Browsing by Subject "Abstract"
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Item Adequacy of glycemic control in early pregnancy with Type 2 diabetes and perinatal outcomes(2023-02-09) Izewski, Joanna; Tang, Rachel; Crites, Kundai; Campbell, Meredith; Pelton, Sarah; Saiko-Blair, Morgan; Scifres, ChristinaObjective In non-pregnant individuals with type 2 DM (T2DM), an HbA1c target < 7% is recommended. We sought to assess if an HbA1c < 7% in early pregnancy is associated with a lower risk for adverse pregnancy outcomes. Study Design We conducted a retrospective cohort study of individuals with T2DM and a singleton gestation who delivered at 2 health systems between 2018-2020. Demographics, markers of health care utilization, and perinatal outcomes were abstracted from the medical record. Race and ethnicity were self-reported. The primary exposure was levels of glycemic control at less than 20 weeks’ gestation using recommended HbA1c targets in non-pregnant individuals (HbA1c < 7% vs. HbA1c ≥7%). Patients without documentation of HbA1c prior to 20 weeks were excluded. Perinatal outcomes were abstracted from the medical record, and logistic regression was used to adjust for covariates. Results Of the individuals who had a documented HbA1c < 20 weeks of gestation, 128/281 (46%) had a HbA1c < 7%, and 153/281 (54%) had a HbA1c ≥7%. Patients with HbA1c < 7% were more likely to be of White race and have private insurance. They also had the first HbA1c measured earlier in pregnancy, a lower mean HbA1c across gestation, less overall weight gain, and were less likely to require insulin at the time of delivery. There were no significant differences in other demographics or markers of healthcare utilization (Table 1). Outcomes are shown in Table 2. After adjusting for covariates, those with a HbA1c ≥7% were more likely to have a preterm birth < 37 weeks (aOR 2.3, 95% CI 1.3-4.0), cesarean delivery (aOR 1.9, 95% CI 1.1-3.3), and a neonate requiring NICU admission (aOR 2.9, 95% CI 1.7-4.9). Conclusion Adverse perinatal outcomes are common among individuals with T2DM even when early pregnancy HbA1c values are within recommended targets for non-pregnant individuals. Those who present with a HbA1c ≥7% are at even higher risk for several outcomes. We observed important disparities in HbA1c values in early pregnancy that likely represent barriers in accessing medical care prior to pregnancy.Item An Architectural Imaginary(2014-05-20) Shopoff, Marna; Horvath, RobertMy work is a vehicle to investigate the perceptual intimacy I find within public spaces. Blending contemporary with classical approaches to art and spatial relationships, I use the idea of perception as a function of human experience, place and personal memory. I explore compositional, personal and experiential connections while creating an invitation for the viewer to do the same. A paradox exists within the material realm. I identify with who I am through the spaces I inhabit and feel as if my body can extend its presence into the built environment. My artwork becomes a lens that reveals the temporality of my experiences. Using architecture and abstraction as a philosophical approach in my paintings, architecture becomes both a visual bridge between inside and out, and a passageway of self-reflection. Abstraction is a way to move through a space. My work explores how art can become a space by its interaction with the environment and how the space can become the artwork. I conceptualize ideas relating to place identity and my lived experiences within the built environment. I view the world in a particular way because of the context in which I have experienced it: the architecture, spatial politics, personal relationships, public and private intimate spaces. I am interested in the interpretation of and the interactions with the spaces that surround me: what memories or feelings do these spaces spark and what sort of energy do they project? Likewise, I am interested in the roles that art plays in culture, architecture, and the site-specificity of spatial relationships that are formed by these interactions. My work explores whether, through art, we can share our individual perceptions, whether someone can access and experience a new view of the world through my artwork and how I can create a new space via my art.Item Arsenal(2018) Carroll, Brenna; Jefferson, Corey; Baker, Lesley; Robertson, JeanTraumatic experience inspires the human drive for expression. Survivors carry the memory of trauma with them throughout their lives while they struggle to comprehend its impact. They maintain a fragile stability as their capacity to more forward is challenged and their perception of the world around them is altered. The force of memory compels those who have survived a traumatic event to build a defensive arsenal and to search for and to convey an understanding of their experience. My minimalist abstract ceramic sculpture examines the incidence of trauma and explores the transference of concepts and emotions associated with its effects.Item Breaking Naming: The Multi-Valency of Being Human(2017) Eicher, Stefan; McDaniel, CraigViolence, whether physical or psychological, is sustained by the act of 'naming' -- placing people into categories of 'the other' based on a singular difference in socio-economic, ethnic, cultural, or religious identity. Art by its very nature works best when it succeeds in breaking the categories of certainty inherent in naming, disabling the mastery of language and optical assumptions the viewer brings with them to the work. My work seeks to break the 'violence of naming' -- transforming depictions and objects of violence by undermining the ability to fit them easily into pre-existing visual categories. Through the creation of dislocating juxtapositions, visual layering, and the deployment of surrealism my work seeks to change the meaning and substance of oppositional relationships and objects of violence, and in the process explores the multi-valency of human identity and connections between people. At a secondary level, within the context of war, and specifically Western interventions in the Middle-East and Central Asia, my work is also a critique of imperialism and power. "Breaking Naming: The Multi-Valency of Being Human" consists of three large-scale oil & acrylic paintings and two smaller sculptural/interactive installations which collectively serve as my Thesis Exhibition. In the course of this thesis paper I explore my strategies for 'breaking naming' by using specific descriptions of the works as launching points for formal, thematic, and conceptual discussions of the works. In the process I also draw on examples from my research and close with an exploration of the theoretical and metaphysical framework for the pieces.Item Maternal weight gain among individuals with Type 2 diabetes and associated perinatal outcomes(2023-02-10) Izewski, Joanna; Crites, Kundai; Tang, Rachel; Saiko-Blair, Morgan; Campbell, Meredith; Pelton, Sarah; Scifres, ChristinaObjective The prevalence of type 2 Diabetes Mellitus (T2DM) in pregnancy is increasing, and adverse perinatal outcomes are common. We sought to assess whether higher or lower weight gain is associated with adverse perinatal outcomes in T2DM. Study Design This was a retrospective cohort study of patients with T2DM and a singleton gestation who delivered at 2 health systems between 2018-2020. Demographics, markers of health care utilization, and various perinatal outcomes were abstracted from the medical record. Race and ethnicity were self-reported. Our primary exposure was weight gain < 5 kilograms(kg) across gestation compared to those who gained ≥5kg. We excluded patients for whom weight gain could not be calculated. We assessed multiple perinatal outcomes, and we used multinomial logistic regression to adjust for covariates. Results We included 341 individuals with T2DM. There were 216/341 (63%) in the ≥5kg group, and 125/341 (37%) in the < 5kg group. The < 5kg group was more likely to be of Black race. The ≥5kg group initiated prenatal care earlier in gestation, were more likely to have ≥12 total prenatal visits, and be on insulin at the time of delivery. There were no significant differences in other demographics or markers of healthcare utilization (Table 1). Perinatal outcomes are shown in Table 2. Those with < 5kg of weight gain were less likely to develop a hypertensive disorder of pregnancy (aOR 0.3, 95% CI 0.2-0.5), or undergo a cesarean delivery (aOR 0.6, 95% CI 0.4-0.9). Stillbirth was more common among those who gained < 5kg (7 vs. 2%, p=0.02). There was a statistical difference in neonatal birthweight category (AGA vs. SGA vs. LGA) (p=0.04) between the 2 groups that did not persist after adjusting for covariates. Conclusion Weight gain is associated with adverse perinatal outcomes among individuals with T2DM. While weight gain < 5kg is associated with a reduced risk for certain outcomes, the increased risk for stillbirth deserves further study.Item Steroids Precipitating Acute Thyrotoxic Paralysis(2022-03-25) Garcia, Jennifer; Pelton, Sarah; Vander Missen, Marissa; Vultorius, Daniela; Patel, Neha; Saeed, ZebCase Description: A 34-year-old Black male was admitted with a new diagnosis of Graves’ disease and impending thyroid storm with a Burch-Wartofsky Score of 25. Initial labs showed undetectable TSH, total T3 of >800, free T4 of 7.21, and TrAb of 21.53. He was started on methimazole, propranolol, and hydrocortisone 100mg q8h. On day 2 of hospitalization, he presented with acute bilateral lower extremity paralysis shortly after eating lunch. His blood glucose was 231, and a stat BMP showed a potassium of 2.0. He was found to have thyrotoxic periodic paralysis (TPP). Steroids were stopped immediately, and he was given additional propranolol and potassium repletion. He received a total of 60mEq KCl and did not have recurrence after steroids were stopped. Conclusion: Steroids are very commonly used in treatment of thyroid storm but can potentially exacerbate endocrine emergencies, such as thyrotoxic periodic paralysis. Additionally, demographic factors may have also decreased the likelihood of considering the potential for TPP as the patient’s race did not correspond to the most common demographics, Asian populations. Thus, it is important to be aware of the potential effects of steroids. Clinical Significance: TPP is a rare complication of thyrotoxicosis. Excess thyroid hormones in the blood increase activity of the Na+/K+-ATPase pump, leading to intracellular shifts of potassium and consequential hypokalemia. Glucocorticoids have been shown to increase the relative amounts of Na+/K+-ATPase pumps and exacerbate hypokalemia. Steroids are one of four common treatments for thyroid storm, so their effects on transcellular ion balance must be monitored. Insulin was also found to increase Na+/K+-ATPase pump activity, explaining why episodes of TPP often correlate with carbohydrate-rich meals. Treatment of TPP, which can be done with repletion of KCl and beta blockers, must monitor for and avoid inducing a hyperkalemic state.Item Treatment of Metastatic Her2Neu+ Breast Cancer with Oligoprogressive Disease(2024-03-22) Pelton, Sarah; Ayub, Jinan; Kenyon, Taylor; Ramchandani, Muskaan; Newton, ErinBackground Information: In treating metastatic Her2Neu+ breast cancer, trastuzumab-based chemotherapy regimens typically result in fairly durable tumor control. Historically, when there was any disease progression, the systemic therapy was changed, but it has recently been recognized that “oligoprogressive disease” (when only a limited number of metastatic sites progress) might be approached differently. This heterogeneous response to treatment is due to variation in tumor cell phenotypes, which confer drug resistance. Oligoprogressive disease is often treated with local therapy, such as stereotactic body radiotherapy (SBRT), or resection, and determination of optimal treatment regimens remains a challenge. Case Description: We report a case of a 37-year-old, premenopausal female with locally advanced, Her2Neu+ right breast cancer with de novo metastases to the liver and bone. First line systemic therapy was well-tolerated and resulted in disease control. Unfortunately, she had symptomatic progression in her primary breast tumor, which was treated with mastectomy while continuing the same systemic therapy. Later, she developed a painful, right infraclavicular metastasis; surgical resection was ultimately declined due to local edema and the tumor’s proximity to significant neurovasculature. She elected to receive palliative radiation therapy for pain control via SBRT, and her systemic therapy remained unchanged. Currently, she shows no signs of progression and continues to have excellent tolerance of her systemic therapy. Clinical Significance: Oligoprogression is a clinically significant concept for numerous cancers, but the best methods of control have not been elucidated. This case contributes to the limited knowledge base as an example of treating Her2Neu+ breast cancer-associated oligoprogressive disease with local therapy. Conclusion: The treatment approach in this case helps to define best practices for treatment of Her2Neu+ breast cancer-associated oligoprogressive disease.Item Unattached(2015) Connelly, Carly; Hull, GregI am anxiously aware of human vulnerability; the brevity of living and the impermanence of the present. There is a prism of experience in the complexity of life and death through which my work is influenced. Nothing is a direct reproduction of reality but rather, a reformed, reshaped and restored version of its past. My work imitates subconscious fears, passions, and relationships with a world that provides both destruction and renewal; the dichotomy of pain and pleasure in life in many ways informs the understanding of self and identity - but it does not define it. The work blurs between reality and fantasy, exposure and repression, surface and structure, eternity and the ephemeral. I transform materials and blend processes to create mixed media sculptures and installations that respond to space, form, and compositional relationships that re-examine my own existence and serves as a self-portrait.