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Introduction There has been considerable research on the association between smoking status and thyroid cancer risk in males, yet the findings are inconsistent. In this study, we investigated the associations of intensity, duration, cumulative dose, and age at start of smoking, with thyroid cancer in Chinese males. Methods From a 1:1 matched case-control study conducted between 2015 and 2017 in Zhejiang Province, China, 676 pairs of male subjects were included in the analysis. The associations between smoking characteristics and thyroid cancer were evaluated in logistic regression models by odds ratios (ORs) with 95% confidence intervals (CIs). Results Compared with never smokers, the former smokers were 0.096 times (95% CI: 0.012-0.778) less likely to have thyroid cancer. The significant inverse association was not observed in current smokers (OR=0.333; 95% CI: 0.084-1.322). Among both former and current smokers, higher smoking intensity (>10 cigarettes/day), duration (>15 years), and cumulative dose of smoking (>10 packyears) were significantly associated with reduced occurrence of thyroid cancer. Conclusions Our findings indicate that former smoking is inversely associated with thyroid cancer occurrence in Chinese males. The reduction in the occurrence of thyroid cancer was also confirmed for both former and current smokers with higher smoking intensity, duration, and cumulative dose.

Background Fear of falling (FoF) and physical activity (PA) are important psychological and behavioral factors associated with falls. No instrument quantifies the link between these two factors to evaluate the risk of falls. We aimed to design a scale linking FoF with PA (Composite Activities-specific Risk of Falls Scale, CARFS) for people with various disability levels. Methods First, we designed a questionnaire comprising 40 balance-related activities from the International Classification of Functioning, Disability, and Health (ICF) for a pilot survey. Second, participants were interviewed about their activities-specific FoF degree and PA frequency. The participants comprised 30 community-dwelling older adults, hospitalized patients with strokes, and those with spinal cord injuries, each with different disability levels. Third, the content validity of the items was evaluated twice by 12 experienced rehabilitation professionals: one based on experience and the other on the survey responses. Items with a higher than moderate relevance in both evaluations were included in the CARFS. The panel of professionals discussed and voted on the contribution of FoF and PA on the CARF score. Finally, the scale sensitivity in distinguishing disability levels was analyzed to evaluate the population suitability to the CARFS. Results The CARFS included 14 activities. A five-point Likert scale was used to quantify degree of FoF (A) and frequency of PA (B). The CARF score (C), which was determined using the eq. C = A+(4-B) + A × B/2, reflected sensitivity to disability levels in most items. Conclusions The CARFS has strong content validity for measuring risk of falls in relation to the FoF and PA of people with various disability levels. It has a potential to provide a guide for designing individualized exercise- and behavior-focused fall prevention programs and enable the precise trtrun 0acking of program effectiveness as a multidimensional outcome measure.

Complementarity of variable renewable energy sources at multiple temporal scales is important in order to ensure reliability of a decarbonizing energy system. In this study, we investigate the hypothesis that a decrease in the fraction of precipitation falling as snow (SWE/P) would increase monthly complementarity of hydro and solar power generation in the western U.S. With a focus on 123 dams responsible for 93% of generation, we found that these resources are seasonally complementary at about half of dams, as indicated by the sign of correlation coefficients (ρ). As hypothesized, average SWE/P at individual dams was generally positively correlated with ρ, but the dependence of ρ on SWE/P was non-linear and SWE/P only explained a modest portion of the variance in complementarity. At each dam, the dependence of annual ρ on interannual variations in SWE/P between 2002–2020 was assessed; these relationships were positive at 72% of dams but not statistically significant at the level of individual dams. Finally, at the system scale ρ was significantly related to SWE/P, with a stronger relationship observed than the dependence of total hydropower generation on SWE/P. Notably, the system-scale relationship between ρ and SWE/P changed dramatically in the latter part of the temporal domain (2012–2020), with a much steeper slope and greater fraction of variance explained by SWE/P. These results illustrate the historical relationship between SWE/P, monthly complementarity of hydro and solar power, complexities of these relationships due to snow and watershed hydrology and reservoir management, and a change in the observed relationship between SWE/P and hydropower generation timing. To the extent that hydro and solar power generation complementarity is responsive to SWE/P, expected declines in SWE/P may indicate greater seasonal complementarity but reduced hydropower available for load-balancing when solar power generation is highest.

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There are few data on outcomes for patients with metastatic urothelial carcinoma (MUC) who receive chemotherapy (CT) after progression on immune checkpoint inhibitors (ICIs). We carried out a retrospective single-centre analysis of MUC patients who progressed after ICI and then received CT. Patients fell into two groups: CT-naive (no prior-CT) and CT-pretreated (platinum-based CT followed by ICI on progression). The response rate (RR), progression-free survival (PFS), and duration of response (DOR) were assessed. A total of 29 patients received CT following progression on ICI. The median follow-up was 17.0mo (interquartile range 9.1-20.5mo). In the CT-naive group (n=17), 53% had a partial response, 18% had stable disease, and 29% had progressive disease. In the CT-pretreated group (n=12) 17% had a partial response, 67% had stable disease, and 16% had progressive disease. The median PFS was 6.4mo (95% confidence interval [CI] 3.8-9.1) in the CT-naive and 4.4mo (95% CI 1.5-7.3) in the CT-pretreated group. The median DOR was 8.1mo (range 5.1-11.1) among the ten patients with a response to CT after ICI in both groups. Some 38% of patients in the CT-naive and 17% in the CT-pretreated group had dose reductions on post-ICI CT. CT and ICI can be sequenced after previous chemotherapy exposure, although this does not induce long-term durable remissions in most patients. PATIENT SUMMARY: We looked at outcomes for patients with metastatic bladder cancer who received chemotherapy after the cancer got worse while on immunotherapy. We found that patients can be safely treated with further chemotherapy. However, the positive effects of chemotherapy will not be durable in the majority of patients.

The practical and symbolic significance of the sun and the moon was coded for a world sample of societies. Methods included use of the eHRAF World Cultures (hereafter eHRAF) Word Search function and the coding of relevant eHRAF materials. The sun, objectively of greater importance than the moon for many aspects of human existence, was expected to be ethnographically more prominent than the moon, and this was found in 55 of 60 cases. There was also a strong tendency for ethnographic mentions of the moon to be made in connection with magico-religious ideas, whereas statements about the sun tended to be more equally divided between the magico-religious and techno-econo-environmental domains. In exploratory investigation, it was found that both sun and moon were frequently mentioned in the ethnographies of foraging societies, which in turn were found to be at the low end of a scale of cultural complexity. Discussion centered on interpretation of the findings and on suggestions for further research.

Sudden cardiac death (SCD) remains an unsolved problem in the twenty-first century. It is often due to rapid onset, ventricular arrhythmias caused by a number of different clinical conditions. A proportion of SCD patients have identifiable diseases such as cardiomyopathies, but for others, the causes are unknown. Viral myocarditis is becoming increasingly recognized as a contributor to unexplained mortality, and is thought to be a major cause of SCD in the first two decades of life. Myocardial inflammation, ion channel dysfunction, electrophysiological, and structural remodeling may play important roles in generating life-threatening arrhythmias. The aim of this review article is to examine the electrophysiology of action potential conduction and repolarization and the mechanisms by which their derangements lead to triggered and reentrant arrhythmogenesis. By synthesizing experimental evidence from pre-clinical and clinical studies, a framework of how host (inflammation), and viral (altered cellular signaling) factors can induce ion electrophysiological and structural remodeling is illustrated. Current pharmacological options are mainly supportive, which may be accompanied by mechanical circulatory support. Heart transplantation is the only curative option in the worst case scenario. Future strategies for the management of viral myocarditis are discussed.