admitting

“You’re overreacting” is a phrase that I have been told too many times that it has now become an immediate response to emotional situations. Because of this, most emotions are dismissed. The drawings and prints that I make are developed from a highly personal narrative discussing specific events, interactions and/or thoughts that arouse tension. They are an opportunity to admit damaging internal, uncomfortable conversations and interactions, while depicting tension and mental confinement. During the production process of a drawing or print there is a conversation of acknowledgement happening between these objects and myself, creating an uncomfortable, yet honest conversation. Innocent, metaphorical objects help illustrate these internal disruptions. A wooden chair, vintage tv and a hare, along with a variety of secondary objects, are depicted in minimalistic settings dominated by negative space forcing the viewer’s attention on these objects, reinforcing mental confinement while adding a somber and tense disposition. Through the use of selective color, I am able to shed light on those tense moments even more. The combination of objects create a small moment within a larger narrative. The chair represents stability, comfortable or not and the vintage tv represents static, mental noise and implied disconnection. The hare is at the bottom of the food chain, and they are hyper-aware along with being naturally vulnerable and their solitary nature. Silkscreen is my printing medium of choice due to its encouragement of transparency and layers, allowing my images to be soft and subtle. Artistic influences derive from mixed-media artist Toba Khedoori, with solitary spaces she creates through minimal imagery and compositions. I also look to lithographer Kathryn Polk for her use of interactions between figures and objects, as well as her muted color pallet. Other influences are words. Words are powerful; from poems such as milk and honey by Rupi Kaur, to music, or simply everyday conversations and the lack thereof. Words shape our day to day lives. Overreaction or not, your body is trying to tell you something. Something is causing distress and tension, and the last thing we want to hear is that we are overreacting. My work brings light to interactions and concepts that cause emotional strain and the desire to understand why.https://digitalcommons.murraystate.edu/art498/1044/thumbnail.jp

Hanna Kesty

I am not one to make myself the center of attention, therefore self-portraits or any aspect of myself were never an obvious choice. My work is developed from a personal narrative through drawing and printmaking, and is an opportunity to have an open conversation about mental health as a complex form that has multiple parts and pieces. Innocent, metaphorical objects help illustrate a variety of internal disruptions of that form. During the production process of a drawing or print there is a conversation of acknowledgement and honesty happening between these objects and myself. These objects are depicted in minimalistic settings dominated by negative space forcing the viewer’s attention on the object. Due to the minimalistic settings there is a somber and desolate disposition that dominates the objects, such as a wooden chair, vintage TV, a hare and tree trunk mask. The pieces/objects are typically depicted distressed and covered with two-dimensional string to emphasize internal distress and chaos. Visual cues help the viewer in navigating the composition. Artistic influences stem from lithographer Kathryn Polk with her use of a realistic and imagined figure, as well as her muted color pallet, and from mixed-media artist Toba Khedoori and the solitary spaces she creates with minimal imagery. Other influences are words. Words are powerful; from poems such as milk and honey by Rupi Kaur, to music, or simply everyday conversations, words shape our day to day lives. Mental health is different from person to person, yet every person can relate to other people’s stories to a certain extent. It is something that should be openly discussed and not dismissed or suppressed. With this discussion I am connecting to others universally and possibly helping them figure out their own parts and pieces.https://digitalcommons.murraystate.edu/art399/1052/thumbnail.jp

Bitter Sweet

This written document is the accompanying thesis for my Master of Fine Arts Exhibition, Bitter Sweet. The exhibition featured traditional framed prints with sculptural accents that reveal brutally honest negative personal experiences, interactions, and emotions, paired with delicately cute aesthetics. My work embodies the necessity of personal artistic expression to process years of emotional repression. The prints and sculptures in the exhibition focus around a collection of insults and harsh comments coupled with feelings of loneliness and isolation. I allow personal vulnerability to show, to reinforce that these moments have molded and shaped who I am and will continue to do so. My aim is to illustrate the reality of a contradictory and bitter sweet existence, and give the viewer the time and space to feel or experience similar emotions

Preterm Labor Predictors: Maternal Characteristics, Ultrasound Findings, Biomarker, and Artificial Intelligence

The identification of risk factors for preterm labor is an important predictor. The risk factors for preterm labor can be maternal characteristics, namely maternal obstetric history, maternal body mass index and weight gain, multiple pregnancy, maternal infections, periodontal disease, maternal vitamin D deficiency, and lifestyle. Nowadays, various accurate diagnostic methods have been developed to diagnose preterm labor, namely ultrasound (cervical length, cervical consistency, uterocervical angle, and fetal adrenal gland) and biomarkers (IL-6 and IL-8 in cervicovaginal fluid, Placental Alpha Microglobulin-1 (PAMG-1), and Insulin-Like Growth Factor Binding Protein-1 (IGFBP-1), Vascular Endothelial Growth Factor (VEGF), Placental Growth Factor (PGF), Soluble VEGF Receptor-1 (sFlt-1), High Mobility Group Box-1 (HMGB1), and calponin. Artificial Intelligence was developed to predict preterm labor, namely in the form of ultrasound software which is capable of detecting cervical funneling processes ranging from resembling the T, Y, V, and U-shaped. This software is expected to be easily used by general practitioners and obstetricians and gynecologists, especially those who work in rural areas.

CURRENT UPDATE ON CONGENITAL HEART DISEASE SCREENING IN PREGNANCY

Congenital Heart Disease (CHD) affects 8 births per 1,000 live births; equivalent to 1.35 million children born with CHD each year. Based on global incidence rate, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), and Atrioventricular Septal Defect (AVSD) are found on 54.5% of CHD cases. Genetic factors are known to involve in CHD. Moreover, it can also be caused by environmental and infectious factors. Ultrasonography has been widely utilized to screen CHD at 18-22 weeks gestational age. Screening aims to measure heart rate, heart size, heart position, four chamber of the heart, pericardium, atrium, ventricles, atrioventricular junctions, and ventriculoatrial junctions. Doppler echocardiography becomes primary diagnostic tools in CHD patients because of its high sensitivity and specificity, safety, and noninvasiveness. Follow-up examination is indicated on a few conditions. Maternal indications include autoimmune antibody, family history of defects, in vitro fertilization, maternal metabolic disease, or teratogenic exposure. Fetal indications include abnormal screening result, family history of CHD, abnormal heart rhythm, chromosomal abnormalities, extracardiac abnormalities, hydrops, or monochorionic twin pregnancy. With increased rate of CHD, better screening and follow-up should be conducted to achieve acceptable detection rate

Maternal Mortality Rate at East Ogan Komering Ulu (East OKU) Regional Public Hospital Over a Four Year Period: Trends, Its Associated Factors and Neonatal Outcome

Objective: To determine the MMR trends, its associated factors, and neonatal outcome at East OKU Regional Public Hospital from 2013 until 2016. Methods: This descriptive study was performed from January 2013 until December 2016 in maternity ward and Intensive Care Unit (ICU) of East OKU Regional Public Hospital, South Sumatera. Data was collected from medical records. There were 17 maternal deaths, but 1 data was excluded due to lack of data. Results: We recorded 2,191 pregnancies and 17 maternal deaths. Over 4 years, the lowest MMR occurred in 2013 (229/100,000) and achieved its peak in 2014 (1,306/100,000). Then, MMR followed downward trend dropping from 1,087/100,000 in 2015 until 588/100,000 in 2016. Most of deceased were childbearing age women (50.0%), multigravida (62.5%), but nulliparous (50.0%), and aterm (87.5%). The major etiology of maternal deaths were hypertensive disorder (37.5%), followed by hypertensive disorder + hemorrhage and hypertensive disorder + infection in the same proportion. MMR were higher in inborn cases (87.5%), born via C-section (87.5%), and treated for less than 48 hours (93.75%). Alive neonatal were born in most cases (62.5%). Conclusion: MMR trends in our hospital were fluctuating with a downward trend, but still much higher than the MDGs target in 2015 (102/100,000). Hypertensive disorder plays significant role in maternal deaths. In addition, most of neonates were born alive. We hope that this study can be a feedback for hospital to do maternal and perinatal audit. Keywords: Factors, Maternal mortality rate, Neonatal outcome, Regional public hospital, Trends     Tujuan: Untuk menentukan pola, faktor yang berkaitan, dan luaran neonatus di RSUD OKU Timur dari 2013 hingga 2016. Metode: Studi deskriptif dilakukan dari Januari 2013 hingga Desember 2016 di bangsal kebidanan dan unit perawatan intensif RSUD OKU Timur, Sumatera Selatan. Data dikumpulkan dari rekam medik. Terdapat 17 kematian ibu, tetapi 1 data dieksklusi karena data yang kurang lengkap. Hasil: Terdapat 2.191 kehamilan, dan 17 kematian ibu. Selama 4 tahun, AKI terendah terjadi pada 2013 (229/100.000) dan mencapai puncaknya pada 2014 (1.306/100.000). Kemudian, AKI mengalami penurunan dari 1.087/100.000 pada 2015 hingga 588/100.000 pada 2016. Mayoritas sampel berusia reproduktif (50,0%), multigravida (62,5%) dan nulipara (50,0%), serta aterm (87,5%). Mayoritas kematian ibu disebabkan oleh hipertensi dalam kehamilan (HDK) (37,5%), diikuti oleh HDK + perdarahan dan HDK + infeksi dalam jumlah yang sama. AKI lebih tinggi pada ibu yang melahirkan di RS (87,5%), melahirkan melalui sectio caesaria (87,5%), dan dirawat selama kurang dari 48 jam (93,75%). Mayoritas neonatus dilahirkan hidup (62,5%). Kesimpulan: Pola AKI di RSUD berfluktuasi dengan pola menurun, tetapi masih jauh lebih tinggi dari target MDGs pada tahun 2015 (102/100,000). Hipertensi dalam kehamilan berperan signifikan terhadap kematian ibu. Mayoritas neonatus dilahirkan hidup. Studi ini diharapkan dapat menjadi masukan bagi rumah sakit untuk melakukan audit maternal dan perinatal. Kata kunci: Angka kematian ibu, Faktor, Luaran neonatus, Pola, Rumah sakit umum daera

Risk Factors of Postpartum Urinary Retention: Faktor Risiko Retensio Urine Pascasalin

Objective: To determine the correlation between risk factors and the incidence of postpartum urinary retention (PUR) at RSUP Dr. Mohammad Hoesin Palembang. Method: Analytical observational study with cross sectional design to find out the correlation between risk factors and incidence of PUR at emergency room, delivery room and ward at dr. Mohammad Hoesin General Hospital Palembang since October 2018 to April 2019. There were 82 samples that met inclusion criteria. The correlation between risk factors and the incidence of urinary retention was analyzed using Chi Square test/ Fisher Exact test, and the most important risk factor was determined using the Logistic Regression test. Data analysis used SPSS version 22.0. Result: In this study, it was found that there was a significant relationship between prolonged second stage of labor (PR=40.75, p=0.000), type of labor (PR=9.028 CI 95% 2.114–38.558; p=0.004 ) and perineal laceration (PR=12.938 CI95% 1.872–89.414; p=0.016) with PUR. However, there was no significant relationship between age, parity, neonatal birth weight, episiotomy, vulvar edema and urinary retention (p>0.05). It was concluded that instrumental delivery had a significant effect on the incidence of urinary retention (PR=13,541 CI95% 2.381–77.018, p value=0.003) by using logistic regression test.Conclusion: The most important risk factor of urinary retention was instrumental delivery.Keywords:   instrumental delivery, perineal laceration, postpartum urinary retention, type of labor   Abstrak Tujuan: Untuk mengetahui hubungan antara faktor risiko dan kejadian retensio urine pascasalin di RSUP Dr. Mohammad Hoesin Palembang.Metode: Penelitian observasional analitik dengan desain potong lintang untuk mengetahui hubungan antara faktor risiko dan kejadian retensio urine pascasalin di IGD, kamar bersalin dan bangsal perawatan RSUP Dr. Mohammad Hoesin Palembang sejak Oktober 2018 sampai April 2019. Didapatkan 82 sampel yang memenuhi kriteria inklusi. Hubungan antara faktor risiko dan kejadian retensio urine dianalisis menggunakan uji Chi Square/Fisher Exact, sedangkan untuk mengetahui faktor risiko yang paling berperan menggunakan uji regresi logistik. Analisis data menggunakan SPSS versi 22.0.Hasil: Pada penelitian ini, didapatkan hubungan yang signifikan antara lama kala II (PR=40,75, p=0,000), jenis persalinan (PR=9,028 IK95% 2,114–38,558; p=0,004), laserasi perineum (PR=12,938 CI95% 1,872–89,414; p=0,016), dan retensio urine pascasalin. Namun, didapatkan hubungan yang tidak signifikan antara usia, paritas, BBL bayi, episiotomi, edema vulva, dan kejadian retensio urin (p>0,05). Dengan uji regresi logistik, didapatkan kesimpulan bahwa jenis persalinan dengan instrumen berpengaruh secara signifikan terhadap kejadian retensio urine (PR = 13,541 IK95% 2,381–77,018, p value = 0,003).Kesimpulan: Faktor risiko yang paling berperan terhadap kejadian retensio urine pascasalin adalah persalinan dengan instrumen.Kata Kunci: jenis persalinan, instrumen, laserasi perineum, retensio urine pascasali

Primigravida Hamil 12 Minggu dengan Atrial Septal Defect Secundum dan Hipertensi Pulmonal Berat Janin Tunggal Hidup Intrauterin

Latar Belakang: Atrial Septal Defect (ASD) apabila disertai hipertensi pulmonal berat harus dikonseling karena tingginya insiden morbiditas dan mortalitas ibu dan janin. Tujuan: Memaparkan sebuah kasus primigravida dengan ASD secundum dan hipertensi pulmonal berat sehingga dapat dilakukan tatalaksana dan pemilihan kontrasepsi yang sesuai.Metode: Laporan kasus seorang wanita berusia 30 tahun, hamil 12 minggu, mengeluh sesak nafas, batuk pada malam hari, dan jantung berdebar-debar. Hasil rontgen thoraks menunjukkan gambaran hipertensi pulmonal disertai peningkatan vaskularisasi paru. Kateterisasi jantung menunjukkan ASD secundum besar, hipertensi pulmonal berat, high flow, high resistance, dan reaktif dengan tes O2. Hasil ekokardiografi (2017) menunjukkan ASD secundum berat, regurgitasi trikuspid dan pulmonal moderat. Ultrasonografi abdomen menunjukkan kesan hamil 12 minggu janin tunggal hidup intrauterin, mioma uteri intramural dan subserosum, perdarahan subamnion dan subkorion. Pada pasien ini, dilakukan abortus provokatus medisinalis melalui pemberian Prostaglandin dilanjutkan dengan dilatasi dan kuretase.Kesimpulan: Kehamilan pada wanita dengan ASD umumnya ditoleransi dengan baik, dengan luaran ibu dan janin yang baik. Pasien dengan penyakit jantung berat sebaiknya tidak hamil dan bila hamil sebaiknya diterminasi. Preparat estrogen merupakan kontraindikasi pada pasien jantung. Pemilihan kontrasepsi harus mempertimbangkan keparahan, tipe anatomis kelainan jantung, dan keinginan ibu untuk mempertahankan fungsi reproduksinya.Kata Kunci: primigravida, ASD secundum, hipertensi pulmonal  AbstractBackground: Atrial Septal Defect (ASD) with severe pulmonary hypertension should be counseled because of the high incidence of maternal and fetal morbidity and mortality. Objective: Describing a case of primigravida with ASD secundum and severe pulmonary hypertension so that appropriate management and contraception can be selected.Method: A 30-year-old woman, 12 weeks pregnant, suffered from shortness of breath, coughing at night, and palpitations. Chest X-ray showed pulmonary hypertension with increased pulmonary vascularity. Cardiac catheterization showed a large ASD secundum, severe pulmonary hypertension, high flow, high resistance, and reactive O2 test. Echocardiography (2017) showed severe ASD secundum, moderate tricuspid, and pulmonary regurgitation. Abdominal ultrasonography showed 12 weeks gestational age single live fetus intrauterine, intramural and subserosal uterine myoma, and also subamniotic and subchorionic bleeding. We did provoked abortion using Prostaglandin continued with dilatation and curettage.Conclusion: Pregnancy in women with ASD is generally well tolerated, with good maternal and fetal outcomes. Patients suffered from severe heart disease should not be pregnant, and if necessary get pregnancy terminated. Estrogen preparations are contraindicated in these patients. The choice of contraception must consider the severity, the anatomy of heart abnormality, and mother's desire to maintain her reproductive function. Key words: primigravida, ASD secundum, pulmonary hypertension

Sustained Weight Loss Following 12-Month Pramlintide Treatment as an Adjunct to Lifestyle Intervention in Obesity

OBJECTIVE—To assess long-term weight loss efficacy and safety of pramlintide used at different dosing regimens and in conjunction with lifestyle intervention (LSI)