Prior Attempts Research Articles

An exploration of attitudes regarding the use of a state tobacco Quitline for smoking cessation among low-income adults with a history of smoking.

Smoking rates among low-income smokers are significantly elevated. State tobacco quitlines offer free and evidence-based treatments for smokers living in that state. This study investigated knowledge, attitudes, and beliefs associated with engagement with the Illinois Tobacco Quitline among confirmed smoking patients at a Federally Qualified Health Center (FQHC). Further goals were to obtain recommendations for strategies to improve patient awareness and engagement. Data for this study were collected from August to October 2021 from patients receiving care in an FQHC in a large midwestern city in the USA. Clinic-based recruitment was used to enroll a sample of adult current smokers. In-depth interviews and brief surveys were completed with a volunteer sample of patients recruited from an FQHC. The interviews took approximately 60 minutes. Data analysis used descriptive statistics to summarize the responses to the study and deductive thematic analysis to analyze the qualitative interviews. Study participants (n=25) were primarily male, African American, and middle-aged (mean age: 52.5 years). The majority were daily smokers. Over half had heard about the Quitline from sources such as radio advertisements, but usage was low. Barriers to use included low motivation to quit, questions about effectiveness, and poor success with prior Quitline attempts. Participants described factors that would increase the appeal of the Quitline, including testimonials, personalization, and an empathetic approach. Participants were asked about the acceptability of receiving information about the Quitline via patient portals, and most were in support. Interventions are needed to raise awareness and utilization of Quitlines among patients receiving care in FQHC settings. Distribution of Quitline information via patient portals is an acceptable strategy for increasing awareness of services.

Highly Resistive Biomembranes Coupled to Organic Transistors enable Ion‐Channel Mediated Neuromorphic Synapses

AbstractOrganic electrochemical transistors (OECTs) functionalized with lipid membranes could enable new hybrid synapses for sensing and neuromorphic computing in biological media. However, prior attempts to pair these components resulted in low quality membranes formed on the OECT surface. We present a new method for forming a highly‐resistive phospholipid bilayer coupled to a poly(3,4‐ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) OECT that avoids the disruptive effects of the rough polymer surface. Transistor coupled droplet bilayers (TCDBs) formed from diphytanoyl phosphatidylcholine lipids exhibit an average specific resistance that is 1000X higher than values reported for solid‐supported lipid membranes assembled on PEDOT:PSS. High membrane resistance and the addition of voltage‐activated ionophores enable us to demonstrate that selective ion transport and spontaneous membrane resealing in response to dynamic gate voltage imparts selective programming and memory‐storage capability to an OECT without chemical modification of the PEDOT:PSS. These capabilities enable paired‐pulse facilitation and depression with writing speeds and memory retentions that are both >10X higher than previously reported with membrane‐coated OECTs. The high resistance of the TCDB establishes a basis for hybrid biomolecular synapses that can integrate stimuli‐responsive membranes and organic electronics for future applications in sensing, signal processing, and neuromorphic computing at the edge of biology.

Understanding smoking cessation process in Tunisia from 2020 to 2023: description of quit attempts

Abstract Background Many smokers attempt multiple cessation methods before seeking specialist intervention. This study aims to describe these prior cessation attempts and identify relapse factors to enhance support for these individuals. Methods Data from 440 patients consulting the Department of Epidemiology Statistics at Abderrahman Mami Hospital from 2020 to 2023 were analyzed. It included information on previous quit attempts, methods used, longest duration of abstinence, number of attempts, reaction to cessation, and reasons for relapse. Statistical description was conducted using IBM SPSS 25. Results Among participants, More than half of the smokers had previously attempted to quit smoking 63,4%, with an average of 2 attempts ± 1,7 (0-10 attempts) per patient. The majority of patients (86.8%) quit smoking without using substitution methods. Among those who resorted to substitution, nicotine replacement therapy was the most frequently used method (n = 30; 6.8%). The longest duration of abstinence averaged 8 years. The main reaction to smoking cessation among patients was an improvement in their health (9,1%). The most common reasons for relapse were psychosocial problems (5.5%), followed by relapses during social events (4.3%), and withdrawal symptoms (3%). Conclusions This study emphasizes the importance of considering each patient’s journey during their smoking cessation process. Analyzing these factors will enable better management of the cessation program with the patient, as well as a deeper understanding of their feedback regarding our program, ensuring long-term cessation success. Key messages • Failed spontaneous quit attempts prior to NRT initiation are prevalent among smoking patients. • Understanding failed spontaneous cessation attempts can guide the development of more effective strategies.

Flexible bronchoscopy-assisted removal of aspirated scarf pins from the tracheobronchial tree: the experience of 146 subjects.

Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

Analysis of the impact of a rhinologist-assisted endoscopic approach on a single neurosurgeon’s outcomes in transsphenoidal resection of pituitary adenomas

ObjectivesDetermine the improvements in outcomes of transsphenoidal pituitary adenoma resection following addition of a skull base rhinologist to the neurosurgical team. DesignAll patients that underwent transsphenoidal resection of pituitary adenoma were identified. Demographic data, Otolaryngology (ENT) involvement, initial adenoma size, extent of resection, hormonal secretion status, visual field exam, post-operative DI, CSF leak, recurrence, need for nasoseptal flap (NSF), re-operation rate were all collected. A linear-regression model adjusteds for confounders. SettingA single academic institution Participants271 patients who underwent transsphenoidal surgery between 2015 and 2020.Main Outcome MeasuresThe main outcome measures were Extent of Resection and Endocrinologic remission. ResultsOf the 271 patients identified, 228 (84 %) patients had macroadenomas, one-third of patients presented with bitemporal hemianopsia, and 27 % (72) were hormonally active. For these and demographics there were no statistically significant differences between the microscopic or endoscopic approach (EEA) groups. For patients with cavernous sinus invasion of >50 %, EEA was more likely to achieve gross total resection (GTR) (OR 2.6; p<0.001). For patients who had prior sellar surgery, EEA was 2.5x more likely to get a GTR (p=0.05). The EEA approach resulted in an extra hospital day (1–2 vs 2–3 p<0.05) and surgery lasted an additional hour (1.17 vs 2.5, p<0.05), but did not require fat grafts or lumbar drains on a routine basis. ConclusionsWhile the operating time and LOS were longer, the EEA approach performed by two specialized co-surgeons demonstrates superior value for adenomas that have had a prior surgical attempt or with significant cavernous sinus invasion.

Predicting Unplanned Trauma ICU Admissions for Initial Nonoperative, Non-ICU Patients.

Unplanned intensive care unit (ICU) admissions are associated with increased morbidity and mortality. This study uses interpretable machine learning to predict unplanned ICU admissions for initial nonoperative trauma patients admitted to non-ICU locations. TQIP (2020-2021) was queried for initial nonoperative adult patients admitted to non-ICU locations. Univariable analysis compared patients who required an unplanned ICU admission to those who did not. Using variables that could be known at hospital admission, gradient boosting machines (CatBoost, LightGBM, XGBoost) were trained on 2021 data and tested on 2020 data. SHapley Additive exPlanations (SHAP) were used for interpretation. The cohort had 1,107,822 patients; 1.6% had an unplanned ICU admission. Unplanned ICU admissions were older (71 [58-80] vs. 61 [39-76] years, p < 0.01), had a higher Injury Severity Score (ISS) (9 [8-13] vs. 9 [4-10], p < 0.01), longer length of stay (11 [7-17] vs. 4 [3-6] days, p < 0.01), higher rates of all complications and most comorbidities and injuries (p < 0.05). All models had an AUC of 0.78 and an F1 score of 0.12, indicating poor performance in predicting the minority class. Mean absolute SHAP values revealed ISS (0.46), age (0.29), and absence of comorbidities (0.16) as most influential in predictions. Dependency plots showed greater SHAP values for greater ISS, age, and presence of comorbidities. Machine learning may outperform prior attempts at predicting the risk of unplanned ICU admissions in trauma patients while identifying unique predictors. Despite this progress, further research is needed to improve predictive performance by addressing class imbalance limitations.

University student suicides in Türkiye: Insights from two decades of media reports

University student suicides have emerged as a significant societal concern, reflecting challenges inherent in the transition to adulthood and academic pressures. This study aims to analyze two decades of national media coverage on university student suicides in Türkiye, examining demographic trends, suicide methods, and social factors implicated in these tragic incidents. A comprehensive scan of Turkish national media archives from January 1, 2004, to December 31, 2023, identified 213 unique reports of university student suicides. Data extracted included age, sex, year of incident, prior suicide attempts, geographic distribution, housing status, academic major, psychiatric history, social background, suicide method, and presence of suicide notes or social media posts. Statistical analyses utilized Fisher's Exact Test and Pearson's Chi-square to examine categorical data. Male students accounted for 61.6% (n=125) of reported suicides, with a mean age of 22.2 years (SD=3.05). The most common suicide method was jumping from height, differing by sex, with hanging prevalent among males and jumping more frequent among females. Mobbing emerged as a predominant social stressor implicated in suicide incidents, surpassing other factors reported in the literature. The findings highlight an alarming increase in media-reported university student suicides, predominantly affecting males and characterized by distinct suicide methods. The pervasive impact of mobbing underscores the urgent need for targeted interventions addressing social stressors, alongside comprehensive medical, psychological, social, and economic support systems within academic settings. Efforts should prioritize proactive mental health initiatives, policy reforms, and community-based interventions to mitigate suicide risks among university students.

8768 Initiation of Exogenous Sex Hormones in a Pediatric Gender Clinic

Abstract Disclosure: C.M. Roberts: None. M.M. Knoll: None. G. Robertson: None. A. Egan: None. C. Moser: None. Introduction: The demographics of patients seeking care for gender dysphoria have changed significantly since care was started in 1987. The criteria for prescribing sex hormones have also evolved to allow a greater range of patients to receive gender-affirming hormones. We examined factors associated with prescription of gender-affirming hormones to patients presenting for gender-affirming care our clinic. Methods: Secondary analysis of sex hormone initiation as a minor among 14-17-year-old adolescents diagnosed with gender dysphoria, seen in the pediatric gender clinic between 2/19/2018 and 7/20/2022. We extracted demographic variables, appointment dates, and sex hormone prescription data from our electronic medical record. We collected patient reports of gender identity and suicidal behavior, and parent and adolescent reports of general adolescent well-being, months of gender dysphoria and social transition, and parental support for the adolescent’s gender identity from electronic clinic surveys. Results: We identified 273 adolescent-parent dyads with complete data. Most of our sample were assigned female at birth (74.4%), transgender male (59.3%), and white (83.5%) adolescents who lived in urban (86.4%) and lower-middle-income (64.5%) areas. The average age was 15.9+/-1.1 years. A minority of adolescents reported recent suicidal ideation 60/273 (22%), and prior suicide attempts 20/273 (7%). Parents reported a shorter duration of gender dysphoria (-16.7 months (95%CI: -22.0, -11.5)) and social transition (-4.7: -6.5, -3.0), and higher levels of parental support than adolescents. Approximately half, 146/273 (53.5%), of adolescents started sex hormones. The average age at initiation was 16.5 years +/- 0.9. Age at presentation, length of gender dysphoria or social transition, and the presence of suicidal ideation or attempts were not associated with initiation of sex hormones. Assigned males (OR:1.82:95%CI 1.04, 3.19), adolescents with higher parent-reported parental support for the adolescent’s identity (1.03:1.01, 1.04), and adolescents with private insurance rather than Medicaid (Blue Cross- 5.39:2.73, 10.64) were more likely to start sex hormones as a minor. Conclusion: Published criteria for the initiation of sex hormones among adolescents with gender dysphoria, including age, persistence of dysphoria, and the presence of suicidality, did not predict the prescription of sex hormones to minors in our clinic. Parent-reported support for the adolescent’s gender identity played a small role in predicting the prescription of hormones, but male sex assigned at birth and having private health insurance played larger roles. Further exploration of these findings is needed to ensure equity in the treatment of gender dysphoria. Presentation: 6/3/2024

First Suicide Attempts in Early Adolescents: A Descriptive Outcomes Study

ObjectiveIn 2021, suicide was the second leading cause of death in early adolescent Americans ages 10-14. Research into suicidal behavior in this age group is limited. We report on prior psychiatric care, attempt method, and attempt outcomes in a cohort of 164 early adolescents accrued by first suicide attempt coming to medical attention. MethodsOur cohort constitutes a subsample from a previously reported retrospective-prospective study identified through the Rochester Epidemiology Project that recruited individuals making first suicide attempts coming to medical attention (index attempt, IA) during a 22-year period (1/1/1986-31/12/07). Among 1490 all-age index attempters followed until 12/31/2010, 164 (11.0%) were aged 10-14. Results3/164 died on IA (1.8% of the cohort; 2 females, 1 male). Nearly half (72/164, 43.9%) had no prior psychiatric history. Females were less likely than males to have seen a mental health provider (p=0.029) or been prescribed psychiatric medications (p<0.001) prior to IA. Medication overdose was the most common attempt method in females (81/128, 63.3%), while cutting or piercing wounds were the most common method in males (13/36, 36.1%). Females were significantly more likely than males to overdose (p=0.001). Of IA survivors, 19.9% (32/161) were initially medically hospitalized, 52.8% (85/161) were psychiatrically hospitalized—initially or in transfer—and 37.2% (60/161) were discharged without hospitalization. ConclusionMedication overdoses accounted for over half of all IAs and were significantly more common in females. While IA mortality was low relative to older patients from the all-age-cohort, morbidity was substantial with nearly a fifth of attempts severe enough to warrant medical hospitalization and more than half initial or eventual psychiatric hospitalization. These findings emphasize the importance of both means restriction and identification of early adolescents at risk before they make their first attempt.

Cystine and urate cystoliths in dogs are frequently visible on radiographs prior to surgical or nonsurgical removal.

To investigate the frequency at which cystine and urate cystoliths (stones) are visible on radiographs prior to surgical or nonsurgical retrieval. Records of client-owned dogs (n = 331) were analyzed between January 2019 and December 2023 for cystoliths submitted for stone analysis after surgical removal or nonsurgical retrieval. Records were analyzed for cystolith type; when cystine or urate stones were identified, records were analyzed for signalment, procedure, presence of mineral opaque cystoliths on pre-procedural radiographs, urine pH and crystalluria, history of previous cystoliths, prior prescription diet attempt, recurrence, and genetic, congenital and acquired comorbidities. Descriptive statistics were generated after data collection. 31 of 331 (9%) were cystine stones, 49 of 331 (15%) were urate, and 1 of 331 (0.3%) was a mix of urate and cystine. When radiographs were taken prior to stone removal, 24 of 28 (85%) of urate, 24 of 26 (92%) of cystine, and 1 of 1 (100%) of urate/cystine were visible on radiographs. Cystine and urate stones are visible on survey radiography at a high frequency in dogs. While cystine and urate stones have been historically designated as radiolucent, they are frequently radiopaque on radiographs. Radiopacity is commonly used as one of the criterion to determine whether a dissolution or prevention diet is an appropriate management technique, particularly when determination of the stone type has yet to be performed. As a result, these findings may prompt clinicians to investigate other patient-specific factors before a specific dietary recommendation is made.

Means to an end: Characteristics and follow-up of emergency department patients with a history of suicide attempt via medication overdose.

Availability and accessibility of a wide range of medications may be a contributing factor to rising medication-related overdose (OD) rates. Treatment for both suicide attempts (SAs) and ODs often occurs in the emergency department (ED), highlighting its potential as a screening and intervention point. The current study aimed to identify sociodemographic and clinical characteristics of individuals who reported SA via medication OD compared to other methods and to examine how these patients' suicide severity and behaviors differed over 12-month post-ED follow-up. Data were analyzed from Phases 1 and 2 of the Emergency Department Safety Assessment and Follow-up Evaluation multicenter study (N = 1376). Participants with a history of SA (n = 987) were categorized based on whether they indicated a past medication-related SA via OD. Of participants with history of SA, 62.7% (n = 619) reported medication OD for either their most serious or their most recent SA. Multivariate analyses indicated female birth sex, diagnosis of bipolar disorder, and having some college education were significantly associated with membership in the medication OD attempt group (p <0.05). Of those who attempted suicide over the 12-month follow-up, nearly 60% of participants in the medication OD attempt group reported a subsequent SA via OD over follow-up. However, nearly half (46.5%) of participants with no medication OD at baseline also reported medication OD at follow-up. Among patients presenting to the ED, females, individuals with bipolar disorder, and patients with a college education, respectively, may be at highest risk for SAs via medication OD. Prospectively, medication OD appears to be a frequent method, even among individuals with no prior attempt via OD, as demonstrated by the high percentage of patients who did not have a medication OD at baseline, but reported a medication OD during follow-up.

Risk of suicide after hospitalizations due to acute physical health conditions—a cohort study of the Norwegian population

BackgroundIt is well known that individuals recently discharged from psychiatric inpatient care face a high risk of suicide. Severe physical health conditions have also been linked to suicide risk. The risk of suicide following discharge from somatic hospitals is not known for individuals admitted due to acute physical health conditions.MethodsA Cohort study using data from the entire Norwegian population aged 12 years and older from 2008 to 2022 linked with information on health service use and cause of death. We used Cox regression with age as time axis to estimate sex-adjusted hazard ratios of suicide following discharge for ages 12 to 64 years and 65 years and older. We also performed analyses after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. To assess individual risk, we performed an adapted case-crossover analysis among discharged patients who died from suicide.ResultsA total of 4 632,980 individuals aged 12 to 64 years and 1,469,265 individuals aged 65 years and older were included. Compared to unexposed individuals at similar ages, we found an increased risk of suicide in the first 4 weeks after discharge, with a hazard ratio (HR) of 7.0 (95% confidence interval (CI) 5.9 to 8.3) among those aged 12 to 64 years and 6.8 (95% CI 5.4 to 8.6) among those 65 years and older. In the younger age group, the risk was attenuated, with a HR of 2.4 (95% CI 1.7 to 3.2) after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. The corresponding HR was 4.8 (95% CI 3.5 to 6.4) among those 65 years and older, declining to 1.9, (1.2 to 3.1) in weeks 5 to 8 and 1.2 (0.7 to 2.2) in weeks 21 to 24. The case-crossover analysis confirmed that individuals 65 years and older were particularly vulnerable.ConclusionsThe heightened risk of suicide following discharge from acute somatic hospitalization, even in the absence of concurrent mental disorders, self-harm, or prior suicide attempts, underscores the critical need for comprehensive mental health and existential support for patients post-discharge.

Characterizing Veteran suicide decedents that were not classified as high-suicide-risk.

Although the Department of Veterans Affairs (VA) has made important suicide prevention advances, efforts primarily target high-risk patients with documented suicide risk, such as suicidal ideation, prior suicide attempts, and recent psychiatric hospitalization. Approximately 90% of VA patients that go on to die by suicide do not meet these high-risk criteria and therefore do not receive targeted suicide prevention services. In this study, we used national VA data to focus on patients that were not classified as high-risk, but died by suicide. Our sample included all VA patients who died by suicide in 2017 or 2018. We determined whether patients were classified as high-risk using the VA's machine learning risk prediction algorithm. After excluding these patients, we used principal component analysis to identify moderate-risk and low-risk patients and investigated demographics, service-usage, diagnoses, and social determinants of health differences across high-, moderate-, and low-risk subgroups. High-risk (n = 452) patients tended to be younger, White, unmarried, homeless, and have more mental health diagnoses compared to moderate- (n = 2149) and low-risk (n = 2209) patients. Moderate- and low-risk patients tended to be older, married, Black, and Native American or Pacific Islander, and have more physical health diagnoses compared to high-risk patients. Low-risk patients had more missing data than higher-risk patients. Study expands epidemiological understanding about non-high-risk suicide decedents, historically understudied and underserved populations. Findings raise concerns about reliance on machine learning risk prediction models that may be biased by relative underrepresentation of racial/ethnic minorities within health system.

Abstract A045: Disrupting local immunosuppression through combination myCAF/myeloid targeting in pancreatic cancer

Abstract Immunotherapy has revolutionized clinical care for many cancers, yet the approach has not been fully realized in immunologically cold tumors like Pancreatic Ductal Adenocarcinoma (PDAC). One striking hallmark of PDAC is local immunosuppression (LIS) which leads to cytotoxic T cell inactivation and exclusion. There is great need for an increased understanding of the cellular crosstalk within tumors and the identification of stromal and immune populations involved in shaping the tumor microenvironment (TME). Oncogenic KRAS activation in tumor cells promotes the invasion and proliferation of tumor-supporting stromal cells, while excluding cancer-targeted cytotoxic T cells. LIS is mediated by multiple subtypes of cancer-associated fibroblasts (CAFs) and myeloid cells resident within the tumor parenchyma. Multiple prior attempts to reverse LIS in PDAC by targeting individual stromal cell populations have been unsuccessful, alluding to the complexity of stromal crosstalk within the TME. The stromal diversity of PDAC complicates investigating paracrine cascades involving multiple cell types. To decipher diverse drug effects on altering the TME, we employ in vivo studies in mouse models recapitulating the human disease, as well as a novel tumor explant model that enables the short-term culture of intact human or murine PDAC. Importantly, PDAC explants maintain their histopathological architecture and cellular diversity over time. This medium-throughput platform allows for testing of multiple drugs and mechanistic hypotheses in the native PDAC TME. We show in preliminary data that Smoothened inhibition (SMOi) decreases proliferation and activity of myCAFs, but provokes the expansion of CD11b-positive myeloid cells in vivo. Thus, we hypothesize that LIS in PDAC is maintained by a delicate balance between myCAFs and myeloid cells, preventing effective T cell invasion. Single cell RNA-seq data comparing ctrl vs. SMOi-treated murine PDAC elucidates stromal subpopulations involved in the LIS phenotype and guides the identification of myeloid subtypes emerging after SMOi. Strikingly, we demonstrated that simultaneous SMOi and targeting myeloid cells via anti-Gr1 or CCR1 inhibition (CCR1i) significantly elevates cytotoxic T cell numbers up to 20x within the TME. We are currently investigating whether the activity of these T cells may be further potentiated through combination with immunomodulatory agents. By testing various treatment combination in the same TME, we will identify the best synergistic effects for future immunotherapy approaches in human PDAC. In summary, we are elucidating the complex mechanism behind LIS in PDAC by employing our novel explant culture system alongside in vivo studies. We aim to develop a translatable regimen to neutralize LIS, reactivating the cytotoxic T cells in the tumor periphery to invade, proliferate, and attack cancer cells. Citation Format: Marie C Hasselluhn, Lukas Vlahos, Dafydd Thomas, Quin T Waterbury, Alvaro Curiel Garcia, Amanda R Decker-Farrell, Tanner C Dalton, Stephen A Sastra, Carmine F Palermo, Timothy C Wang, Andrea Califano, Kenneth P Olive. Disrupting local immunosuppression through combination myCAF/myeloid targeting in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A045.

Boosting cross-modal retrieval in remote sensing via a novel unified attention network

With the rapid advent and abundance of remote sensing data in different modalities, cross-modal retrieval tasks have gained importance in the research community. Cross-modal retrieval belongs to the research paradigm in which the query is of one modality and the retrieved output is of the other modality. In this paper, the remote sensing (RS) data modalities considered are the earth observation optical data (aerial photos) and the corresponding hand-drawn sketches. The main challenge of the cross-modal retrieval research objective for optical remote sensing images and the corresponding sketches is the distribution gap between the shared embedding space of the modalities. Prior attempts to resolve this issue have not yielded satisfactory outcomes regarding accurately retrieving cross-modal sketch-image RS data. The state-of-the-art architectures used conventional convolutional architectures, which focused on local pixel-wise information about the modalities to be retrieved. This limits the interaction between the sketch texture and the corresponding image, making these models susceptible to overfitting datasets with particular scenarios. To circumvent this limitation, we suggest establishing multi-modal correspondence using a novel architecture of the combined self and cross-attention algorithms, SPCA-Net to minimize the modality gap by employing attention mechanisms for the query and other modalities. Efficient cross-modal retrieval is achieved through the suggested attention architecture, which empirically emphasizes the global information of the relevant query modality and bridges the domain gap through a unique pairwise cross-attention network. In addition to the novel architecture, this paper introduces a unique loss function, label-specific supervised contrastive loss, tailored to the intricacies of the task and to enhance the discriminative power of the learned embeddings. Extensive evaluations are conducted on two sketch-image remote sensing datasets, Earth-on-Canvas and RSketch. Under the same experimental conditions, the performance metrics of our proposed model beat the state-of-the-art architectures by significant margins of 16.7%, 18.9%, 33.7%, and 40.9% correspondingly.

Bodyless block propagation: TPS fully scalable blockchain with pre-validation

Despite numerous prior attempts to boost transaction per second (TPS) of blockchain system, most of them were at a price of degraded decentralization and security. In this paper, we propose a bodyless block propagation (BBP) scheme for which the blockbody is not validated and transmitted during the block propagation process, to increase TPS without compromising security. Rather, the nodes in the blockchain network anticipate the transactions and their ordering in the next upcoming block so that these transactions can be pre-executed and pre-validated before the birth of the block. It is critical, however, that all nodes have a consensus on the transaction content of the next block.This paper puts forth a transaction selection, ordering, and synchronization algorithm to drive the nodes to reach such a consensus. Yet, the Coinbase Address of the miner of the next block cannot be anticipated, and therefore transactions that depend on the Coinbase Address cannot be pre-executed and pre-validated. This paper further puts forth an algorithm to deal with such unresolvable transactions for an overall consistent and TPS-efficient scheme. With our scheme, most transactions do not need to be validated and transmitted during block propagation, ridding the dependence of propagation time on the number of transactions in the block, and making the system fully TPS scalable. Experimental results show that our protocol can reduce propagation time by 4× with respect to the current Ethereum blockchain, and its TPS performance is limited by the node hardware performance rather than block propagation.

A Case of Nasoseptal Flap Reconstruction for Refractory Medial Canthal Fistula.

Sino-orbital cutaneous fistulas (SOCFs) are a rare and challenging complication from conditions including granulomatosis with polyangiitis. SOCFs are difficult to manage due to poor vascular supply, compromised tissue, and systemic immunocompromise, which lead to a high rate of recurrence. Given the overall rarity of SOCFs, optimal surgical repair remains controversial, with options ranging from conservative management, onlay grafts, and vascularized flaps. This case report describes a novel one-step approach to SOCF closure using a composite chondral mucosal nasoseptal flap in a patient with a large left medial canthal SOCF that had recurred despite 2 prior attempts at closure including a vascularized paramedian forehead flap. Nasoseptal flaps may provide vascularized mucosal tissue to allow for greater success in closure over traditional, external flaps, and skin grafts.

ChromaFlash: Snapshot Hyperspectral Imaging Using Rolling Shutter Cameras

Hyperspectral imaging captures scene information across narrow, contiguous bands of the electromagnetic spectrum. Despite its proven utility in industrial and biomedical applications, its ubiquity has been limited by bulky form factors, slow capture times, and prohibitive costs. In this work, we propose a generalized approach to snapshot hyperspectral imaging that only requires a standard rolling shutter camera and wavelength-adjustable lighting. The crux of this approach entails using the rolling shutter as a spatiotemporal mask, varying incoming light quicker than the camera's frame rate in order for the captured image to contain rows of pixels illuminated at different wavelengths. An image reconstruction pipeline then converts this coded image into a complete hyperspectral image using sparse optimization. We demonstrate the feasibility of this approach by deploying a low-cost system called ChromaFlash, which uses a smartphone's camera for image acquisition and a series of LEDs to change the scene's illumination. We evaluated ChromaFlash through simulations on two public hyperspectral datasets and assessed its spatial and spectral accuracy across various system parameters. We also tested the real-world performance of our prototype by capturing diverse scenes under varied ambient lighting conditions. In both experiments, ChromaFlash outperformed state-of-the-art techniques that use deep learning to convert RGB images into hyperspectral ones, achieving snapshot performance not demonstrated by prior attempts at accessible hyperspectral imaging.

Decolonizing leadership knowledge: Context, culture, and complexity.

Leadership knowledge is viewed as an essential aspect of overall leadership learning, yet questions abound as to who decides what forms of knowledge are recognized as legitimate. This article reviews existing frames of leadership knowledge along with prior attempts to codify leadership knowledge. We then examine the function of leadership knowledge within the leadership learning framework (LLF) and explore how it connects to and illuminates other facets of the LLF model. Finally, critical questions are asked about the future evolution of leadership knowledge and the roles of context, culture, and complexity in decolonizing leadership knowledge.

Impact of Hysteroscopic Polypectomy on IVF Outcomes in Women with Unexplained Infertility.

Objective: To assess the effect of hysteroscopic polypectomy on the in vitro fertilization (IVF) results in infertile women with at least one prior negative IVF outcome. Methods: This retrospective cohort study included women who had attended the "2nd Department of Obstetrics and Gynecology of the National and Kapodistrian University of Athens" and "Iaso" Maternity Hospital from October 2019 to January 2023 for infertility treatment. The medical records of 345 women aged 18-45 years old without abnormal findings in hysterosalpingography (HSG) and with at least one previous failed IVF procedure were analyzed. The male factor was excluded, as well as a prior hysteroscopic removal of polyps. In 67 women, polyps were suspected during initial two-dimensional ultrasound (2D-US) examination. The final sample of the study comprised 40 patients, in which endometrial polyps were removed by hysteroscopy with the use of resectoscope. All patients underwent ovarian stimulation and IVF in the consecutive cycle using a short GnRh antagonist protocol. Main Results: After hysteroscopic polypectomy, 29 (72.5%) out of 40 patients had a positive pregnancy result: 26 (65%) clinical and 3 (7.5%) biochemical pregnancies were documented. There was a statistically significant difference between the number of clinical pregnancies before and after polypectomy (p < 0.001), as well as between the total number of pregnancies (p < 0.001). Secondary Results: Women with positive outcome were significantly younger and had significantly lower FSH levels (p < 0.007). They also had significantly higher AMH (p < 0.009) and peak estradiol levels (p < 0.013) and yielded more M II oocytes (p < 0.009) and embryos (p < 0.002). Conclusions: Hysteroscopic polypectomy in women with a suspected endometrial polyp using 2D ultrasound and a history of prior failed IVF attempt improves IVF outcomes in terms of the clinical and total number of pregnancies.