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What is equipoise in clinical trials? Real uncertainty among medical experts about which treatment works best. Why is equipoise important for clinical trials? It ensures that trials are ethical and that patients are not knowingly given inferior treatments. What happens if researchers know one treatment is clearly better? It is unethical to randomize patients, as it would harm them. What is individual equipoise? A single doctor is unsure about which treatment is better. What is clinical equipoise? The medical community as a whole is unsure about which treatment is superior. What did Freedman argue about the old view of equipoise? He argued that it is acceptable for individual doctors to have preferences as long as the expert community disagrees overall. When must a clinical trial stop? When strong evidence shows that one treatment is better than the others. What are multi-arm trials? Trials that compare multiple treatments, requiring equipoise among all options. What tension exists in clinical trials regarding patient care? The tension between the need for randomization in research and the desire to provide the best care for patients. What is the response to critics who say equipoise slows research? Freedman argues that ethics is more important than the speed of research. What is the problem with randomization starting at the first patient? It can be difficult due to changing opinions and preferences of doctors throughout the trial. What is the 'counsel of desperation' according to Freedman? Suggestions to abandon equipoise for the sake of advancing medical knowledge. What does Marquis suggest regarding participation in clinical trials? He suggests a new kind of ethics that forces people into participating in medical research. What is theoretical equipoise? A perfect balance between two treatments, which is unrealistic due to inherent biases. How does Freedman view theoretical equipoise? He believes it is fragile and can be easily disrupted by any evidence or instinct. What is the bottom line rule for ethical trials according to Freedman? Only conduct trials when experts truly do not know which treatment is best. What happens if a trial lacks equipoise? The trial can collapse and fail, as seen in the breast cancer trial example. What is the significance of the breast cancer trial mentioned? It was stopped because the researchers were not in a state of equipoise. What is the ethical concern with giving patients inferior treatment? It is considered unethical to knowingly provide a treatment that is believed to be worse. What is the role of the medical community in establishing equipoise? The community must have honest disagreements about the effectiveness of treatments. What does Freedman say about the ethics of research? Ethics should never be sacrificed for faster results in clinical trials. What is the impact of personal opinions on clinical trials? Personal opinions can create bias and affect the ethical nature of trials. What is the challenge of maintaining equipoise during a trial? It can be difficult due to the evolving nature of medical knowledge and opinions. What is the ethical implication of abandoning equipoise? It risks losing the moral foundation necessary for conducting ethical trials. What does Freedman suggest about overly neat trials? They should only be conducted if experts are truly uncertain about treatment effectiveness. What is the consequence of having a clear preference among doctors? It can render a trial unethical if there is a consensus on which treatment is superior. What is the importance of randomization in clinical trials? It ensures fairness and helps eliminate bias in treatment assignment. What is one potential problem with patient consent in trials? Patients may refuse what the physician considers the best treatment.
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Infant Development (chapter 2) Alcohol Favorite toy as a transitional Baby’s wants and needs are the same thing Non-emotion induced tears- see two things water and salt. Emotion induced tears- water, salt,endorphins, and endoxified protiens. Toxins and endorphins reduce stress. Prolactin and oxytocin (frequency, duration, intensity) Egotistical response Bioevolutionary speaking crying is a survival instinct. Babies absorb about 10 times radiation than adults. Closer chromosomes with female chimp than a human male. culture dictates how much time we spend with our babies. Bowlby said that culture is so powerful that it can override instincts. Behaviorism theory can say that instinct do not exist in humans. About 77% of infants (12 m) 40 or more hours a week. About 8 of our babies are not raised with their parents. It matters how we raise our kids, because they will grow up and make choices for us. About 75%-80% of women said they were working for personal fulfillment. Women would rather be at work than be with their children at home. Snowball effect- To be able to read those cues, it takes times. so when you don’t spend time with them you wont pick up their cues. Quality time involves quantity. Having kid at work can also be counted as quality because they can still ask questions and make memories. It’s just about the amount of time you spend. They have the highest turnover rates than any other job Cultural feminist- belief that women are superior than men because they will never do things that women could. Feminism-men and women should be treated equally. Formula is digestible and allows you to sleep longer but when awake stomach hurts Ferberize a baby to make them sleep longer. Works for any age, put in crib, pat their back (3 time) and turn off lights and leave room Come back 20 minutes and pat back again and leave without turning light on. Next night 21, 22, 23, and increase each night. Can leave baby alone because they are starving and also since they don’t have a sense of time (they think you leave forever) We spoil babies (holding too much, pick up when crying) 1912 We spoil babies the exact why we spoil fruit, (leave them alone) Anecetipmen is also to ADHD, brain is not receiving signals Day 2 Relational play- understanding what goes with what. Stranger anxiety- you like people you don’t know at all (8-9 months) Categorical anxiety- they don’t like glasses etc. Visual cliff- she was born knowing not to go off cliff. Strange situation test- You can not measure attachment Other countries when given money for having a baby only have one baby. ( Sweden) Independence cannot be taught. Our need for sleep that drives what happens to our babies 80% world’s co-sleeping because everyone sleeps better. Moms slept with babies in the past. Needs have never changed for babies from very first baby to the ones present. According Erickson the first year is where we determine if the word is a safe place. Emotional needs for babies are as important as their physical needs. Letting a child cry it out is perceived as child abuse in other countries. You can be taken to jail and/or ticketed. (Other cultures) Formula feeding is super convenient 88% of white educated American pediatricians In American in curbs where SIDS occurred the most Royal rode to the unconscious - you will deal with the hard stuff when you are awake. Boy and girls develop differently All around the world, all babies start using words at 12 months If not start using words 12 months then might check hearing. Nouns are the first words Chomsky ( are speaking is innate) Talking to us or someone to talk for us The more you’re talked to the more you are verbal fluently The word no Bali is a country where babies that are perceived to be devine Refuse to babies on the ground up until the first 6 months 6 months ceremony 6 months can crawl, and sit up Breastfeeding, staying close proximity, co-sleeping Wearing your baby much more likely to read their cues Make them scared of the whole world Developmentally appropriate More child is held the happier they are, more nursed she will be happier (oxytocin, prolactin) We call this an ancient physiological interdependence. Advanced motor skill, more vertigo Baby is learning through the mothers experience Instinct Less crying ( more time together) Non-medicated births, baby-led breastfeeding, co-sleeping Colic can be withdrawal- formula fed - stomach issues - co-sleeping— miss mom Motor skills- body doing everything the mother is doing Lower vertigo, because you get a workout Separated from their mothers they cry Higher self esteem, they are more self -reliant- lower rates of anxiety and depression Strong sense of self Mesozoic era Two types of mammals -caching hide their young to protect them while they go look for food. Their babies can remain silent for long periods of time Their milk is very very high is protein very high is fat Caring mammals- their young are born helpless, they can’t regulate body temperature, they need constant contact with their mom for protection, their milk is low in fat and low in protein designed for continuous and on demand feeding Humans are caring mammals Monkeys, apes, Pigmies - long term breastfeeding 4-5 years Learn from experiences Babies worn long term !Kung- very very tall people They breastfeed 4-5 years Not having babies often Very sexual people Master gland- nursing often, gland stays silent Breastfeeding becomes spaced not they can have a child Not having periods Sleep 4-7 hours, period comes Baby nursing almost all the time It’s nutritional and its medicinal, and attachment formation More the baby suckle the more milk you make What kind of birth control pill- cannot breastfeed on birth control About 200 years ago the crib was introduced According to John bowlby separation form attachment figure can be physiological damaging Bowlbys primary attachment theory Tears and constant waiting for mom to return Very sad, no affect, low affect Deattachment- know she’s not going to come back Can be long term, Can impair child’s ability to form loving relationships Internal working model is our prototype for all later relationship Bowlby hypothesized in the 1940s that separation from mother can leave to chronic anxiety and depression It is impossible to measure neurotransmitters of a brain of a living human The number one cause of disability is depression Babies don’t have a concept to time Existential sense of self Dichotomy of the public and private sphere Is where you nurture and raise children Family was a man and a women and their children Three types of women Those that have to be mothers They love kids, they want take them back to their parents She doesn’t want kids, doesn’t like them Bought a house 10.5 years after they got married 600 and 25 ft 28 years old car Few months after marriage Car is no 20 years old It is not 600 and 25 ft If we breastfed for 12 months and you save 7,
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