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#home's morse code would give Major insight into their place in all of this!!!
womenandfilm5 · 4 years
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The Virgin Suicides (1999) is Sophia Coppola’s adaptation of the novel by Jeffery Eugenides, also being her first feature film. The inspiration for the film came from her discovery of the novel in her mid-20’s. Despite being told from a male perspective, the story still seems to be an extremely feminine yet morbid coming of age tale. Coppola never imagined becoming a filmmaker, with a focus upon fashion in her late teens into her 20’s. In an interview, she says how she wanted to make a teenage film unlike the others. “There aren’t alot of quality art films made for teenagers,” she said, which she effortlessly did, portraying themes of teen angst, sex, boys, a desire to break away from societal norms, and family. The film also was low budget, as the budget dissolved a week before filming. Coppola gives credit to the novel for inspiring her film career. Her herself was in her early 20’s, which is a period of time in which you are still trying to figure yourself out as you do in your teenage years. Reflecting upon the film 20 years later, she had came to the realization that despite the male focus upon the Lisbon girls, the film felt so personal and feminine as a reflection of her life growing up. She was always surrounded by men with all brothers and all male cousins, so she found solace in grasping to femininity. This being said, it reflects the personal touch the film has, almost bringing the viewer back to reminisce in their own days of teenage angst.  .
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The film encompassed everything a teenage girl experiences, but brings a situation that isn’t exemplified in the typical coming of age film. The Lisbon girls, 13 year old Cecilia, 14 year old Lux, 15 year old Bonnie, 16 year old Mary, and 17 year old Therese, lived in a home of a scholar father, and a mother who was the obvious source of dominance and constriction in the house. The girls lived an extremely strict lifestyle, never being able to have interactions outside of their home and school life, never to dress in any manner that wasn’t conservative, and especially no romantic relations. The setting of 1970’s Michigan in an extremely tight knit neighborhood made their situation stand out from the other children in the neighborhood. Everyone knew one another, even if they had never interacted; and everyone knew the mysterious Lisbon girls. The film also visits religion quite frequently. The mother, Mrs. Lisbon, is a very high strung catholic. In many scenes, starting from the very beginning there is imagery of the Virgin Mary and sigils placed seemingly everywhere. A notable symbolic image is a card of the Virgin Mary, which we see in the opening scenes as Cecelia lays unconscious in the bathtub after her first suicide attempt. The card lies on the floor, splattered in blood. The themes associated with religion seem to be displeasure and breaking away. The theme of femininity also ties into the religious aspects. Despite the girl’s disapproval yet lack of voice upon their mother’s strictness and beliefs, every religious image is very feminized. Every time we see a rosary, or crosses, they are always surrounded by jewelry, flowers, perfume, intricate glass wear, makeup or small trinkets. The ratio to these objects is usually many feminine items with just one or two religious symbols, which displays an overpowerment that they could never express themselves. There is a profound sense of freedom the girls display, yet having no freedom at all. They are restricted by the boundaries of the religious values their mother follows, yet still embrace their girlhood and find ways to enjoy their femininity despite this. 
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. The most profound technique I found in the film was the use of the soundtrack in accordance to each scene. For example, in this particular scene, the girls had begun to communicate with the boys through morse code; due to Lux not coming home on the night of prom, the girls were under house arrest. Lux was forced to burn all of her records, so the boys spend hours upon hours playing music through the phone for the girls. In this scene which shows a progression of the boys projecting the music overtime, and the girls listening, the song “Alone Again Naturally,” by Gilbert O’ Sullivan. Although the boys never personally knew the Lisbon girls, and had had only one interaction with them at most, there was a sense of loneliness coming from the boys as they dedicated so much time to please the girls. The girls had been granted the slightest amount of freedom to attend the dance, and because of Lux never returning home that night, they had once again returned to seclusion, but even stronger than before. In another scene, during Cecilia’s party, as she excuses herself, the song “The Air that I Breathe,” by the Hollies plays. In some sense, it acts as very ironic foreshadowing. For the entire duration of her party, Cecilia sat alone in the corner, while all of the other boys socialized with the older girls. Joe, the boy with special needs, was the only one kind enough to say hello to Cecilia and give her attention. The music abruptly stops when a sound is heard, and the father is found standing outside with Cecilia’s lifeless body impaled through a spoke in the fence.  .
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This scene in particular occurs directly after Trip leaves the Lisbon household after spending time with Lux as the mother sat in between them. Trip goes to his car, flustered and sits back in the seat with his head back and eyes closed, visibly flustered. From his body language, you can assume that this response was due to the lust from Lux’s embraced sexuality that she displayed very quietly so no one would catch on besides Trip. Through his car window we see the upstairs middle light turn on, which we can assume to be the parent’s bedroom. The car door opens, and Lux jumps in and immediately begins to make out with Trip. At the same time, the song “Crazy on You,” by Heart plays. The dynamic in this scene has clear sexual tension, and also highlights the theme of disobedience and teenage angst. Trip knew what he was getting himself into by trying for a girl in such a reserved family, but also with the knowledge that Lux had a personality unlike her sisters. In the reading “Pleasure in Looking/ Fascination with the Human Form,” the term scopophilia is brought up, which is the pleasure of looking. In Freudian theory, humans enjoy viewing things that bring them pleasure, and the idea of voyueristic viewing enhances this pleasure further. Cinema essentially fulfills every aspect of scopophilia; we as the viewers are watching Lux and Trip has this passionate moment, and as a viewer of two subjects within a scene, there is no possible way for them to have any knowledge of this. Having insight into an intimate moment reflects upon the viewer, and you can almost relate the the sexual tension from a personal reflection of your own experiences, and from your own teenage years.
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The film definitely acts as the most absurd coming of age movie you can get. In comparison to a film such as say, Sixteen Candles, there is no existential crisis that is met with a resolution that acts a life lesson. The boys are under the impression they will final have the moment they craved since the beginning of the film; to take the girls and run off and have what they imagined to be the time of their life. Instead, the girls had other plans the entire time. As the boys wait, each girl meets her demise. Bonnie was hanging, Therese overdoses on pills, and Lux is found with her fingers still clutching a cigarette, dead in the garage from carbon monoxide poisoning. If anything, the film is an anti coming of age film, yet the strong vibes of femininity and softness make the viewer feel as if it’s the complete opposite. Surely families exist as the Lisbon’s, yet the strong theme of escapism through death is hard to tell as the movie progresses. 
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The tile of the film itself relates back to the major theme of religion. This theme doesn’t feel so prevalent aside from the imagery, but breaking it down becomes more understandable. In Catholocism, a virgin is a figure of purity, free of sin. The Virgin Mary was a saint because she was so pure, and conceived a child while never having sex, upholding her virginity. Despite Lux losing her virginity to Trip, the girls were viewed by everyone around them as completely pure girls who were perfect from their blonde hair down to their mysterious nature. All of the sisters met their demise through suicide, Cecilia being the first and the rest through a suicide pact. The title has two contradicting topics in nature; virginity and suicide. Maybe this acts as a not so gentle reminder that absolute purity does not always equate to perfection, as the matriarch mother believed. In fact, she believed that she raised her children perfectly and never did anything wrong. The film makes you question where true happiness actually comes from. In the mind of the family, upholding perfect standards of purity and Catholic values, and sheltering the girls from anything that could harm them, was the best way. The girls always wanted freedom, even if Lux was the forefront of breaking away from her family’s expectations. In the end, there is no perfect definition of what true happiness is. Everyone will always want what they truly desire, not what others confine them to. – JA
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https://theplaylist.net/sofia-coppola-criterion-virgin-suicides-20180502/2/
. Mulvey, Laura. “Visual Pleasure and Narrative Cinema” [1975]. Feminist Film Theory: A Reader. Ed. Sue Thornham. New York: New York University Press, 1999. 58-69.
. https://www.theguardian.com/film/2018/jan/25/sofia-coppola-on-the-virgin-suicides-director-debut
. https://thedissolve.com/features/movie-of-the-week/1076-the-virgin-suicides-is-a-window-into-sofia-coppola/
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blodreina-noumou · 5 years
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6x07 - The Good, The Bad, and The Ugly
The Good
I really enjoyed the back-and-forth dynamic between Josephine and Clarke, and the entire pretense of the episode. I know a lot of people found it cheesy, and don’t like those actresses (I don’t agree with that at all, personally, but I think that’s subjective). I had so much fun watching them run from room to room in Clarke’s psyche, seeing the way that affected Clarke’s wardrobe and hairstyle, seeing how they decided to represent certain people and certain memories. It could’ve been a “flashback episode”, but it ended up being so much more than that. 
Was it occasionally cringey and was some of the dialogue forced? Sure. But given that we were inside of Clarke’s mind for most of the episode, I’m willing to give it a pass. If you see every line as coming directly from Clarke or Josephine’s internal monologue, it makes more sense. They’re both emotional, dramatic, and self-centered. They both probably stopped developing from a psychological point-of-view a bit too early in late adolescence/early adulthood. It makes perfect sense to me that their insides would be over-the-top. Frankly, I enjoyed this aspect of the episode so much that, if it weren’t for the last ninety seconds, this would’ve easily been in my Top 5 Favorites. I really loved the premise of this - but I’m a big sucker for the trope where we enter someone’s mind and see literal interpretations of their thoughts, feelings, and memories. I’m also a huge sucker for inside jokes and flashbacks, so I loved that aspect. In some ways, this show has leaned fully into fanservice - I’m okay with that, for the most part, though I obviously have my personal qualms and squicks about it.
Bringing back Monty was an excellent choice that made my heart ache and soar in equal measure. Would the “real” Monty feel so warmly towards Clarke? Maybe not. But as a projection of her subconscious, it was perfect. A supportive Monty being on her team has led to some of Clarke’s best and worst moments. He’s so often been the key that unlocks the door to whatever lever she has to pull - him, and Raven, of course, but I definitely don’t think Raven would’ve been a positive presence in Clarke’s mind at that point in time. Monty, though? Humanity’s Big Savior? The guy who spent thirty lonely years in space cracking the Eligius III file, which led to their Second Chance? It’s honestly so meaningful that Clarke places so much value in his opinion and his support. Whether she’s worthy of her perceived viewpoint of her is almost irrelevant to how special he has become to her. Monty Green really is a hero, a good guy, and he’s still the driving force, pushing them all to “do better.” That made me happy. I’m gonna make a separate meta on each ghost-from-the-past, but it’s worth mentioning that the reappearance of Monty Green was everything to me.
The set dressing, costumes, wardrobe, and hairstyling were all so on point this episode. All of Clarke’s worlds, but especially the isolation cell, and the clearing in the woods with Lexa’s throne. The crowded contrast of the world-before-the-bombs versus the clinical cleanness we’ve seen everywhere else - before the bombs, decorations and clutter abound, but after, everything has to be salvaged for practical use. The difference in the various Josephines, that glimpse of the young woman she used to be before she witnessed that kid’s suicide in that diner. Her unbridled rage at Clarke discovering this painful memory. All of Clarke’s incarnations playing together in one episode, striking so painfully and perfectly at some of the most emotional moments of the series. I have my issues with Clarke, but whether we like it or not, she is the center of this show. She’s been through some shit. Seeing it all play out in one episode really drives home that Clarke is a very broken person, and she’s got more baggage than most. I’m still always going to prefer other characters and other storylines, but this one definitely was one of my favorites of hers.
The Bad
The real shame of this episode is that I don’t think much of it was bad at all, right up until the last ninety seconds, as I’ve mentioned, so uh, let’s just jump into -
The Ugly
That last scene. Good god. In an episode that is potentially one of my favorites, that scene is definitely up there as one of my most reviled. I don’t understand why they didn’t leave it on more of a cliffhanger? I know we’ve got a bit of a hiatus coming up after next week's episode, which will also likely focus mostly on other characters, but the reveal of Bellamy figuring out Clarke was still alive gave me literal whiplash. It was so rushed. It might’ve been the most rushed thing to ever happen on this show, and that’s saying something.
There is so much he had to randomly connect, in the midst of his grief, and trying to negotiate peace for his people, from Josephine’s sudden reappearance, bleeding nose, and randomly tapping hand. I still need to rewatch, but was her nose even bleeding when Bellamy saw her? It was before, and after, but I think she had cleaned herself up to go face them. So he didn’t even have that hint that something was going wrong in her brain. If he did, I missed it, and that’s because that scene was so goddamn rushed. Not everyone rewatches like we do, so for the casual viewer, it must’ve felt even more ridiculous.
Randomly dropping that Pike taught them all Morse code (which he probably did, he was the main teacher on the Ark, and Morse code can be useful in some situations - plus, there’s preserving it for the sake of preserving human history, which was also a major priority for them) was not enough to make it feel earned. I’m really hoping everyone looks at him like he’s crazy in the next episode, and challenges the hell out of his sudden burst of insight. Otherwise, it is so deus ex machina it hurts. Honestly, even everyone challenging him won’t be enough to remove my eye-rolling reaction to it all.
So for now, I’m gonna pretend like the episode ended with Josephine waking up or something, because that final scene just makes me too mad. The rest of it was really good, I enjoyed it a lot. Compartmentalization is key in this fandom.
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kristinsimmons · 4 years
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Maternal Mortality – Separating Signal from Noise
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By AMEYA KULKARNI, MD
When Samuel Morse left his New Haven home to paint a portrait of the Maquis du Lafayette in Washington DC, it was the last time he would see his pregnant wife. Shortly after his arrival in Washington, his wife developed complications during childbirth. A messenger took several days on horseback to relay the message to Mr Morse. Because the trip back to New Haven took several more, his wife had died by the time he arrived at their home.  So moved was he by the tragedy of lost time that he dedicated the majority of the rest of his life to make sure that this would never happen to anyone again. His subsequent work on the telegraph and in particular the mechanism of communication for the telegraph resulted in Morse code – the first instantaneous messaging system in the world.
Mr Morse’s pain is not foreign to us in the 21st century. We feel the loss of new mothers so deeply that, when earlier this year new statistics on the rate of maternal death were released and suggested that American women died at three times the rate of other developed countries during child birth, doctors, patient advocates, and even Congress seemed willing to move heaven and earth to fix the problem. As someone who cares for expectant mothers at high risk for cardiovascular complications, I too was moved. But beyond the certainty of the headlines lay the nuance of the data, which seemed to tell a murkier story.
First at issue was the presentation of the data. Certainly, as a rate per live births, it would seem that the United States lagged behind other OECD countries – our maternal mortality rate was between 17.2 and 26.4 deaths per 100,000 live births, compared to 6.6 in the UK or 3.7 in Spain. But this translated to approximately 700 maternal deaths per year across the United States (among approximately 2.7 million annual births). While we would all agree that one avoidable maternal death is one too many, the low incidence means that small rates of error could have weighty implications on the reported results. For instance, an error rate of 0.01% would put the United States in line with other developed countries.
Surely, the error rate could not account for half the reported deaths, right? Unfortunately, it is difficult to estimate how close to reality the CDC reported data is, primarily because the main source data for maternal mortality is a single question asked on the application for death certificates. The question asks whether the deceased was pregnant at the time of death, within 42 days of death, or in the 43 to 365 days prior to death. While pregnancy at the time of death may be easy to assess, the latter two categories are subject to significantly more error.
Just how much error is remarkably uncertain. One program called Review to Action attempted to ascertain this error rate by using Maternal Mortality Review committees to better understand the real causes of death among women who died around the time of the birth of their child. They looked at data from four states (Colorado (2008-12), Delaware (2009-14), Geogia (2012-13), and Ohio (2008-12)) to see if a deeper look at maternal deaths could uncover the true drivers of maternal mortality. Of the 650 deaths examined, 97 had no evidence of pregnancy in the year prior to death, a false positive rate of 15%. Among the remaining 553 deaths deemed “pregnancy associated” (death within one year of being pregnant), only 175 were thought to be pregnancy related, defined as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy related complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.” If this number was used to define maternal mortality, the rate would be 5.8/100,000 births, similar to other OECD countries.
Of course, this is an unfair comparison, because there is great variation in how maternal mortality rates are calculated across the world. Moreover, the rate of error in small numbers has as much likelihood of underreporting as it does overreporting. But it does demonstrate a core problem in the measurement of maternal mortality. Because the numbers are so small to begin with, small errors have the risk of having significant effects on the results.
Even with uncertainty in the incidence, could we learn something from those deaths confirmed to be pregnancy related? In cardiology circles, there is great emphasis placed on the fact that the leading cause of death was cardiovascular disease. If true, this could offer significant insight on how to make an impact on reducing maternal deaths. But the devil is in the details, and here the details suggested that in order to make cardiovascular disease the leading cause of pregnancy-related death, we had to combine stroke, cardiomyopathy, and “other CV conditions” which include a variety of conditions (including congenital, ischemic, hypertensive and other heart diseases) (taken from MMWR report on pregnancy related death). Though this broad grouping may make epidemiologic sense, it makes less sense when attempting to build measures to prevent death.
This is at the crux of the problem of the overemphasis on these statistics. They enable well-meaning people to create broad policies that have the potential for more harm than good. Take, for example, the administrator who boasted that he reduced the death rate to half the national average by getting automatic chest x-rays for all pregnant women with shortness of breath and automatic treatment for hypertension. At first blush it seems an impressive statistic. But even if they started at the national average, they would have reduced maternal deaths by 18. How many pregnant women received unnecessary chest radiation and medications to achieve that goal? The risks to casting wide nets to catch rare conditions are real and sometimes outweigh the benefit gained.
To understand where the balance of risks and benefits are optimized, we must start with an earnest accounting of the data in the public sphere.  As currently reported in both the medical and the lay media, the limitations of data derived from small numbers are not discussed. Though messier than the headlines suggest, this nuance offers the chance to shift focus to the actions that give clinicians, patients, and caregivers the tools to really advocate for women at risk.
We also need to lower the barriers to expertise. Cardiac obstetrics teams have become more common but are still not widespread. Most programs offer great multidisciplinary care for patients with established risk, but few offer virtual services to support the care of lower risk patients with complex circumstances. Conditions like mild hypertension, edema, or even palpitations are often benign conditions, but easily accessible expert support for these circumstances could help identify signals of increased risk at times and reassurance to the mother and her primary doctor at others. In the group I work in, we have attempted to address this problem by creating a telemedicine based consult system, so patients can be cared for by their own doctor with the benefit of background support of a larger village of experts. Building virtual support networks to broader populations offers the chance to create a safety net without the risks of overtreatment seen with reflexive care algorithms. And critically, patients can still be cared for by their own doctors, who they know and trust.
We also need to rebuild the village of support networks around new mothers. Many of the interventions that can reduce maternal risk have to do with early detection, identification of conditions like post-partum depression and unsafe home situations, and simpler things like offering new moms time to engage in self-care (exercise, sleep, stress reduction, eating right). While medical interventions seem to center on the detection of disease once medical care is sought, broadening the frame of care and creating the opportunity for peer based social support has the chance of helping all new moms, not just those at highest risk.
Most importantly, though, we need to acknowledge the complexity of the issue of maternal mortality. Our solutions are not as singular as they were for Mr Morse, and accepting this will give us our best chance at success. For us, the answer is likely a series of incremental solutions, both small and large, working together to extinguish once and for all the tragedy of lost time.
Dr Ameya Kulkarni is the Chief of Cardiology in Northern Virginia at the Mid-Atlantic Permanente Medical Group.
The post Maternal Mortality – Separating Signal from Noise appeared first on The Health Care Blog.
Maternal Mortality – Separating Signal from Noise published first on https://wittooth.tumblr.com/
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lauramalchowblog · 4 years
Text
Maternal Mortality – Separating Signal from Noise
Tumblr media
By AMEYA KULKARNI, MD
When Samuel Morse left his New Haven home to paint a portrait of the Maquis du Lafayette in Washington DC, it was the last time he would see his pregnant wife. Shortly after his arrival in Washington, his wife developed complications during childbirth. A messenger took several days on horseback to relay the message to Mr Morse. Because the trip back to New Haven took several more, his wife had died by the time he arrived at their home.  So moved was he by the tragedy of lost time that he dedicated the majority of the rest of his life to make sure that this would never happen to anyone again. His subsequent work on the telegraph and in particular the mechanism of communication for the telegraph resulted in Morse code – the first instantaneous messaging system in the world.
Mr Morse’s pain is not foreign to us in the 21st century. We feel the loss of new mothers so deeply that, when earlier this year new statistics on the rate of maternal death were released and suggested that American women died at three times the rate of other developed countries during child birth, doctors, patient advocates, and even Congress seemed willing to move heaven and earth to fix the problem. As someone who cares for expectant mothers at high risk for cardiovascular complications, I too was moved. But beyond the certainty of the headlines lay the nuance of the data, which seemed to tell a murkier story.
First at issue was the presentation of the data. Certainly, as a rate per live births, it would seem that the United States lagged behind other OECD countries – our maternal mortality rate was between 17.2 and 26.4 deaths per 100,000 live births, compared to 6.6 in the UK or 3.7 in Spain. But this translated to approximately 700 maternal deaths per year across the United States (among approximately 2.7 million annual births). While we would all agree that one avoidable maternal death is one too many, the low incidence means that small rates of error could have weighty implications on the reported results. For instance, an error rate of 0.01% would put the United States in line with other developed countries.
Surely, the error rate could not account for half the reported deaths, right? Unfortunately, it is difficult to estimate how close to reality the CDC reported data is, primarily because the main source data for maternal mortality is a single question asked on the application for death certificates. The question asks whether the deceased was pregnant at the time of death, within 42 days of death, or in the 43 to 365 days prior to death. While pregnancy at the time of death may be easy to assess, the latter two categories are subject to significantly more error.
Just how much error is remarkably uncertain. One program called Review to Action attempted to ascertain this error rate by using Maternal Mortality Review committees to better understand the real causes of death among women who died around the time of the birth of their child. They looked at data from four states (Colorado (2008-12), Delaware (2009-14), Geogia (2012-13), and Ohio (2008-12)) to see if a deeper look at maternal deaths could uncover the true drivers of maternal mortality. Of the 650 deaths examined, 97 had no evidence of pregnancy in the year prior to death, a false positive rate of 15%. Among the remaining 553 deaths deemed “pregnancy associated” (death within one year of being pregnant), only 175 were thought to be pregnancy related, defined as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy related complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.” If this number was used to define maternal mortality, the rate would be 5.8/100,000 births, similar to other OECD countries.
Of course, this is an unfair comparison, because there is great variation in how maternal mortality rates are calculated across the world. Moreover, the rate of error in small numbers has as much likelihood of underreporting as it does overreporting. But it does demonstrate a core problem in the measurement of maternal mortality. Because the numbers are so small to begin with, small errors have the risk of having significant effects on the results.
Even with uncertainty in the incidence, could we learn something from those deaths confirmed to be pregnancy related? In cardiology circles, there is great emphasis placed on the fact that the leading cause of death was cardiovascular disease. If true, this could offer significant insight on how to make an impact on reducing maternal deaths. But the devil is in the details, and here the details suggested that in order to make cardiovascular disease the leading cause of pregnancy-related death, we had to combine stroke, cardiomyopathy, and “other CV conditions” which include a variety of conditions (including congenital, ischemic, hypertensive and other heart diseases) (taken from MMWR report on pregnancy related death). Though this broad grouping may make epidemiologic sense, it makes less sense when attempting to build measures to prevent death.
This is at the crux of the problem of the overemphasis on these statistics. They enable well-meaning people to create broad policies that have the potential for more harm than good. Take, for example, the administrator who boasted that he reduced the death rate to half the national average by getting automatic chest x-rays for all pregnant women with shortness of breath and automatic treatment for hypertension. At first blush it seems an impressive statistic. But even if they started at the national average, they would have reduced maternal deaths by 18. How many pregnant women received unnecessary chest radiation and medications to achieve that goal? The risks to casting wide nets to catch rare conditions are real and sometimes outweigh the benefit gained.
To understand where the balance of risks and benefits are optimized, we must start with an earnest accounting of the data in the public sphere.  As currently reported in both the medical and the lay media, the limitations of data derived from small numbers are not discussed. Though messier than the headlines suggest, this nuance offers the chance to shift focus to the actions that give clinicians, patients, and caregivers the tools to really advocate for women at risk.
We also need to lower the barriers to expertise. Cardiac obstetrics teams have become more common but are still not widespread. Most programs offer great multidisciplinary care for patients with established risk, but few offer virtual services to support the care of lower risk patients with complex circumstances. Conditions like mild hypertension, edema, or even palpitations are often benign conditions, but easily accessible expert support for these circumstances could help identify signals of increased risk at times and reassurance to the mother and her primary doctor at others. In the group I work in, we have attempted to address this problem by creating a telemedicine based consult system, so patients can be cared for by their own doctor with the benefit of background support of a larger village of experts. Building virtual support networks to broader populations offers the chance to create a safety net without the risks of overtreatment seen with reflexive care algorithms. And critically, patients can still be cared for by their own doctors, who they know and trust.
We also need to rebuild the village of support networks around new mothers. Many of the interventions that can reduce maternal risk have to do with early detection, identification of conditions like post-partum depression and unsafe home situations, and simpler things like offering new moms time to engage in self-care (exercise, sleep, stress reduction, eating right). While medical interventions seem to center on the detection of disease once medical care is sought, broadening the frame of care and creating the opportunity for peer based social support has the chance of helping all new moms, not just those at highest risk.
Most importantly, though, we need to acknowledge the complexity of the issue of maternal mortality. Our solutions are not as singular as they were for Mr Morse, and accepting this will give us our best chance at success. For us, the answer is likely a series of incremental solutions, both small and large, working together to extinguish once and for all the tragedy of lost time.
Dr Ameya Kulkarni is the Chief of Cardiology in Northern Virginia at the Mid-Atlantic Permanente Medical Group.
The post Maternal Mortality – Separating Signal from Noise appeared first on The Health Care Blog.
Maternal Mortality – Separating Signal from Noise published first on https://venabeahan.tumblr.com
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lumenatic · 5 years
Text
-Preface- Liebe Leser, normalerweise schreibe ich diesen Blog auf Deutsch. Da ich diesen Artikel aber speziell für die Mitglieder eines amerikanischen Motorradfotografie-Forums erstellt habe, ist er auf Englisch. -End of preface-
I am in a motorcycle photography group on Facebook, the Motorcycle Photographers Forum. One of the administrator is a professional photographer who makes a living out of motorcycle photography – Don Kates from Shooters Images. In one post he shared an insight on his lighting setup and equipment. He uses only the most exquisite equipment which lives up to the highest standards of magazine photography. While the list is mouth-watering, it is not the standard gear collection the masses use due to the high cost. With this post I am sharing my gear collection in order to give another viewpoint. Please keep in mind that this does not have to be the best solution in the world. It works for me personally, but yet I am still constantly looking for ways to improve my workflow with better (or other) tools.
Disclaimer DO NOT FOCUS ON GEAR! The slogan sounds corny, but the gear is just a tool and YOU are the one creating the image. I maintain that any DSLR and mirrorless on the market is technologically capable of capturing great images. What you need to know is how to manipulate and set the light. End of disclaimer.
Enough of the introductory blabla, here we go!
Lighting
My lighting equipment consists of standard Nikon Speedlight strobes. I own two SB-800s, one SB-910 and a SB-700. The strobes are small, light, and powerful for their size. If you buy the flashes second hand they might cost 200-250 Euro per piece (230-290 USD). They are powered by four AA batteries and those last a several hour long shooting if fully charged.
The Speedlights are triggered with Yongnuo flash triggers. They are cheap (35 Euro/40 USD per piece) and reliable. Before I owned the radio triggers I fired the flashes with the Nikon CLS system, which means that the popup flash of the camera acts as the commander, sending out a kind of morse code to the slave flashes. That worked pretty well for a while, but since I had issues triggering when shooting out on an open field (the light got lost in the surroundings), I decided to go for the radio triggers.
Light formers
I am either using 80×80 cm softboxes (31,5×31,5 inch) or – start throwing tomatoes – no light former at all (more on that later).
The softboxes have a popup design (you know, like those spring-loaded tents you throw into the air, they fold out and you never know how to fold them back). The one I use are from Neweer, they are cheap (again around 40 USD each) and well made for the money. They are very portable as they do not take up much space and can be assembled in roughly a minute.
Pro tip: When packing the softbox back up, take out the diffusor screen before folding the softbox to avoid wrinkling of the fabric. Gently roll up the diffusor screen and pack it separately. These wrinkles will leave „trails“ in reflections of closeup shots as the wrinkles will appear a little darker than the smooth part of the fabric. Yes, you can also get rid of that in post, but with a little effort – rolling the screens – you can save time in post.
A while ago I used shoot-through umbrellas (see title image), but ditched those as they leave ugly reflections and are even more prone to falling over in the wind than softboxes.
As stated above, sometimes I use no light former at all. I employ this every time I do not want or need these big reflections on the painted parts. Then the flashes are “naked” on the light stands and off we go. Here is a good example of the flashes being fired without light formers. The matt finish of this Ducati Diavel Dark lights up very nicely with the flashes being so far away. From this distance an even light pattern reaches the bike, and the matt finish of the bike does not show punctual reflections (on a glossy finish the flashes would leave a small white dot as a reflection, if they are visible at all).
Lighting setup
Lighting is a complex issue with countless possible variations. If I had to compress my most freuqently used setup into a paragraph, it would read like this:
My standard setup consists of two flashes, one to the left, one to the right. Sometimes I use a third flash to give the background an additional dash of light. Most of the times I aim the light towards the bike in a steep angle, so that the contours come out nicely.
My rule of thumb for setting the lights is to determine which parts of the bike are exposed to the camera and then aim one light at each main body. If you are shooting a side view, one flash aims at the front half of the bike, the other at the rear half. If the front of the bike is facing the camera, one flash takes the bike head on, the other one illuminated the side of the bike.
Tripods and stands
My camera tripod is a Manfrotto carbon fibre one. The aluminum one I had before was also very good, but since I like cool stuff I bought the carbon fibre version 😊 I use a Novoflex MagicBall head. It is heavy, but absolutely robust. Due to the simple twist-and-align action you can compose the image very quickly. Also I like the blue colour of the ball 😉 On the downside you can break your fingers when tightening the screw. Also hooting in portrait mode is not possible with this head, unless you have a lens bracket. When turning the ball head sideways to achieve portrait mode, the weight of the lens forces the camera to rotate downwards (because you can’t tighten the screw enough with your fingers, so those two things are connected)
I use standard foldable lighting stands, see image to the right behind the doggo. They (the light stands) are cheap and do the job, but without sandbags they are prone to falling over when wind is blowing. If I were using studio flashes instead of small camera strobes, I would opt for the more robust C stands. But since the Speedlights and the softboxes I use are comparatively lightweight, the standard light stands are good.
Hauling the stuff
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Peli 1560 with padded dividers. Has rollers and an extendable handle
I prefer to be mobile on a shoot, so I tend to change the location during a shooting several times. Sometimes we only move a metres, sometimes a few dozen or a hundred, but nevertheless all the equipment needs to be moved from one place to the next. I have two big cases for all my stuff. The first one is a Pelicase with a padded divider inlay (Peli 1560. 51x39x23cm, 20×15,3×9″). Note: Those are sewn divider pads, not the foam system. This holds all the cameras, lenses, batteries, flashes, radio triggers, a small travelling tripod and all the auxiliary stuff a photographer needs like filters, a blower to clean the lens etc.
  A studio equipment case. holds lighting stands, softboxes and lightpainting equipment. Bulky thing.
The second box is a studio suitcase, here all the tripods and light formers find their home, also the Yongnuo YN360 LED stick I use for lightpainting. Moving both boxes at the same time is not practical, so an assistant comes in handy (or you have to run twice). I am not that happy with the studio case. It is so big that it does not smoothly fit in the back of my car (Toyota Verso family van). Also the sewn on carrying handles are not well placed. if you pull the box by one handle only the seams will protest. I’ve heard one or two stitches pop already, let’s see how long this lasts.
What I found to be very handy is the use of a collapsible cart like the one on the left. It folds to a very compact size and can hold quite some equipment. The photo was taken before I got the Pelicase, so my equipment is crammed into a box usually used to buy groceries (yes, that’s very basic). The Peli 1560 fits snugly into the cart with some 20 cm left to one side. Only the transport of tripods and stands is problematic, as they won’t fit in the cart. I already thought about using two hooks on the side, onto which tripods can be placed, but did not realise this solution (also because this is not my cart, it belongs to our neighbours :-D).
Cameras and lenses I shoot Nikon full format, owning a D800 and a D750 with a variety of lenses. The D750 is my workhorse and I like it a lot as it is a little slimmer than the D800 and it has a tiltable screen, which I use very frequently. I am blessed to own the „holy trinity“ of Nikkor lenses, the 14-24 f/2.8, the 24-70 f/2.8 (workhorse) and the 70-200 f/2.8 (should use that more often). I also have some other lenses like a fisheye and a 150-600 mm Tamron, but those I use seldom for motorcycle photos.
Bottom line I hope this post gave you an insight look on the technical and logistical aspects of my photo shoots. This post is meant to give you a perspective on what a set of lighting equipment could look like. I am constantly searching for better options, but this is the setup I’ve been shooting with all year long and it worked fine.
Recently (as in “this week”) I bought battery powered studio flashes, so a major shift in the lighting equipment is imminent. After collecting first experiences with this new equipment there might be changes in the logistics (bags, cases) again. Always strive for the better!
Motorcycle photography equipment -Preface- Liebe Leser, normalerweise schreibe ich diesen Blog auf Deutsch. Da ich diesen Artikel aber speziell für die Mitglieder eines amerikanischen Motorradfotografie-Forums erstellt habe, ist er auf Englisch.
0 notes
edwardmoorthy · 7 years
Text
Gone is the day when one needs maps and travel guide to visit foreign countries. Nowadays our smartphones have made planning trips easier and you can find apps that will serve as better travel guides. There are many travel apps that will help you find the most affordable flight and hotel while making sure you will have plenty of spending cash during your trip.
The iPhone and iPad are great travel companions, they are portable and thanks to the cellular models, they keep you connected anywhere, anytime! To aid your travels, the App Store features a number of quality travel apps for the iPhone & iPad, that you are going to love if you are indeed a road warrior.
However, choosing the right app can be just as confusing as deciding where to stay or how to get there. So we have combed through dozens of the latest travel apps to determine which tools are the most useful for planning a trip, getting around, finding friends, and saving money along the way. Unless noted, all apps are free and available for both iPhone and iPad.
So without further ado, here is our list of 15 Best Travel Apps for iOS.
1. Google Maps
Google Maps
Google Maps
Google Maps
Google Maps
Getting lost is not much fun, and Google Maps makes losing your way pretty much impossible. If you have got a web connection, you will have maps, live transport information, Street View, and local information. In fact, Google Maps is widely-regarded as one of the best navigation apps around, and it has reigned king for quite a while. There is voice guided GPS navigation for walking, driving, and biking.
You can also use Maps to look at when places like museums or restaurants close, and as of a recent update, you can check to see how busy a place is in real time. For the bikers, there is elevation info as well. The app also brings you live traffic reports, automatic rerouting while navigating and a lot more. If you are in a new city, the transit directions and maps that Google Maps are a must have. Another standout feature is Offline maps. Tap Offline Areas in the main menu and you can store a large chunk of virtual territory on your phone. Turn-by-turn will even work without an internet connection.
[appbox appstore 585027354]
2. CityMapper
CityMapper
CityMapper
CityMapper
CityMapper
This app is essential if you want to be able to move around like a local while abroad. Supporting many major cities worldwide, Citymapper is a map app that you can use to plan a route using any mode of transport the city offers. It gives live updates on delays and closures and is very intuitive to use.
You can save maps offline and can access the maps for transport services like Tube maps, so if you want to navigate your own way, you can do that too.
[appbox appstore 469463298]
3. Hopper
Hopper
Hopper
Hopper
Hopper
If you are really looking to get the cheapest possible price for a plane ticket, you need to download Hopper. Like Kayak and Skyscanner, you can look at the cheapest dates to fly via a month-view calendar, but Hopper prides itself on telling you when to buy your tickets via push notifications. The company claims it can save you up to 40 percent on your next flight, and that is all done by analyzing and tracking billions of flights. The user interface is simple, and Hopper says you can book a flight in 60 seconds or less. Apple added it to the App Store’s Best of 2015 list, and Google made it a 2016 Google Play Award winner.
[appbox appstore 904052407]
4. Google Trips
Google Trips
Google Trips
Google Trips
Google Trips
Are you the kind of person who prepares for every trip by getting a manila folder and filling it with every bit of your travel itinerary? Well, Google Trips is like that folder, but without the annoyance of maintaining a tatty pile of paper printouts; the app gathers all your travel information from Gmail and Inbox and organizes it automatically. It also maps out half-day or day itineraries, with suggestions of things to see or do. Best of all, it works entirely offline, so you do not need to worry about arriving in a new country and having to find a wifi spot before you can find out where you are going.
[appbox appstore 1081561570]
5. Skyscanner
Skyscanner
Skyscanner
Skyscanner
Skyscanner
Flights, hotels, rental cars – Skyscanner has got you covered. The app searches for the most affordable and best options via its travel partners. Like with Google Flights, you can see the cheapest dates to fly through a month view calendar, and you can also get alerts when prices change. If you are not sure where exactly you want to go, Skyscanner offers a category that lets you explore “Top Deals” from your nearest airport, as well as a curated list of destinations at affordable prices.
[appbox appstore 415458524]
6. Google Translate
Google Translate
Google Translate
Google Translate
Google Translate
A golden oldie (in internet terms), Google Translate has an almost sci-fi feature: offline and real-time translation. Download the language you need, and aim the camera at the text you need translating. Boom – instant translation. It even works on ingredients for Spanish supermarket bread that is printed in absurdly tiny letters.
[appbox appstore 414706506]
7. SAS Survival Guide
SAS Survival Guide
SAS Survival Guide
SAS Survival Guide
SAS Survival Guide
Know your Morse code? How about how to start a fire? With this app, you will. If you are venturing anywhere remotely off the beaten path, it is a must have. Written by a former SAS soldier and instructor, the app contains hundreds of survival skills that will help you both at home and away. Sure, you might be staying at a 5-star hotel in NYC’s Greenwich Village, but hey – better safe than sorry, right?
[appbox appstore 357811968]
8. TripAdvisor Hotels Flights Restaurants
TripAdvisor
TripAdvisor
TripAdvisor
TripAdvisor
This is of one the best free travel apps for iPhone and iPad, the official TripAdvisor app. With this app, you can easily access all the TripAdvisor features on your iPhone and iPad. You can read other users reviews, see photos and download maps for free on your iOS devices.
[appbox appstore 284876795]
9. KAYAK Flights, Hotels & Cars
KAYAK
KAYAK
KAYAK
KAYAK
The Kayak app is a great search app if you are traveling to a new place. The app lets you search for almost everything you need in a new city. You can go ahead and search for Hotels, flights. You can search and book cars, The app also brings a flight tracker and itinerary management.
The app works great and fast. You will be presented with various details while you search for something. For example, if you search for a hotel, you will get the various details such as the complete address, the distance from you, its ratings and the price rate.
The app is compatible with iOS 7 and later and it is available for free over at the App Store.
[appbox appstore 305204535]
10. Airbnb
Airbnb
Airbnb
Airbnb
Airbnb
Airbnb is now a household name but it was not that long ago that it upturned the way people booked their accommodation on holiday. It used to be that if you were going away you pretty much stayed at a hotel. Or a hostel.
Then Airbnb came along and suddenly you could stay in a beautiful house in the center of a city, or a little cottage out in the middle of nowhere. The app makes booking your accommodation simple, and also has guides for local inspiration and a section for booking experiences.
[appbox appstore 401626263]
11. Hotel Tonight
Hotel Tonight
Hotel Tonight
Hotel Tonight
Hotel Tonight
This is a reviews database of places to stay, but the quality of these reviews is what makes the app stand out. Hotel Tonight manage to be both insightful and comprehensive without being too long. The app also gives you access to last-minute discounts from hotels looking to fill vacancies.
[appbox appstore 407690035]
12. Packpoint
Packpoint
Packpoint
Packpoint
Packpoint
Packpoint automatically generates a bespoke packing list for your trip: you just enter the destination, date of travel and length of stay along with some details about the activities you are planning. In the event that the app has misjudged your desire to have a different outfit for every evening, it is easiest to tweak the list once it has been generated.
[appbox appstore 953333522]
13. XE Currency
XE Currency
XE Currency
XE Currency
XE Currency
While it is not the prettiest app, XE Currency is one of the more robust currency converter apps available for iOS. It is constantly being updated and offers live exchange rates for “every world currency and precious metals”. What is neat is that it can store the most recent rates so you can access them if your device is offline. You can also use the app on your Android Wear or Apple Watch device.
[appbox appstore 315241195]
14. Yelp
Yelp
Yelp
Yelp
Yelp
Yelp is a very popular app and it is the local guide you would need on your iPad. The app is pretty great if you are into exploring new places. Yelp lets you search for great local businesses and you can find the best place to eat, shop and enjoy near your current location.
There is also ability filter your searches based on rating, prices, distance and more. You can also choose to filter places by what is open at that time. Along with the great discovery capabilities, the app brings you pictures of local places and rating, reviews from the locals, thus giving you a good and honest idea about a place. You can also check out the address of a place and get more details such as the phone number. You can add tips, pictures and more of your own for a place.
Yelp is compatible with iOS 6 or later and it is available for free, over at the App Store.
[appbox appstore 284910350]
15. Uber
Uber
Uber
Uber
Uber
Active in about 77 countries and 527 cities, Uber is the global king of ride-sharing apps. The app pioneered on-demand services, and it can be particularly handy when you are abroad. You can quickly request a car directly within the app after perusing an assortment of differing vehicle rates and fare quotes. Afterward, you can connect with your personal driver, track the approaching car’s location, and securely pay your fair using a credit card – no cash needed. Rather than trying to find a taxi or a taxi stand, just bring one straight to you.
[appbox appstore 368677368]
A few last words
Well, that is our list of the 15 Best Travel Apps for iPhone and iPad. What about you? Tell us your favorite travel apps for the iOS in the comments and do not forget to subscribe for more updates.
See Also
7 Best Free Music Player Apps For iPhone And iPad
12 Best Education And Learning Apps For iOS (iPhone And iPad)
6 Best Free Photo / Image Editing Apps For iOS (iPhone & iPad)
15 Best Travel Apps For iOS (iPhone & iPad)
Gone is the day when one needs maps and travel guide to visit foreign countries. Nowadays our smartphones have made planning trips easier and you can find apps that will serve as better travel guides.
15 Best Travel Apps For iOS (iPhone & iPad)
Gone is the day when one needs maps and travel guide to visit foreign countries. Nowadays our smartphones have made planning trips easier and you can find apps that will serve as better travel guides.
15 Best Travel Apps For iOS (iPhone & iPad) Gone is the day when one needs maps and travel guide to visit foreign countries. Nowadays our smartphones have made planning trips easier and you can find apps that will serve as better travel guides.
0 notes
omggadgets · 7 years
Text
Gone is the day when one needs maps and travel guide to visit foreign countries. Nowadays our smartphones have made planning trips easier and you can find apps that will serve as better travel guides. There are many travel apps that will help you find the most affordable flight and hotel while making sure you will have plenty of spending cash during your trip.
The iPhone and iPad are great travel companions, they are portable and thanks to the cellular models, they keep you connected anywhere, anytime! To aid your travels, the App Store features a number of quality travel apps for the iPhone & iPad, that you are going to love if you are indeed a road warrior.
However, choosing the right app can be just as confusing as deciding where to stay or how to get there. So we have combed through dozens of the latest travel apps to determine which tools are the most useful for planning a trip, getting around, finding friends, and saving money along the way. Unless noted, all apps are free and available for both iPhone and iPad.
So without further ado, here is our list of 15 Best Travel Apps for iOS.
1. Google Maps
Google Maps
Google Maps
Google Maps
Google Maps
Getting lost is not much fun, and Google Maps makes losing your way pretty much impossible. If you have got a web connection, you will have maps, live transport information, Street View, and local information. In fact, Google Maps is widely-regarded as one of the best navigation apps around, and it has reigned king for quite a while. There is voice guided GPS navigation for walking, driving, and biking.
You can also use Maps to look at when places like museums or restaurants close, and as of a recent update, you can check to see how busy a place is in real time. For the bikers, there is elevation info as well. The app also brings you live traffic reports, automatic rerouting while navigating and a lot more. If you are in a new city, the transit directions and maps that Google Maps are a must have. Another standout feature is Offline maps. Tap Offline Areas in the main menu and you can store a large chunk of virtual territory on your phone. Turn-by-turn will even work without an internet connection.
[appbox appstore 585027354]
2. CityMapper
CityMapper
CityMapper
CityMapper
CityMapper
This app is essential if you want to be able to move around like a local while abroad. Supporting many major cities worldwide, Citymapper is a map app that you can use to plan a route using any mode of transport the city offers. It gives live updates on delays and closures and is very intuitive to use.
You can save maps offline and can access the maps for transport services like Tube maps, so if you want to navigate your own way, you can do that too.
[appbox appstore 469463298]
3. Hopper
Hopper
Hopper
Hopper
Hopper
If you are really looking to get the cheapest possible price for a plane ticket, you need to download Hopper. Like Kayak and Skyscanner, you can look at the cheapest dates to fly via a month-view calendar, but Hopper prides itself on telling you when to buy your tickets via push notifications. The company claims it can save you up to 40 percent on your next flight, and that is all done by analyzing and tracking billions of flights. The user interface is simple, and Hopper says you can book a flight in 60 seconds or less. Apple added it to the App Store’s Best of 2015 list, and Google made it a 2016 Google Play Award winner.
[appbox appstore 904052407]
4. Google Trips
Google Trips
Google Trips
Google Trips
Google Trips
Are you the kind of person who prepares for every trip by getting a manila folder and filling it with every bit of your travel itinerary? Well, Google Trips is like that folder, but without the annoyance of maintaining a tatty pile of paper printouts; the app gathers all your travel information from Gmail and Inbox and organizes it automatically. It also maps out half-day or day itineraries, with suggestions of things to see or do. Best of all, it works entirely offline, so you do not need to worry about arriving in a new country and having to find a wifi spot before you can find out where you are going.
[appbox appstore 1081561570]
5. Skyscanner
Skyscanner
Skyscanner
Skyscanner
Skyscanner
Flights, hotels, rental cars – Skyscanner has got you covered. The app searches for the most affordable and best options via its travel partners. Like with Google Flights, you can see the cheapest dates to fly through a month view calendar, and you can also get alerts when prices change. If you are not sure where exactly you want to go, Skyscanner offers a category that lets you explore “Top Deals” from your nearest airport, as well as a curated list of destinations at affordable prices.
[appbox appstore 415458524]
6. Google Translate
Google Translate
Google Translate
Google Translate
Google Translate
A golden oldie (in internet terms), Google Translate has an almost sci-fi feature: offline and real-time translation. Download the language you need, and aim the camera at the text you need translating. Boom – instant translation. It even works on ingredients for Spanish supermarket bread that is printed in absurdly tiny letters.
[appbox appstore 414706506]
7. SAS Survival Guide
SAS Survival Guide
SAS Survival Guide
SAS Survival Guide
SAS Survival Guide
Know your Morse code? How about how to start a fire? With this app, you will. If you are venturing anywhere remotely off the beaten path, it is a must have. Written by a former SAS soldier and instructor, the app contains hundreds of survival skills that will help you both at home and away. Sure, you might be staying at a 5-star hotel in NYC’s Greenwich Village, but hey – better safe than sorry, right?
[appbox appstore 357811968]
8. TripAdvisor Hotels Flights Restaurants
TripAdvisor
TripAdvisor
TripAdvisor
TripAdvisor
This is of one the best free travel apps for iPhone and iPad, the official TripAdvisor app. With this app, you can easily access all the TripAdvisor features on your iPhone and iPad. You can read other users reviews, see photos and download maps for free on your iOS devices.
[appbox appstore 284876795]
9. KAYAK Flights, Hotels & Cars
KAYAK
KAYAK
KAYAK
KAYAK
The Kayak app is a great search app if you are traveling to a new place. The app lets you search for almost everything you need in a new city. You can go ahead and search for Hotels, flights. You can search and book cars, The app also brings a flight tracker and itinerary management.
The app works great and fast. You will be presented with various details while you search for something. For example, if you search for a hotel, you will get the various details such as the complete address, the distance from you, its ratings and the price rate.
The app is compatible with iOS 7 and later and it is available for free over at the App Store.
[appbox appstore 305204535]
10. Airbnb
Airbnb
Airbnb
Airbnb
Airbnb
Airbnb is now a household name but it was not that long ago that it upturned the way people booked their accommodation on holiday. It used to be that if you were going away you pretty much stayed at a hotel. Or a hostel.
Then Airbnb came along and suddenly you could stay in a beautiful house in the center of a city, or a little cottage out in the middle of nowhere. The app makes booking your accommodation simple, and also has guides for local inspiration and a section for booking experiences.
[appbox appstore 401626263]
11. Hotel Tonight
Hotel Tonight
Hotel Tonight
Hotel Tonight
Hotel Tonight
This is a reviews database of places to stay, but the quality of these reviews is what makes the app stand out. Hotel Tonight manage to be both insightful and comprehensive without being too long. The app also gives you access to last-minute discounts from hotels looking to fill vacancies.
[appbox appstore 407690035]
12. Packpoint
Packpoint
Packpoint
Packpoint
Packpoint
Packpoint automatically generates a bespoke packing list for your trip: you just enter the destination, date of travel and length of stay along with some details about the activities you are planning. In the event that the app has misjudged your desire to have a different outfit for every evening, it is easiest to tweak the list once it has been generated.
[appbox appstore 953333522]
13. XE Currency
XE Currency
XE Currency
XE Currency
XE Currency
While it is not the prettiest app, XE Currency is one of the more robust currency converter apps available for iOS. It is constantly being updated and offers live exchange rates for “every world currency and precious metals”. What is neat is that it can store the most recent rates so you can access them if your device is offline. You can also use the app on your Android Wear or Apple Watch device.
[appbox appstore 315241195]
14. Yelp
Yelp
Yelp
Yelp
Yelp
Yelp is a very popular app and it is the local guide you would need on your iPad. The app is pretty great if you are into exploring new places. Yelp lets you search for great local businesses and you can find the best place to eat, shop and enjoy near your current location.
There is also ability filter your searches based on rating, prices, distance and more. You can also choose to filter places by what is open at that time. Along with the great discovery capabilities, the app brings you pictures of local places and rating, reviews from the locals, thus giving you a good and honest idea about a place. You can also check out the address of a place and get more details such as the phone number. You can add tips, pictures and more of your own for a place.
Yelp is compatible with iOS 6 or later and it is available for free, over at the App Store.
[appbox appstore 284910350]
15. Uber
Uber
Uber
Uber
Uber
Active in about 77 countries and 527 cities, Uber is the global king of ride-sharing apps. The app pioneered on-demand services, and it can be particularly handy when you are abroad. You can quickly request a car directly within the app after perusing an assortment of differing vehicle rates and fare quotes. Afterward, you can connect with your personal driver, track the approaching car’s location, and securely pay your fair using a credit card – no cash needed. Rather than trying to find a taxi or a taxi stand, just bring one straight to you.
[appbox appstore 368677368]
A few last words
Well, that is our list of the 15 Best Travel Apps for iPhone and iPad. What about you? Tell us your favorite travel apps for the iOS in the comments and do not forget to subscribe for more updates.
See Also
7 Best Free Music Player Apps For iPhone And iPad
12 Best Education And Learning Apps For iOS (iPhone And iPad)
6 Best Free Photo / Image Editing Apps For iOS (iPhone & iPad)
15 Best Travel Apps For iOS (iPhone & iPad) Gone is the day when one needs maps and travel guide to visit foreign countries. Nowadays our smartphones have made planning trips easier and you can find apps that will serve as better travel guides.
0 notes
kristinsimmons · 4 years
Text
Maternal Mortality – Separating Signal from Noise
Tumblr media
By AMEYA KULKARNI, MD
When Samuel Morse left his New Haven home to paint a portrait of the Maquis du Lafayette in Washington DC, it was the last time he would see his pregnant wife. Shortly after his arrival in Washington, his wife developed complications during childbirth. A messenger took several days on horseback to relay the message to Mr Morse. Because the trip back to New Haven took several more, his wife had died by the time he arrived at their home.  So moved was he by the tragedy of lost time that he dedicated the majority of the rest of his life to make sure that this would never happen to anyone again. His subsequent work on the telegraph and in particular the mechanism of communication for the telegraph resulted in Morse code – the first instantaneous messaging system in the world.
Mr Morse’s pain is not foreign to us in the 21st century. We feel the loss of new mothers so deeply that, when earlier this year new statistics on the rate of maternal death were released and suggested that American women died at three times the rate of other developed countries during child birth, doctors, patient advocates, and even Congress seemed willing to move heaven and earth to fix the problem. As someone who cares for expectant mothers at high risk for cardiovascular complications, I too was moved. But beyond the certainty of the headlines lay the nuance of the data, which seemed to tell a murkier story.
First at issue was the presentation of the data. Certainly, as a rate per live births, it would seem that the United States lagged behind other OECD countries – our maternal mortality rate was between 17.2 and 26.4 deaths per 100,000 live births, compared to 6.6 in the UK or 3.7 in Spain. But this translated to approximately 700 maternal deaths per year across the United States (among approximately 2.7 million annual births). While we would all agree that one avoidable maternal death is one too many, the low incidence means that small rates of error could have weighty implications on the reported results. For instance, an error rate of 0.01% would put the United States in line with other developed countries.
Surely, the error rate could not account for half the reported deaths, right? Unfortunately, it is difficult to estimate how close to reality the CDC reported data is, primarily because the main source data for maternal mortality is a single question asked on the application for death certificates. The question asks whether the deceased was pregnant at the time of death, within 42 days of death, or in the 43 to 365 days prior to death. While pregnancy at the time of death may be easy to assess, the latter two categories are subject to significantly more error.
Just how much error is remarkably uncertain. One program called Review to Action attempted to ascertain this error rate by using Maternal Mortality Review committees to better understand the real causes of death among women who died around the time of the birth of their child. They looked at data from four states (Colorado (2008-12), Delaware (2009-14), Geogia (2012-13), and Ohio (2008-12)) to see if a deeper look at maternal deaths could uncover the true drivers of maternal mortality. Of the 650 deaths examined, 97 had no evidence of pregnancy in the year prior to death, a false positive rate of 15%. Among the remaining 553 deaths deemed “pregnancy associated” (death within one year of being pregnant), only 175 were thought to be pregnancy related, defined as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy related complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.” If this number was used to define maternal mortality, the rate would be 5.8/100,000 births, similar to other OECD countries.
Of course, this is an unfair comparison, because there is great variation in how maternal mortality rates are calculated across the world. Moreover, the rate of error in small numbers has as much likelihood of underreporting as it does overreporting. But it does demonstrate a core problem in the measurement of maternal mortality. Because the numbers are so small to begin with, small errors have the risk of having significant effects on the results.
Even with uncertainty in the incidence, could we learn something from those deaths confirmed to be pregnancy related? In cardiology circles, there is great emphasis placed on the fact that the leading cause of death was cardiovascular disease. If true, this could offer significant insight on how to make an impact on reducing maternal deaths. But the devil is in the details, and here the details suggested that in order to make cardiovascular disease the leading cause of pregnancy-related death, we had to combine stroke, cardiomyopathy, and “other CV conditions” which include a variety of conditions (including congenital, ischemic, hypertensive and other heart diseases) (taken from MMWR report on pregnancy related death). Though this broad grouping may make epidemiologic sense, it makes less sense when attempting to build measures to prevent death.
This is at the crux of the problem of the overemphasis on these statistics. They enable well-meaning people to create broad policies that have the potential for more harm than good. Take, for example, the administrator who boasted that he reduced the death rate to half the national average by getting automatic chest x-rays for all pregnant women with shortness of breath and automatic treatment for hypertension. At first blush it seems an impressive statistic. But even if they started at the national average, they would have reduced maternal deaths by 18. How many pregnant women received unnecessary chest radiation and medications to achieve that goal? The risks to casting wide nets to catch rare conditions are real and sometimes outweigh the benefit gained.
To understand where the balance of risks and benefits are optimized, we must start with an earnest accounting of the data in the public sphere.  As currently reported in both the medical and the lay media, the limitations of data derived from small numbers are not discussed. Though messier than the headlines suggest, this nuance offers the chance to shift focus to the actions that give clinicians, patients, and caregivers the tools to really advocate for women at risk.
We also need to lower the barriers to expertise. Cardiac obstetrics teams have become more common but are still not widespread. Most programs offer great multidisciplinary care for patients with established risk, but few offer virtual services to support the care of lower risk patients with complex circumstances. Conditions like mild hypertension, edema, or even palpitations are often benign conditions, but easily accessible expert support for these circumstances could help identify signals of increased risk at times and reassurance to the mother and her primary doctor at others. In the group I work in, we have attempted to address this problem by creating a telemedicine based consult system, so patients can be cared for by their own doctor with the benefit of background support of a larger village of experts. Building virtual support networks to broader populations offers the chance to create a safety net without the risks of overtreatment seen with reflexive care algorithms. And critically, patients can still be cared for by their own doctors, who they know and trust.
We also need to rebuild the village of support networks around new mothers. Many of the interventions that can reduce maternal risk have to do with early detection, identification of conditions like post-partum depression and unsafe home situations, and simpler things like offering new moms time to engage in self-care (exercise, sleep, stress reduction, eating right). While medical interventions seem to center on the detection of disease once medical care is sought, broadening the frame of care and creating the opportunity for peer based social support has the chance of helping all new moms, not just those at highest risk.
Most importantly, though, we need to acknowledge the complexity of the issue of maternal mortality. Our solutions are not as singular as they were for Mr Morse, and accepting this will give us our best chance at success. For us, the answer is likely a series of incremental solutions, both small and large, working together to extinguish once and for all the tragedy of lost time.
Dr Ameya Kulkarni is the Chief of Cardiology in Northern Virginia at the Mid-Atlantic Permanente Medical Group.
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