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The optical limiting properties of three meso-pyridyl-distyrylBODIPY dyes with differing alkyl substitution patterns at the 2,6- and 1,7-positions on the pyrrole moieties are investigated. Styryl groups are introduced at the 3,5-positions to form dyes with strong donor-[Formula: see text]-acceptor (D-[Formula: see text]-A) properties. Favorable optical limiting properties are obtained for all three dyes, with the highest second-order hyperpolarizability obtained for a dye that is unsubstituted at both the 2,6- and 1,7-positions suggesting that the optical limiting properties are enhanced when the meso-aryl ring can freely rotate into the plane of the BODIPY core.

Acute acquired concomitant esotropia (AACE) is usually a benign form of strabismus that infrequently is associated with intracranial pathology. Clinicians have noted an increase in its incidence and theorize that it may be related to public health "lockdown" measures taken in response to the COVID-19 pandemic. With an increased incidence of AACE clinicians must firstly differentiate AACE from common accommodative esotropia and secondly recognize AACE as a possible sign of serious neuropathology.Diffuse Intrinsic Pontine Glioma (DIPG) is a devastating diagnosis for affected families. Children typically present at age 6-7 years with cranial nerve palsies, long tract signs, and/or cerebellar signs. Diagnosis is made from characteristic findings on magnetic resonance brain imaging (MRI brain) and treatment includes radiotherapy and palliative care. Two years from diagnosis, 90% of affected children will have died from their disease.We present four cases that attended our pediatric ophthalmology clinic with AACE either as a presenting sign of DIPG or as a clinical finding following a DIPG diagnosis. Patient A (age 5 years) presented to the emergency eye clinic with sudden onset diplopia and intermittent esotropia. Suppression later developed, they had 0.00 logMAR visual acuity either eye, and bilateral physiological hypermetropia. MRI brain imaging requested as a result of the unusual presentation led to the DIPG diagnosis. The other 3 cases (ages 11, 55 years) were assessed post DIPG diagnosis and found to have an esotropia measuring bigger on 1/3-meter fixation than 6-meter fixation, full ocular motility, physiological hypermetropia or emmetropia, and visual acuity normal for age. Other than patient B (age 11 years), who had papilledema and gaze evoked nystagmus when they were assessed 2 weeks prior to death, no patient had any other clinical eye findings.This small series of 4 patients attending our clinic within a 12-month period supports the notion that children presenting with AACE should routinely be offered brain MRI. Not all children with DIPG-associated AACE have significant ophthalmic findings indicative of intracranial pathology. With the potential for increased incidence of AACE related to lockdowns, clinicians should be reminded of the infrequent possibility their patient has a more serious condition.

Depictions of mythical beings appear in many different forms of art world-wide, including rock art of various ages. In this paper we explore a particular type of imagery, back-to-back figures, consisting of two human-like figures or animals of the same species next to each other and facing in opposite directions. Some human-like doubles were joined at the back rather than side-by-side, but also face opposite directions. In this paper, we report on new research on rock art, bark paintings and recent paintings on paper and chart a 9000-year history of making aesthetically, symbolically and spiritually powerful back-to-back figures in Arnhem Land, Northern Territory, Australia.

International audience; Hand stencils directly represent modern humans in landscape settings around the world. Yet their social and cultural contexts are often overlooked due to the lack of ethnography associated with the artwork. This paper explores the hand stencils from Kundumbue and Pundimbung rock art sites, situated in the traditional boundaries of the Auwim people in the East Sepik Province of Papua New Guinea. Combining archaeological rock art analysis with ethnographic knowledge, we demonstrate that the hand stencils are a priority in each clan's place-making practices, around which they construct the community's social narratives. Rock shelters and their rock art also show a form of communal history that is evoked through their production in contemporary settings, in addition to having been a form of esoteric magic in the past. We conclude that hand stencils can have multiple meanings over time and across space as a widespread cultural marker. However, aspects of the identities of individuals, groups and communities who created the now static hand imagery, remain in place.

Purpose: To determine the influence of an elementary methods course and early field experience on eight preservice teachers’ (PTs’) value orientations. Method: The theoretical perspective employed was occupational socialization. Data were collected with the short form of the value orientation inventory and five qualitative techniques (formal and informal interviews, nonparticipant observation, critical incidents, and stimulated recall). The value orientation inventory profiles for the instructor and PTs were visually inspected for similarities and changes. Analytic induction and constant comparison were employed to analyze the qualitative data. Results: Value orientations of PTs with teaching and moderate coaching orientations were influenced by the methods course and early field experience, while those of PTs with strong coaching orientations were not. Factors leading to this evolution were the curriculum model employed, the instructor, and PTs’ increased confidence and knowledge of students. Summary and Conclusions: The study highlights the importance of faculty facilitating reflection on connections between instructional models and value orientations and how these relate to PTs’ beliefs.

Purpose: To determine the impact of two preservice teachers’ value orientations on their interpretation and delivery of the skill themes approach. Method: The short form of the value orientations inventory and five qualitative techniques were used to collect data. Participants’ value orientations inventory profiles were illustrated graphically. Interpretive data were analyzed using analytic induction and constant comparison. Findings: Results from the short form of the value orientations inventory indicated that Meagan prioritized social responsibility, learning process, and disciplinary mastery, while Jared favored social responsibility, self-actualization, and ecological integration. Qualitative data largely supported these value orientation profiles and indicated that the preservice teachers’ approaches to teaching skill themes differed and were influenced by their pedagogical beliefs. Moreover, qualitative data illustrated how Meagan’s and Jared’s value orientations and interpretations of the skill themes approach had changed and developed. Conclusions: These findings emphasize the importance of preservice teachers engaging in philosophical reflection on the connections between their beliefs and their interpretations of curriculum models.

In a period where racial inequities in the United States have garnered more attention and discussion as a result of social media (e.g., increased use of the #BlackLivesMatter hashtag; Anderson et al., 2020) and newer generations (Tatum, 2017b), it is important to ensure that communication between cultural groups is effective and produces systemic change. This paper will review the failures of a “post-racial” society, with emphasis on ineffective communication between Black, Indigenous People of Color and non-Black, Indigenous People of Color. The role of the listener during intercultural verbal exchanges will be examined, while highlighting the barriers and harmful results of ineffective communication. A behavioral conceptualization of effective listener behavior will be presented, which if implemented, may maintain and sustain social equity, inclusion, and justice. A call to action will be made to further investigate intercultural communication using behavior-analytic research methodologies and how such research might inform on how to functionally and precisely mediate reinforcement in the fight against racism.

The aim of this study was to evaluate the use of laparoscopic surgery for common emergency general surgery (EGS) procedures within an integrated Acute Care Surgery (ACS) network. We hypothesized that laparoscopy would be associated with improved outcomes. Our integrated health care system’s EGS registry created from AAST EGS ICD-9 codes was queried from January 2013 to October 2015. Procedures were grouped as laparoscopic or open. Standard descriptive and univariate tests were performed, and a multivariable logistic regression controlling for open status, age, BMI, Charlson Comorbidity Index (CCI), trauma tier, and resuscitation diagnosis was performed. Laparoscopic procedures converted to open were identified and analyzed using concurrent procedure billing codes across episodes of care. Of 60,604 EGS patients identified over the 33-month period, 7280 (12.0%) had an operation and 6914 (11.4%) included AAST-defined EGS procedures. There were 4813 (69.6%) surgeries performed laparoscopically. Patients undergoing a laparoscopic procedure tended to be younger (45.7 ± 18.0 years vs. 57.2 ± 17.6, p

The introduction of new animals into hunter-gatherer societies produces a variety of cultural responses. This article explores the role of rock art in western Arnhem Land, Australia, in helping to mediate contact-period changes in Indigenous society in the nineteenth century. The authors explore etic and emic perspectives on the ‘re-emergence’ of water buffalo into Aboriginal cultural life. Merging archaeological analysis, rock art and ethnographic accounts, the article demonstrates how such artworks were used as a tool for maintaining order in times of dramatic social change. The results of this research have significant implications for understanding how cultural groups and individuals worldwide used rock art during periods of upheaval.

BACKGROUND Necrotizing soft tissue infections (NSTIs) are an acute surgical condition with high morbidity and mortality. Timely identification, resuscitation, and aggressive surgical management have significantly decreased inpatient mortality. However, reduced inpatient mortality has shifted the burden of disease to long-term mortality associated with persistent organ dysfunction. METHODS We performed a combined analysis of NSTI patients from the AB103 Clinical Composite Endpoint Study in Necrotizing Soft Tissue Infections randomized-controlled interventional trial (ATB-202) and comprehensive administrative database (ATB-204) to determine the association of persistent organ dysfunction on inpatient and long-term outcomes. Persistent organ dysfunction was defined as a modified Sequential Organ Failure Assessment (mSOFA) score of 2 or greater at Day 14 (D14) after NSTI diagnosis, and resolution of organ dysfunction defined as mSOFA score of 1 or less. RESULTS The analysis included 506 hospitalized NSTI patients requiring surgical debridement, including 247 from ATB-202, and 259 from ATB-204. In both study cohorts, age and comorbidity burden were higher in the D14 mSOFA ≥2 group. Patients with D14 mSOFA score of 1 or less had significantly lower 90-day mortality than those with mSOFA score of 2 or higher in both ATB-202 (2.4% vs. 21.5%; p < 0.001) and ATB-204 (6% vs. 16%: p = 0.008) studies. In addition, in an adjusted covariate analysis of the combined study data sets D14 mSOFA score of 1 or lesss was an independent predictor of lower 90-day mortality (odds ratio, 0.26; 95% confidence interval, 0.13-0.53; p = 0.001). In both studies, D14 mSOFA score of 1 or less was associated with more favorable discharge status and decreased resource utilization. CONCLUSION For patients with NSTI undergoing surgical management, persistent organ dysfunction at 14 days, strongly predicts higher resource utilization, poor discharge disposition, and higher long-term mortality. Promoting the resolution of acute organ dysfunction after NSTI should be considered as a target for investigational therapies to improve long-term outcomes after NSTI. LEVEL OF EVIDENCE Prognostic/epidemiology study, level III.

This article takes an interdisciplinary approach to understanding Aboriginal rock art artists, drawing together insights from the disciplines of archaeology and biography, as well as from Indigenous knowledge-holders, in order to explore the life and work of a relatively unknown rock painter from western Arnhem Land in Australia: Narlim (born c. 1909). His rock art at Warlkarr (Hawk Dreaming) in Kakadu National Park stands as subtle but powerful testament to his life, his family and unbroken connections to Country. Narlim’s art reveals the ways he creatively engaged with new knowledges and skills introduced by the newcomers to his Country, even as he asserted the enduring traditions and ongoing sovereignty of his people. By reading rock art as a historical source alongside other biographical material, in partnership with Traditional Owners of today, we offer a fresh and holistic approach to better understanding rock art.

Inspired by an intriguing photograph of a painted Bean car with Aboriginal designs, this paper explores the cross-cultural encounter between the renowned adventurer Francis Birtles (1881–1941) and Aboriginal artist Nayombolmi (c. 1895–1967). Meeting by chance during one of Birtles’ overland explorations by motorcar and one of Nayombolmi’s annual walking route journeys, the two men came together in an area that would become synonymous with the Imarlkba gold mine in present day Kakadu National Park. Their acquaintance, based on mutual needs and curiosity, provides a rare insight into cross-cultural colonial relationships in this frontier region. Beginning in 1929 their interactions continued intermittently as the Birtles-initiated Imarlkba gold mine developed and Badmardi people (and others) joined the workforce. By revisiting the well-known photograph of Birtles’ painted Bean car, this paper uses a variety of sources, most notably old and new oral history recordings, to investigate Aboriginal histories and colonial cross-cultural engagements in remote northern Australia, and how newly introduced technologies and material culture could be charged with new meanings.

During recent detailed recording of Nanguluwurr, a rock art site that is part of the Burrungkuy (Nourlangie) complex of cultural sites in Kakadu National Park, Australia, the data showed discrete c...

Community adaptations to increase resilience and reduce vulnerability depend on adaptability, which is constituted by how power shapes collective mobilization of differential capacities across scales and levels of governance systems. A multidimensional power framework (MPF) to track the role of power in adaptability is presented and applied in a qualitative, comparative case study of two historical fishing communities in the United States. The MPF conceptualizes power as differential capacities at the individual and group levels, structural at the policy level, and systemic, reflective of generalized norms, strategies, and technologies of political economic imperatives. The first case, Two Rivers, North Carolina represents an example of collective action failure resulting in transformation to a new resilience regime consisting of fundamentally altered community functions, structures, and identity. The second case, Delcambre, Louisiana represents collective action success; community adaptations resulted in continuity in change for fisher livelihoods. Success here is defined as the ability to maintain a semblance of structure, function, or identity of the original resilience regime without connotations of positive or negative desirability. The cases were similar in demographics, vulnerabilities, and differential capacities. Key differences existed in systemic political economic imperatives, structural power at the policy level, and the ways closure, the ability to enforce a common sense of place within the communities reflected systemic power. The utility of the MPF is mapping vulnerabilities and differential capacities against broader structures and systemic processes to inform effective mobilization for improved socio-ecological resilience and sustainability.

Individuals with developmental disabilities (DD) are twice as likely to have obesity than non-disabled individuals. Replacing the consumption of sugar sweetened beverages (SSBs) with water has many health benefits, including weight reduction. In this study, a token reinforcement system was implemented to increase water consumption and decrease the consumption of SSBs with 14 adult participants with DD living in a community-based independent supported living (ISL) center. Token reinforcement reduced the consumption of SSBs, with associated reductions in calorie consumption and body weight. Findings are especially important for treatment settings where resources for individualized meal planning and staffing to support comprehensive behavioral interventions may be limited.

The contact period rock art of northern Australia provides unprecedented insights into Aboriginal cross-cultural experiences during the last few hundred years. Northwest Arnhem Land, Australia, has...

It has been argued that laundry blue (whitener) was introduced into western Arnhem Land in the second half of the 1920s by missionaries, where it was used by Aboriginal people in rock art and on a variety of objects. Recent examination of museum collections acquired from the Northern Territory Native Industrial Mission at Kapalga in today’s Kakadu National Park, shows that the introduction of laundry blue into local Aboriginal artistic practices was earlier, around 1900. We discuss two examples of objects painted with laundry blue, a fibre basket and a bark belt, as well as broader ethnographic evidence relating to the significance of the color blue. We argue that the use of laundry blue is not only the result of access to an exotic new color but also has links to existing cultural beliefs.

The late R. Lamilami1 had a rich and remarkable life, engaging in many activities and career paths to benefit his community, including working for the Northern Land Council, Kakadu Health Services ...

The Emergency General Surgery (EGS) population is particularly at high risk for readmission. Currently, no system exists to predict which EGS patients are most at risk. We hypothesized that a subset of EGS patients could be identified with increased 30-day unplanned readmission. We also hypothesized that a majority of readmissions occur sooner than the conventional 2-week follow-up period.National Surgical Quality Improvement Program (NSQIP) nonelective general surgery patients were analyzed. Multivariable logistic regression identified factors with increased odds of unplanned readmission. AAST EGS Diagnosis Categories were used to categorize postop ICD-9 codes, and the top 10 CPT codes in each group were analyzed. Readmission rate, the reason for unplanned readmission, and time to readmission were analyzed.A total of 383,726 patients were identified with a readmission rate of 8.1% within 30 d of their primary procedure. The top 50 CPT codes accounted for 84% of EGS readmissions. Increased readmission risk was demonstrated for underweight patients (OR = 1.15, P 0.05). High-risk hospital characteristics were LOS2 d, any inpatient pulmonary complications, and discharge to any facility or rehab (all P 0.05). Surgical site infections cause nearly 25% of readmissions. Intestinal procedures are most frequently readmitted (22% of EGS readmissions), with colorectal procedures having the higher odds of readmission. Most readmissions occur10 d after discharge.A high-risk subpopulation exists within EGS, and most readmissions occur sooner than a typical 2-week follow-up. Early interventions for high-risk EGS subpopulations may allow for early intervention and reduction of unnecessary healthcare utilization.

The present study examined the effects of the Promoting the Emergence of Advanced Knowledge (PEAK) curriculum on standardized measures of intelligence and PEAK pre-assessment scores participants with autism spectrum disorders (ASD). Direct support staff at a specialized school for students with special needs implemented teaching programs from either the PEAK curriculum (n = 26) or the standard academic curriculum (n = 26) using a randomized control design over one semester. Statistically significant change scores were observed in raw IQ on two of three sub-scales, vocabulary and information, and full-scale IQ in a sub-group of participants that scored above the floor of the IQ test at either baseline or following intervention. Statistically significant improvements were also observed in PEAK pre-assessment scores in participants in the PEAK group compared to the control group. Findings indicate that the PEAK curriculum has the potential to positively impact standardized measures of intelligence when implemented for a relatively short period of time by direct support level personnel. These results are especially important given the widespread use of IQ tests to determine placement and eligibility criteria for individuals with special needs.

Adhesive small bowel obstruction (ASBO) has classically been managed with nasogastric tube decompression and watchful waiting. Our group developed an evidence-based protocol to manage ASBO utilizing a water-soluble contrast (WSC) agent. We hypothesized the protocol would decrease the length of stay (LOS) for patients admitted with ASBO along with the time interval from admission to surgery.From 2010 to 2018, a retrospective review was performed, including all patients admitted with a diagnosis of ASBO. These patients were divided into two groups: the preprotocol group included years 2010-2013 and the postprotocol group included years 2015-2018. A Student t-test and a two-proportion z-test were used for statistical analysis.We captured 767 patients; 296 in the preprotocol group and 471 in the postprotocol group. We found a significant decrease in overall LOS between the preprotocol and postprotocol groups (6.56 d versus 4.08 d; P 0.001) along with decreases in LOS for patients managed nonoperatively (5.36 d versus 3.42 d; P 0.001) and operatively (16.09 d versus 9.47 d; P 0.001). Time interval from admission to the operation was significantly decreased in the postprotocol group (3.79 d versus 2.10 d; P 0.050). We identified a trend toward decreased rates of bowel ischemia and resections with our protocol.These results reaffirm previous reports of WSC's impact on overall LOS in ASBO while showing a similar impact on both operative and nonoperative groups. The decreased time interval between admission and operation may impact the incidence of bowel ischemia and resections.

Emergency general surgery (EGS) patients have increased mortality risk compared with elective counterparts. Recent studies on risk factors have largely used national data sets limited to administrative data. Our aim was to examine risk factors in an integrated regional health system EGS database, including clinical and administrative data, hypothesizing that this novel process would identify clinical variables as important risk factors for mortality.Our nine-hospital health system's billing data were queried for EGS International Classification of Disease codes between 2013 and 2018. Codes were grouped by diagnosis, and urgent or emergent encounters were included and merged with electronic medical record clinical data. Outcomes assessed were inpatient and 1-year mortality. Standard and multivariable statistics evaluated factors associated with mortality.There were 253,331 EGS admissions with 3.6% inpatient mortality rate. Patients who suffered inpatient and 1-year mortality were older, more likely to be underweight, and have neutropenia or elevated lactate. On multivariable analysis for inpatient mortality: age (odds ratio [OR], 1.7-6.7), underweight body mass index (OR, 1.6), transfer admission (OR, 1.8), leukopenia (OR, 2.0), elevated lactate (OR, 1.8), and ventilator requirement (OR, 7.1) remained associated with increased risk. Adjusted analysis for 1-year mortality demonstrated similar findings, with highest risk associated with older age (OR, 2.8-14.6), underweight body mass index (OR, 2.3), neutropenia (OR, 2.0), and tachycardia (OR, 1.7).After controlling for patient and disease characteristics available in administrative databases, clinical variables remained significantly associated with mortality. This novel yet simple process allows for easy identification of clinical data points imperative to the study of EGS diagnoses that are critical in understanding factors that impact mortality.Prognostic and Epidemiologic; Level III.