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An insightful overview of how Millet influenced and inspired many modernist artists that followed him Jean-Francois Millet (1814-1875) was one of the most important artists of the Barbizon School. Through his publicly exhibited works and their critical reception, Millet was of crucial significance to modernist painters. Millet's modernity is evident in his varied subjects-from peasant themes to landscapes to nudes-and his anti-academic, rough paint application. He also produced highly inventive pastels and drawings. Jean-Francois Millet examines the international range of artists whom he influenced. For instance, Millet was an artistic hero for Vincent van Gogh, whose treatment of numerous motifs-including The Sower and Starry Night-was directly inspired by the older artist. Van Gogh even painted a remarkable series of 21 \"copies\" after Millet's work while living in the south of France in the final year of his life. Other artists on whom Millet had a profound impact include Camille Pissarro, Georges Seurat, Claude Monet, Edgar Degas, and Winslow Homer, and, in the 20th century, most notably Edvard Munch and Salvador Dali. Exhibition: Van Gogh Museum, Amsterdam, The Netherlands (04.10.2019-12.01.2020) / Saint Louis Art Museum, St. Louis, USA (16.02.-17.05.2020).

From approximately 1900 until 1914, Odilon Redon worked almost exclusively on decorative projects, both privately and publicly commissioned. Additionally, he created numerous uncomissioned decorative works - highly ornamental paintings with decorative subject matter that were conceived of by the artist himself as decorations. Yet despite the fact that decorative works made up a significant portion of Redon's late oeuvre, he is rarely considered as a major figure within the decorative arts movement at the turn of the century, unlike his contemporaries Paul Gauguin and the Nabis. His close involvement with these artists, as well as his affiliation with a number of the same important critics, makes his exclusion from discussion of the decorative revival all the more surprising. There has been very little scholarship on Redon's decorative works that consider them in relation to the international decorative movement. Nevertheless, his late works actively engaged with the avant-garde aesthetic theories of the time. My dissertation will place Redon in the context of the decorative and Symbolist art movements by examining the profusion of decorative projects with which he was involved during the last decades of his career. By considering important themes within these movements, like elevation of craft arts, the encouragement of floral designs, the revival of religious and mythological subject matter, and principles regarding the unification of the arts, I argue that Redon warrants consideration as a decorative painter at the turn of the century in France. My first chapter introduces the idea of the decorative revival in the nineteenth century, and considers the way the definition of the term \"decorative\" evolved during the period. I also present the historiography of Redon scholarship, as it relates to his decorative works. The second chapter examines the historical background of the decorative and Symbolist movements in the nineteenth century. I focus first on the pan-European decorative revival, especially in England and Belgium, then examining how this influenced French art. The Symbolist artistic movement developed simultaneously, and as such, I will examine the ways in which the two movements overlapped. Finally, I consider how Redon's artistic development was affected in this aesthetic climate. Subsequent chapters examine specific themes in Redon's decorative oeuvre, and how these related to ideas and undercurrents in the general decorative and Symbolist art movements. Chapter three focuses on flowers and nature as decoration, exploring the increase of floral imagery in both decoration and Symbolist painting, and how Redon adapted his own artistic language from these influences. Chapter four examines the revival of traditional imagery from religious and mythological subjects, as well as occultist themes, and explores the way Redon used his decorative style to create new symbolic meanings for these themes. Chapter five focuses on Redon's murals at the Abbaye de Fontfroide, in which I argue that they represent a modern Gesamtkunstwerk . My final chapter underscores Redon's place within the decorative and Symbolist movements and examines the influence he exerted on his contemporaries through his use of the decorative arts.

Seasonal influenza viruses cause hundreds of thousands of deaths each year and up to a billion infections; under the proper circumstances, influenza A viruses with pandemic potential could threaten the lives of millions more. The variable efficacies of traditional influenza virus vaccines and the desire to prevent pandemic influenzas have motivated work toward finding a universal flu vaccine. Many promising universal flu vaccine candidates currently focus on guiding immune responses to highly conserved epitopes on the central stem of the influenza hemagglutinin viral fusion protein. To support the further development of these stem-targeting vaccine candidates, in this study, we use negative stain electron microscopy to assess the prevalence of central stem-targeting antibodies in individuals who were exposed to influenza antigens through traditional vaccination and/or natural infection during the 2018–2019 flu season.

Purpose LGBTQ + college students experience interpersonal violence at disproportionately high rates, underscoring the need for college campuses to provide inclusive violence prevention and intervention services. We sought to examine similarities and differences in barriers to accessing campus-based services and recommendations for campus-based violence prevention and intervention service between LGBTQ + college students compared to cisgender heterosexual college students. Methods Open-ended responses to the question on an annual campus climate survey were analyzed from 273 victims of sexual or sexuality-based harassment, sexual violence, dating violence, or stalking. Data were coded using a content analysis approach, with each excerpt being coded by two trained researchers. Results Two major themes emerged: barriers to accessing campus-based resources and recommendations for campus-based resources. Subthemes within barriers included tacit barriers (including off-campus experiences not warranting on-campus responses and dismissal of violence experiences) and explicit barriers (including lack of knowledge about services, reputation of services, and gender). Recommendations for campus-based services included themes of content and outreach, who to train, and additional resources. Many themes were raised by both LGBTQ + students and cisgender heterosexual students, whereas others were unique to either subgroup. Conclusions Universities should consider these themes when developing prevention and intervention services. This includes engaging in awareness campaigns to advertise services to all types of victims (including men and LGBTQ + individuals), as well as integrating content around intersectionality and fetishization into trainings.

Chlorhexidine skin antisepsis is frequently recommended for most surgical procedures; however, it is unclear if these recommendations should apply to surgery involving traumatic contaminated wounds where povidone-iodine has previously been preferred. We aimed to compare the effect of aqueous 10% povidone-iodine versus aqueous 4% chlorhexidine gluconate on the risk of surgical site infection in patients who required surgery for an open fracture. We conducted a multiple-period, cluster-randomised, crossover trial (Aqueous-PREP) at 14 hospitals in Canada, Spain, and the USA. Eligible patients were adults aged 18 years or older with an open extremity fracture treated with a surgical fixation implant. For inclusion, the open fracture required formal surgical debridement within 72 h of the injury. Participating sites were randomly assigned (1:1) to use either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate immediately before surgical incision; sites then alternated between the study interventions every 2 months. Participants, health-care providers, and study personnel were aware of the treatment assignment due to the colour of the solutions. The outcome adjudicators and data analysts were masked to treatment allocation. The primary outcome was surgical site infection, guided by the 2017 US Centers for Disease Control and Prevention National Healthcare Safety Network reporting criteria, which included superficial incisional infection within 30 days or deep incisional or organ space infection within 90 days of surgery. The primary analyses followed the intention-to-treat principle and included all participants in the groups to which they were randomly assigned. This study is registered with ClinicalTrials.gov, NCT03385304. Between April 8, 2018, and June 8, 2021, 3619 patients were assessed for eligibility and 1683 were enrolled and randomly assigned to povidone-iodine (n=847) or chlorhexidine gluconate (n=836). The trial's adjudication committee determined that 45 participants were ineligible, leaving 1638 participants in the primary analysis, with 828 in the povidone-iodine group and 810 in the chlorhexidine gluconate group (mean age 44·9 years [SD 18·0]; 629 [38%] were female and 1009 [62%] were male). Among 1571 participants in whom the primary outcome was known, a surgical site infection occurred in 59 (7%) of 787 participants in the povidone-iodine group and 58 (7%) of 784 in the chlorhexidine gluconate group (odds ratio 1·11, 95% CI 0·74 to 1·65; p=0·61; risk difference 0·6%, 95% CI –1·4 to 3·4). For patients who require surgical fixation of an open fracture, either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate can be selected for skin antisepsis on the basis of solution availability, patient contraindications, or product cost. These findings might also have implications for antisepsis of other traumatic wounds. US Department of Defense, Canadian Institutes of Health Research, McMaster University Surgical Associates, PSI Foundation.

More than a third of all sexual crimes are committed by adolescents. In addition, many adolescents struggle with problematic sexual behaviors (PSB) that may not rise to a criminal offense, but cause harm to themselves and those around them. A significant number of these adolescents also have histories of their own trauma; yet there are no treatment models that integrate both PSB and trauma into one comprehensive treatment for this population. This qualitative study’s aim was to use the expertise of clinicians who work with adolescents with PSB as well as clients and their caregivers who had completed PSB treatment to understand what they believe are the necessary components and elements needed for an integrated model that seeks to simultaneously address both PSB and the consequences of traumatic experiences. Twenty-six mental health professionals and one former client and his caregiver participated in focus groups (three with clinicians and one with the caregiver and former client) to share their experiences and expertise regarding an integrated model. The thematic analysis procedure yielded six major themes: family, external systems, treatment structure, therapeutic themes, specialized PSB targets, and trauma and PSB integration. Each of these major themes was comprised of subthemes that are presented as well. Implications for practice and future research are discussed, including that clinicians could benefit from guidance and structure to assist them in structuring their interventions to address the multiple needs of their clients that seek to reduce their risk of reoffending while simultaneously enhancing the quality of their lives.

Background: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. Summary: It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients’ lived experiences; move beyond simplistic approaches of “eat less, move more” and address the root drivers of obesity. Key Messages: People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay.

Racial disparities in treatment benchmarks have been documented among older patients with hip fractures. However, these studies were limited to patient-level evaluations. To assess whether disparities in meeting fracture care time-to-surgery benchmarks exist at the patient level or at the hospital or institutional level using high-quality multicenter prospectively collected data; the study hypothesis was that disparities at the hospital-level reflecting structural health systems issues would be detected. This cohort study was a secondary analysis of prospectively collected data in the PREP-IT (Program of Randomized trials to Evaluate Preoperative antiseptic skin solutions in orthopaedic Trauma) program from 23 sites throughout North America. The PREP-IT trials enrolled patients from 2018 to 2021, and patients were followed for 1-year. All patients with hip and femur fractures enrolled in the PREP-IT program were included in analysis. Data were analyzed April to September 2022. Patient-level and hospital-level race, ethnicity, and insurance status. Primary outcome measure was time to surgery based on 24-hour time-to-surgery benchmarks. Multilevel multivariate regression models were used to evaluate the association of race, ethnicity, and insurance status with time to surgery. The reported odds ratios (ORs) were per 10% change in insurance coverage or racial composition at the hospital level. A total of 2565 patients with a mean (SD) age of 64.5 (20.4) years (1129 [44.0%] men; mean [SD] body mass index, 27.3 [14.9]; 83 [3.2%] Asian, 343 [13.4%] Black, 2112 [82.3%] White, 28 [1.1%] other) were included in analysis. Of these patients, 834 (32.5%) were employed and 2367 (92.2%) had insurance; 1015 (39.6%) had sustained a femur fracture, with a mean (SD) injury severity score of 10.4 (5.8). Five hundred ninety-six patients (23.2%) did not meet the 24-hour time-to-operating-room benchmark. After controlling for patient-level characteristics, there was an independent association between missing the 24-hour benchmark and hospital population insurance coverage (OR, 0.94; 95% CI, 0.89-0.98; P = .005) and the interaction term between hospital population insurance coverage and racial composition (OR, 1.03; 95% CI, 1.01-1.05; P = .03). There was no association between patient race and delay beyond 24-hour benchmarks (OR, 0.96; 95% CI, 0.72-1.29; P = .79). In this cohort study, patients who sought care from an institution with a greater proportion of patients with racial or ethnic minority status or who were uninsured were more likely to experience delays greater than the 24-hour benchmarks regardless of the individual patient race; institutions that treat a less diverse patient population appeared to be more resilient to the mix of insurance status in their patient population and were more likely to meet time-to-surgery benchmarks, regardless of patient insurance status or population-based insurance mix. While it is unsurprising that increased delays were associated with underfunded institutions, the association between institutional-level racial disparity and surgical delays implies structural health systems bias.

Cellular and molecular characterization of immune responses elicited by influenza virus infection and seasonal vaccination have informed efforts to improve vaccine efficacy, breadth, and longevity. Here, we use negative stain electron microscopy polyclonal epitope mapping (nsEMPEM) to structurally characterize the humoral IgG antibody responses to hemagglutinin (HA) from human patients vaccinated with a seasonal quadrivalent flu vaccine or infected with influenza A viruses. Our data show that both vaccinated and infected patients had humoral IgGs targeting highly conserved regions on both H1 and H3 subtype HAs, including the stem and anchor, which are targets for universal influenza vaccine design. Responses against H1 predominantly targeted the central stem epitope in infected patients and vaccinated donors, whereas head epitopes were more prominently targeted on H3. Responses against H3 were less abundant, but a greater diversity of H3 epitopes were targeted relative to H1. While our analysis is limited by sample size, on average, vaccinated donors responded to a greater diversity of epitopes on both H1 and H3 than infected patients. These data establish a baseline for assessing polyclonal antibody responses in vaccination and infection, providing context for future vaccine trials and emphasizing the importance of carefully designing vaccines to boost protective responses towards conserved epitopes.