high

Attribute substitution

occurs when individuals must make judgments that are complex but instead they substitute a simpler solution or apply heuristic

- subsituiting attribution of danger for attribution of frequency

Micromort

a one-in-a-million chance of death

- dangers of giving birth roughly around 100 micromorts 1/ 10,000

Judgement

The act of judging people and their actions based on associative memory & heuristics

Systematic distortions with birth

- overestimating the risk of not intervening
- underestimating the risk of intervening

Culturally dominant representations of birth avoid...

- physiological reality: blood, bodily fluids, organs etc.
- vulnerability & dependency of newborns on mothers
- animalism & emotionality of birth

Accuracy motive

people are motivated to believe what is right and to avoid believing what is wrong

- makes us expand more cognitive effort, process info. more deeply, use more complex thinking strategies

Directional motive

motive to arrive at a particular, directional explanation

- leads us to try & justify a conclusion in a rational, convincing manner

The self-serving bias

the tendency for people to take personal credit for success but blame failure on external factors
* satisfies human need to sustain positive self image

Culture serving bias

created by self-serving bias that; positive outcomes are dominant cultural values & negative outcomes are non-dominant

(leads us to reaffirm our cultures)

Labour induction

intervening to end pregnancy

Due date

280 days (40 weeks) after 1st day of last period

Term pregnancy

between 37 and 42 weeks

Preterm pregnancy

before full 37 weeks of pregnancy

Postterm pregnancy

after 42 weeks of pregnancy (overdue)

Nulliparous

a woman who has never given birth

Multiparous

An woman that has given birth multiple times.

Membrane sweeping

A manual separation of the fetal membranes from the uterus intended to stimulate labour, usually preformed around 38-41 weeks to induce labour naturally

- presumed to cause the release of endogenous prostaglandins

Pros & cons of membrane sweeping

pros:
- may decrease length of pregnancy
- may reduce rate of formal induction

cons:
- can be very painful
- can cause bleeding or irregular contractions
- possibility of rupture of amniotic sac

Prostaglandins

hormone like lipid compounds known to play partial role in initiation of labour

Induction of labour methods

- artificial oxytocin
- prostaglandins
- mechanical methods

Artificial oxytocin

continuous oxytocin administration throughout labour & after delivery through IV drip, thought to induce & strengthen contractions

Prostaglandins induction of labour

in the hope to release during membrane sweeping, more effective in bringing vaginal delivery within 24 hrs

- more likely to cause uterine hyperstimulation (local administration cannot be done)
- if contractions are too strong there is higher likelihood of uterine rupture

Balloon catheters

Saline-filled balloon inserted through the cervical canal to mechanically dilate the cervix

- increased infection for mother & baby

Amniotomy

incision into the amnion (rupture of the fetal membrane to induce labor; a special hook is generally used to make the incision)

- increased infection for mother & baby

Base rate neglect/ fallacy

a common fallacy in which a person ignores the overall frequency of some behaviour or characteristic in making a decision

- ignoring important background info.
- failing to take into account multiple probabilities (shyness & math example)

Representativeness heuristic

judging the likelihood of things in terms of how well they seem to represent, or match, particular prototypes; may lead us to ignore other relevant information

- based on automatic attribute substitution (representativeness = likelihood of occurrence bias)

What makes us over and underestimate risks of intervention?

the representativeness heuristic + our model about birth = overestimating risk of not intervening & underestimating risk of intervening

Precautionary principle

assumed unsafe until proven otherwise (anti-intervention)

Anti-cautionary principle

assumed safe until proven otherwise (intervention is good)
- often applied to new medical technologies

Medical reversals for pregnancy

- routine x-rays (found to cause cancer)
- thalidomide for nausea (found to cause severe birth defects)
- routine pubic area shaving (found to cause infection rather than prevent it)
- routine episiotomy (found to cause tearing rather than prevent it)

Cord clamping / cutting

stops the function of cord (no more blood or oxygen from it)

- if cord isn't cut immediately it actually enables a gradual transition to breathing & allow lungs to inflate & begin to learn how to work

Wharton's jelly

a gelatinous substance within the umbilical cord that protects blood vessels

- changes structure with cooler temps.

Umbilical cord

a tube containing the blood vessels connecting the fetus and placenta

- contains 2 veins & 1 artery

Placental transfusion

transfer of residual placental blood to baby within first few minutes of age

Immediate cord clamping

within 30 seconds of delivery, first records date from late 1600s
- early explanations were to avoid blood loss from baby before closure of umbilical blood vessels or to spare bed linen

Apgar score

a scale of 1-10 to evaluate a newborn infant's physical status at 1 and 5 minutes after birth

Standard of care

Written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.

Active management of 3rd stage of delivery

1. administration of pitocin
2. early cord clamping & cutting
3. controlled traction of umbilical cord to help deliver placenta

Evidence of practices

- immediate cord clamping doesn't decrease post partum hemorrhage rates
- cord traction may not be important
- only pitocin may be associated with reduced hemorrhage

Post partum hemorrhage

when a woman has abnormal excessive bleeding after birth

Cord clamping guidelines

WHO: delay umbilical cord clamping for 1-3 mins
Canada: the risk of jaundice is weighed against physiological benefits of delayed clamping
UK: delay clamping earlier than necessary (unless circumstances of heavy maternal blood loss or need for immediate neonatal resusicitation take priority)

Practice gap

it takes a long time for science to influence medical practice & if it does its only done partially

Archie Cochrane

Called for efforts to make research summaries about interventions available to health care providers
Efforts led to the development of Cochrane Center in Oxford and the Cochrane Collaboration.

- helped lay foundation for evidence-based medicine

Levels of evidence

1. systematic reviews (view stats)
2. critical appraisal evidence synthesis & guidelines
3. critical appraisal article synopses
4. randomized controlled trials
5. cohort studies (compare already existing outcomes)
6. case-controlled studies/case series (1 person outcome)
7. expert opinion

Evidence based medicine

medical care based on the latest and most accurate clinical research

- involves clinical judgement, relevant scientific evidence & patients values/ preferences

Semantic knowledge

forms & changes based on the evidence we are exposed to

Procedural knowledge

forms & is based on what we frequently do (habits)

Medical knowledge

mostly procedural and only some semantic knowledge that serves procedural (explains why certain practices are adopted or not)

Scientific knowledge

mostly semantic and procedural knowledge is only used to determine what to do to update & improve

What influences the practice of obstetrics?

- personal "I wanna help"
- professional (duty of care)
- financial
medico-legal

Emotional salience

the emotional significance of percepts, thoughts, or other elements of mental experience, which can draw and sustain attention through mechanisms outside of cognitive control (system 1)

Cognitive control

deliberate guidance of current thoughts, perceptions or actions (system 2)
- conscious thoughts or actions
- imposed in goal-directed manner by currently active top-down executive processes

Amygdala

integrative center for emotions, emotional behaviour & motivation -> detects emotional salience, not threat
- located deep in the anterior inferior temporal lobe
- analogy: a smoke detector detects smoke not fire
- the stronger the emotional salience the more active

Amygdala activation & emotions

detects highest:
- disgust
- fear
- sad
- happy
- anger

fear + disgust = highly motivating

The insula

- Primary Gustatory Cortex
- taste identification & intensity
- damage can lead to the inability to identify taste experiences

Orbifrontal cortex

- secondary gustatory cortex
- A region of the brain which converts sensory information into thoughts and actions
- the motivational value (approach / avoid) of taste experience

Ventromedial prefrontal cortex (VMPFC)

involved in controlling emotional responses from the amygdala and decision-making
- very important for automatic reasoning / judgements

Somatic markers

bodily reactions that arise from the emotional evaluation of an action's consequences

- "gut feelings" or a tight stomach can indicate feelings of nervousness
- arise through unconscious process
- different markers created by different stimuli are integrated into VMPFC to produce a net somatic state

When we are in conflict with our values...

- we need to recruit cognitive control & the lateral prefrontal cortex
- increased cognitive difficulty

When we do something that agrees with our values...

- we recruit the VMPFC
- relatively high processing fluency

The Georgia Case

- hospital sought a court order authorizing to perform a c-section should she enter the hospital & refuse
- based on ultrasound stating she had placenta previa
- 99% chance fetus would die during delivery
- 50% chance mother would die

Placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus

Ultrasounds

the use of ultrasonic waves to see inside the body without performing surgery.
- sends pulses of waves into tissue using a probe & when these sound waves encounter material with different density part is rejected back to probe & detected as an echo (creating image)

What causes a baby to loose oxygen?

- if umbilical cord is stretched, punctured or pressed on

Electric fetal monitoring (EFM)

- uses ultrasound 'belts' to produce info. about the baby's heart rate & record the intensity of contractions
- gives info. about baby's distress
- introduced in 1960's with the promise to reduce 50% incidence of cerebral palsy (no evidence to back up)
- interpretations are highly subjective
- higher contractions = lower heart rate for baby

Brain injury litigation (legal action)

- EFM records used during law suites
- main tool of blame
- heavily relied on to support counterfactual claims

Counterfactuals

alternatives to what happened
- often activated automatically in response to negative events
- usually takes form of if/ then statements or questions

Counterfactual reasoning

a method of testing claims for causality by asking what might have happened if one event had not occurred

Hindsight bias

the tendency to believe, after learning an outcome, that one would have foreseen it
- "I knew it all along"
- linked to availability heuristic (makes all related info. come to mind)
- an overconfidence of one's judgement

Cerebral Palsy causes

damage to the brain before, during, or shortly after birth
- rarely due to events during childbirth
- a major cause of c-section eseclation

Hypoxia

Low oxygen saturation of the body, not enough oxygen in the blood

Neonatal mortality

morality within 1st month of birth

Infant mortality

morality within 1st year of life

Stillbirth

the birth of a dead fetus, can happen during last 3 months of pregnancy or duirng labour

Intrapartum

the number of babies who die during labour or birth, very difficult to establish

Perinatal mortality

refers to death of a child under a week or stillbirth, also included intrapartum

Biggest causes of neonatal deaths

- premature baby complications (36%)
- infection (23%)
- intrapartum related conditions (23%)
- other/ not established (18%)

Can medical care reduce neonatal mortality?

- nearly impossible to decrease neonatal mortality, however the death of children under 6 decreases with resources (proper care)

Assimilation knowledge

adding new info. into our existing model & rejecting evidence if it doesn't fit
- wrong care, wrong data

Accommodation knowledge

alternating our existing model as a result of new info. or experiences
- rejecting model of evidence doesn't fit
- wrong model, wrong thinking

Errors of judgement

based on dual-system models of reasoning
- automatic operations of system 1 generate a faulty intuition
- the controlled operations of system 2 fail to detect & correct

3 features of associative activation

- associative coherence
- attribute substitution
- processing fluency

Judgement bias

an overweighting of some aspects of info. & an underweighting / neglect of others
- those given more weight are strongly activated & vice versa
-principles of associative activation help explain biases

Associative coherence

- a stimulus evokes a coherent & self-reinforcing pattern of reciprocal activation in associative memory
- "everything reinforces everything"
- high-level inferences evoked by a stimulus
- when an idea makes intuitive sense during 'fast-thinking mode' because it fits with associations we already made around something
- what does a cow drink? - many people will say milk