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Sexual concerns after prostate cancer (PCa) treatment are high. Flexible coping is a crucial element to maintaining sexual activity after PCa and improves adaptation outcomes. We aimed to identify potential sexual adaptation styles reported by men following PCa treatment, and to assess relationships among associated variables and outcomes. Individuals ( n  = 223) with PCa treatment history (e.g., radical prostatectomy [ n  = 165, 74.0%], external beam radiation [ n  = 83, 37.2%], hormone/androgen deprivation therapy [ n  = 83, 37.2%]), completed an online survey assessing sexual variables and processes of sexual adaptation. Using a combination of inductive and deductive coding, open-ended responses were thematically analyzed and grouped into sexual adaptation styles. Factors potentially associated with sexual adaptation styles (e.g., age, perceived partner involvement, co-morbidities, relationship duration, time since PCa treatment, desire for physical affection, depression, relationship adjustment) were tested using multinomial logistic regression. Outcomes of sexual well-being (sexual distress, sexual bother, sexual satisfaction) and relationship adjustment were compared against each sexual adaptation style using a multivariate analysis of variance. Sexual activity status and satisfaction with the adaptation process was assessed across the sexual adaptation styles using a chi-square analysis and post-hoc tests. Two distinct categories were identified: those who had Adapted ( n  = 185) and those who had Not Adapted ( n  = 38). Four sexual adaptation styles emerged in the adapted category: Relationship Renegotiation ( n  = 53) and Sexual Renegotiation ( n  = 47), which were couples-focused styles, and Acceptance/Resignation ( n  = 34) and Masturbation/Erection ( n  = 48), which were individual-focused styles. Participants who could not be categorized as one style, but rather met several, were identified as Mixed ( n  = 3). Higher rates of depression, lower relationship adjustment, lack of sexual activity, and greater dissatisfaction with the adaptation process were observed for Not Adapted participants. Participants engaged in any type of adaptation style fared better than those who had Not Adapted. Couples-focused styles tended to emphasize renegotiation, including a changed perspective on the expression of the relationship. Perceived direct engagement of the partner facilitated adaptation and emphasized engagement with flexible coping, either through redefining priorities or ways of being sexual. Individual-focused styles emphasized pre-cancer erectile function, and either aimed to return to capacity for penetrative sexual activity or accepted its inaccessibility and largely an abandonment of partnered sexual activity.

Introduction Only one-quarter of smokers in Pakistan attempt to quit smoking, and less than 3% are successful. In the absence of any literature from the country, this study aimed to explore factors motivating and strategies employed in successful smoking cessation attempts in Pakistan, a lower-middle-income country. Methods A survey was carried out in Karachi, Pakistan, amongst adult (≥ 18 years) former smokers (individuals who had smoked ≥100 cigarettes in their lifetime but who had successfully quit smoking for > 1 month at the time of survey). Multivariable logistic regression, with number of quit attempts (single vs. multiple) as the dependent variable, was performed while adjusting for age, sex, monthly family income, years smoked, cigarettes/day before quitting, and having suffered from a smoking-related health problem. Results Out of 330 former smokers, 50.3% quit successfully on their first attempt with 62.1% quitting “cold turkey”. Only 10.9% used a cessation aid (most commonly nicotine replacement therapy: 8.2%). Motivations for quitting included self-health (74.5%), promptings by one’s family (43%), and family’s health (14.8%). Other social pressures included peer-pressure to quit smoking (31.2%) and social avoidance by non-smokers (22.7%). Successful smoking cessation on one’s first attempt was associated with being married (OR: 4.47 [95% CI: 2.32–8.61]), employing an abrupt cessation mode of quitting (4.12 [2.48–6.84]), and telling oneself that one has the willpower to quit (1.68 [1.04–2.71]). Conclusion In Pakistan, smoking cessation is motivated by concern for self-health and family’s health, family’s support, and social pressures. Our results lay a comprehensive foundation for the development of smoking-cessation interventions tailored to the population of the country. Implications Little is known about the patterns and strategies employed by smokers who are attempting to quit smoking, especially in lower-middle-income countries like Pakistan. Likewise, there are very few smoking cessation programs designed to assist in quitting. Our study will allow for a better understanding of the culture-specific motivating factors and strategies that most contributed to successful quit attempts. Based on these results, evidence based smoking cessation interventions can be developed tailored to the socioeconomic demographic of our country and region, including smoking cessation clinics and public outreach and media campaigns highlighting key elements of successful smoking cessation.

Agitation is common in the emergency department (ED) and with emergency medical services (EMS), which can pose significant challenges to safety and patient care. In older adults, agitation is a common symptom of dementia or delirium. Managing agitation in older adults is challenging in emergency care environments. A scoping review of literature for agitation management approaches for older adults in ED/EMS environments was completed. We searched Medline, Embase, and APA PsycINFO, combining key words and subject headings for 3 concepts: “older adults, aged 65 and older,” “agitation/dementia/delirium,” and “ED/EMS.” Studies which explored management strategies for older adults with agitation, dementia, or delirium in the ED or EMS were included. Studies with younger populations (<65 years old) and/or lacking patient data specifically from the ED or EMS were excluded. A total of 7113 studies were screened, of which 22 were included in this review: pharmacological (n = 8), non-pharmacological (n = 5), multi-component (n = 3) treatments, and recommendations (n = 6). Most were in the ED, and 5038 older adults were included across all studies. Antipsychotics and benzodiazepines to manage agitation were common. Non-pharmacological and multi-component interventions were less commonly evaluated and lacked exploration of patient outcomes. Recommendations stressed caution with pharmacological medications rather than prioritizing non-restraint strategies. Most studies identified use of pharmacological treatment for agitation amongst older adults in ED/EMS settings, however, are not found to be overly effective and are associated with patient harm. There is a significant gap in evidence specific to EMS settings and evaluation of effectiveness of non-pharmacological interventions, highlighting the need for further research.

This paper addresses the critical issue of road safety in the indispensable role of transportation for societal well-being and economic growth. Despite global initiatives like Vision Zero, traffic accidents persist, largely influenced by driver behavior. Advanced driver monitoring systems (ADMSs) utilizing computer vision have emerged to mitigate this issue, but existing systems are often costly and inaccessible, particularly for bus companies. This study introduces a lightweight, deep-learning-based ADMS tailored for real-time driver behavior monitoring, addressing practical barriers to enhance safety measures. A meticulously curated dataset, encompassing diverse demographics and lighting conditions, captures 4966 images depicting five key driver behaviors: eye closure, yawning, smoking, mobile phone usage, and seatbelt compliance. Three object detection models—Faster R-CNN, RetinaNet, and YOLOv5—were evaluated using critical performance metrics. YOLOv5 demonstrated exceptional efficiency, achieving an FPS of 125, a compact model size of 42 MB, and an mAP@IoU 50% of 93.6%. Its performance highlights a favorable trade-off between speed, model size, and prediction accuracy, making it ideal for real-time applications. Faster R-CNN achieved an FPS of 8.56, a model size of 835 MB, and an mAP@IoU 50% of 89.93%, while RetinaNet recorded an FPS of 16.24, a model size of 442 MB, and an mAP@IoU 50% of 87.63%. The practical deployment of the ADMS on a mini CPU demonstrated cost-effectiveness and high performance, enhancing accessibility in real-world settings. By elucidating the strengths and limitations of different object detection models, this research contributes to advancing road safety through affordable, efficient, and reliable technology solutions.

Epigenetic machinery is a cornerstone in normal cell development, orchestrating tissue-specific gene expression in mammalian cells. Aberrations in this intricate landscape drive substantial changes in gene function, emerging as a linchpin in cancer etiology and progression. While cancer was conventionally perceived as solely a genetic disorder, its contemporary definition encompasses genetic alterations intertwined with disruptive epigenetic abnormalities. This review explores the profound impact of DNA methylation, histone modifications, and noncoding RNAs on fundamental cellular processes. When these pivotal epigenetic mechanisms undergo disruption, they intricately guide the acquisition of the 6 hallmark characteristics of cancer within seemingly normal cells. Leveraging the latest advancements in decoding these epigenetic intricacies holds immense promise, heralding a new era in developing targeted and more efficacious treatment modalities against cancers driven by aberrant epigenetic modifications.

Background Supernumerary testis, or polyorchidism, is a rare congenital anomaly characterized by the presence of an extra testis anywhere in the line of anatomical descent. Adenomatoid tumors are benign neoplasms of mesothelial origin that can be found anywhere in the genital tract; however, the occurrence of this rare tumor in a congenitally present extra testis is an extremely unique finding to add to the medical literature. Case presentation A 35-year-old male with an unremarkable medical history presented with chronic testicular pain for 2 months. On examination, mild, tender, palpable nodular mass was felt in the right scrotal sac. On ultrasonography, a hypoechoic area was identified in the third extra right testis, and on MRI, a small hypointense area is appreciated in the separate right testis on T2-weighted images, and enhancement did not increase on T1-weighted images. The tumor markers for the testicular mass were within normal range, and he was scheduled for surgical exploration. The removed testis was sent to the histopathology section, which revealed microscopically, hematoxylin and eosin-stained sections of the tumor display tubules and cords of cuboidal to columnar cells having moderate eosinophilic cytoplasm with prominent vacuoles, with occasional signet ring morphology, separated by intervening delicate fibrovascular stroma. No hemorrhage or necrosis is noted. Conclusion Adenomatoid tumors are the most common paratesticular tumors; however, their presence in the testis is considered rare, and their presence in the supernumerary testis is an extremely rare occurrence. This case highlights the importance of considering adenomatoid tumors in the differential diagnosis of testicular masses, especially in rare anatomical variations such as supernumerary testes. Our literature review provides a deeper insight into the understanding of this rare entity.

Introduction: Cytomegalovirus (CMV) infection is a notable gastrointestinal infection affecting immunocompromised patients. In the gastrointestinal tract, CMV often presents with patchy or diffuse mucosal involvement and can cause fulminant colitis. However, polypoid CMV lesions are rare. We present a case of a 49-year-old man with ulcerative colitis (UC) in remission on ozanimod who developed CMV isolated to inflammatory colon polyps. Case Presentation: A 49-year-old patient with UC in clinical remission on ozanimod underwent routine surveillance colonoscopy, which revealed multiple inflamed polyps with white caps. Biopsy results confirmed inflammatory polyps with positive CMV immunostaining, while adjacent tissues and plasma CMV PCR tests were negative. The patient successfully completed a 3-week course of valganciclovir. Follow-up colonoscopy revealed additional inflammatory polyps but no evidence of CMV. He remained in clinical remission and continued ozanimod therapy. Conclusion: The unusual nature of this presentation suggests a clinically silent CMV reactivation or, alternatively, a primary CMV infection in our patient, with an unclear natural history and optimal management. This report emphasizes the importance of considering CMV in UC patients with unusual endoscopic findings and the need for multidisciplinary collaboration to optimize care.

'Climate Resilient Cities: A Primer on Reducing Vulnerabilities to Disasters' provides city administrators with exactly what they need to know about the complex and compelling challenges of climate change. The book helps local governments create training, capacity building, and capital investment programs for building sustainable, resilient communities. A step-by-step self-assessment challenges policymakers to think about the resources needed to combat natural disasters through an innovative \"hot spot\" risk and vulnerability identifi cation tool. This primer is unique from other resources in its treatment of climate change using a dual-track approach that integrates both mitigation (lowering contributions to greenhouse gases) and adaptation (preparing for impacts of climate change) with disaster risk management. The book is relevant both to cities that are just beginning to think about climate change as well as those that already have well established policies, institutions, and strategies in place. By providing a range of city-level examples of sound practices around the world, the book demonstrates that there are many practical actions that cities can take to build resilience to climate change and natural disasters.

Abstract Laccases are blue multicopper oxidases that oxidize a wide range of phenolic as well as non-phenolic substrates in the presence or absence of mediators. They occur in various species of bacteria, fungi, insects, and plants; bacterial laccases show high substrate specificity. Bacteria produce these enzymes either extracellularly or intracellularly and exhibit stability to a wide range of pH and temperature. Therefore, they are suitable for various industrial processes such as food, textile, and paper and pulp industry. They are also valuable for producing biofuels, pharmaceuticals, biosensors, and degradation of various environmental pollutants and xenobiotics compounds. Since bacterial laccases are more versatile in the sense of nutritional needs and ecological factors, their use can provide a promising solution to various problems related to industry and the field of biotechnology. However, there is a need for a thorough understanding of the chemistry and activity of bacterial laccases to enable their full potential use in bioremediation and biofuel production.