Absorbing and transferring risk: assessing the impact of a statewide high-risk-pregnancy telemedical program on VLBW maternal transports

BACKGROUND: Prior research has shown that resources have an impact on birth outcomes. In this paper we ask how combinations of telemedical and hospital-level resources impact transports of mothers expecting very low birth weight (VLBW) babies in Arkansas. METHODS: Using de-identified birth certificate data from the Arkansas Department of Health, data were gathered on transports of women carrying VLBW babies for two six-month periods: a period just before the start of ANGELS (12/02-05/03), a telemedical outreach program for high-risk pregnancies, and a period after the program had been running for six months (12/03-05/04). For each maternal transport, the following information was recorded: maternal race-ethnicity, maternal age, and the birth weight of the infant. Logistic regression was used to assess the relationship between the predictors (telemedicine, hospital level, maternal characteristics) and the probability of a transport. RESULTS: Having a telemedical site available increases the probability of a mother carrying a VLBW baby being transported to a level III facility either before or during birth. Having at least a level II nursery also increases the chance of a maternal transport. Where both level II nurseries and telemedical access are available, the odds of VLBW maternal transports are only modestly increased in comparison to the case where neither is present. At the individual level, Hispanic mothers were less likely to be transported than other mothers, and teenaged mothers were more likely to be transported than those 18 and over. A mother's being Black or being over 35 did not have an impact on the odds of being transported to a level III facility. CONCLUSION: Combinations of resources have an impact on physician decisions regarding VLBW transports and are interpretable in terms of the capacity to diagnose and absorb risk. We suggest a collegial review of transport patterns and birth outcomes from areas with different levels of resources as a vehicle for moving the entire system of care forward over time. With such an evidence-based review in place, the collegial relations among level III specialists and obstetricians from around the state can, over time, develop workable protocols for when and how level III facilities should be involved

The horror of orthodoxy: Christina Mirabilis, thirteenth-century ‘zombie’ saint

In 1232, Thomas of Cantimpré wrote his Life of Christina Mirabilis (c. 1150–1224), an account of the miraculous life and three deaths of an unenclosed holy woman from the Low Countries. The text opens with an explicit vindication of Christina’s return(s) as divinely mandated. Yet, the narrative shows that her community struggles to deal with the revenant in their midst. Through her example, they must confront the terrifying mechanics of purgatory, resurrection, and the co-incidence of body and soul. A similar unease is found in modern scholarship, in which Christina is typically referred to dismissively in terms more commonly applied to cinematic monsters. I work with such dismissive language – specifically the term ‘zombie’ – to move beyond this heuristic roadblock. The terms of filmic zombie-ism provide new insight into the merging of orthodoxy and terror in Christina’s vita

How doctors generate diagnostic hypotheses: a study of radiological diagnosis with functional magnetic resonance imaging.

In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life