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PURPOSE OF REVIEW: Raynaud’s phenomenon (RP) is a common vasospastic condition that results in digital hypoperfusion in response to cold and/or emotional stress and is associated with significant pain and disability. The aim of our review is to provide a practical approach for clinicians to inform assessment and management of patients with RP. RECENT FINDINGS: Autoantibodies and nailfold capillaroscopy are key investigations to stratify the risk of progression to systemic sclerosis SSc in patients RP, which was recently confirmed in the multi-center, very early diagnosis of systemic sclerosis ‘VEDOSS’ project. Research has explored the complex lived-patient experience of RP including digital vasculopathy in SSc and has highlighted the need for outcome measure development to facilitate research in the field. Pharmacological treatment strategies vary significantly internationally and there is continued interest in developing surgical approaches. SUMMARY: We provide a practical and up-to-date approach to inform the assessment and management of patients with RP including guidance on drug initiation and escalation. Calcium channel blockers are first-line treatment and can be initiated by primary care physicians. We also highlight second-line drug therapies used for refractory RP and the potential role for surgical intervention.

Background: There is a lack of studies comparing hospitalization and post-hospitalization outcomes between internal medicine (IM) hospitalists and family medicine (FM) hospitalists. Objective: To compare the length of stay (LOS), hospital cost, and 30-day all-cause readmission rate among patients treated by IM hospitalists and FM hospitalists. Design and Setting: Prospective cohort study in a referral center. Propensity score matching was used to balance baseline characteristics between comparative arms. Participants: 747 patients 18 years and older who were admitted to hospitalist services. Intervention: Treatment by IM hospitalists and FM hospitalists. Main Measures: LOS, hospital cost, and 30-day all-cause readmission. Treatment arms were compared by two methods. We compared patients who were seen by FM exclusively with those treated exclusively by IM services. Covariate adjusted differences in outcomes were estimated by multivariable regression. For a secondary set of analyses, exposure to FM and IM was converted to a continuous independent variable. Key Results: Forty, 333, and 374 patients were seen by FM, IM, and a combination of both services, respectively. Using average treatment on the treated as the estimand, FM care provided a shorter weight-adjusted LOS by 0.5 days (CI: -0.92- -0.04, P =0.026) compared to IM, but no difference in hospital cost (-126, CI: -906-653, P=.74). There was no difference in adjusted hazard for 30-day readmission between FM and IM (HR: 2, CI: 0.67-6.2, P =0.062). Propensity weight-adjusted multiple regression models of the complete cohort (n=747) did not show any difference in any outcomes with increased exposure to FM care. Conclusions: Understanding variation in practices and outcomes between different hospitalist models opens opportunities to improve care and decrease the length of stay.

Objectives The aim of this study was to identify risk factors of percent predicted forced vital capacity (ppFVC) decline in patients with SSc-associated interstitial lung disease (SSc-ILD). Methods We identified 484 patients with SSc who had HRCT Chest, of which 312 with ILD. Those with serial pulmonary function tests were included in a longitudinal analysis (n = 184). Linear mixed effect models were fitted to assess the decline in ppFVC over time, and to explore the effect of demographics and baseline characteristics on ppFVC decline. Results The majority of SSc-ILD patients were female (76.3%) and 51.3% had diffuse cutaneous subset. The mean (s.d.) age was 53.6 (12.7) years, median disease duration since first non-RP symptoms was 2.6 years, and 48.4% of the patients had ILD extent >20% on HRCT. In the univariate analysis, longer disease duration (>2.37 years), ILD extent >20%, and anti-topoisomerase I (ATA) positivity were significantly associated with ppFVC decline. In the multivariate analysis, the only statistically significant variable associated with ppFVC decline was ATA positivity. The overall group’s mean decline in ppFVC was –0.28% (P-value 0.029), with –0.13% (n = 163) in those who were alive and –8.28% (P-value 0.0002 for the change in ppFVC trajectory) in patients who died within 2 years. Conclusion Our study confirms that ppFVC is a marker of survival in SSc-ILD, supporting its use for risk stratification to identify patients who may benefit from earlier interventions and treatment. Our study also supports the role of ATA positivity as a predictive marker for ppFVC decline in this population.

The association between gout and arrhythmias has not been thoroughly examined. This study discusses the underappreciated burden, patterns, and outcomes of several arrhythmias, which may have prognostic value in patients with gout. This is a retrospective cohort study that used the US National Inpatient Sample for 2015-2019. Complex samples multivariable logistic and linear regression models were used to assess the incidence and trends in gout-related arrhythmia and consequential inpatient mortality, hospital length of stay (LOS), hospitalization charges, and predictors of mortality. Hospitalizations that included a diagnosis of gout accounted for 60,360 admissions. Arrhythmias affected roughly one-fourth of those. When compared to individuals without arrhythmia, those who experienced arrhythmias were older. Arrhythmias were found to be equally common in both men and women. The most common subtype was AF (88%), followed by atrial flutter (6.2%), conduction disorders (4.7%), and ventricular tachycardia (3.2%). In individuals with gout, there was a rising trend in arrhythmia-related hospital admissions and mortality. The gout-arrhythmia group had more traditional cardiac comorbidities. After adjusting for baseline variables, the arrhythmia group had significantly greater mortality (693 vs 77 per 100,000 hospitalizations), mean LOS (4.3 vs 3.7 days), and hospital costs ($33,057 vs $28,384). In gout, incident arrhythmia dramatically raised the risk of death (adjusted odds ratio, 2.06; 95% CI, 1.95-2.16; P0.001). Gout patients who are hospitalized with concurrent arrhythmia have a likelihood of longer stays in the hospital and higher mortality. Early identification and treatment of arrhythmia may benefit outcomes in gout patients.

Recent achievement and progress in solar PV play a significant role in controlling climate change. This study reviewed comprehensively electrical characteristics, life cycle of dust, optical characteristics, and different cleaning techniques related to the effect of dust on the performance of PV modules throughout different climate regions of the world. The power maximum power point (MPP) and curve of PV module under the effect of irradiance and temperature were presented. The effect of dust (shading) on the electrical efficiency of PV module was discussed based on soft, partial, and complete (soiling) shading. The physical properties of dust around the globe such as PM

Background There are no prospective studies comparing hospitalization and post-hospitalization outcomes between teaching internal medicine services and non-teaching hospitalists, and no prospective studies comparing these outcomes between locum and employed hospitalists. Objective To compare the length of stay, hospital costs readmission rate, and mortality rate in patients treated by teaching internal medicine services vs. hospitalists and among patients treated by locum vs. employed hospitalists. Design Prospective cohort study. Propensity score was used to obtain weighted estimates. Setting Referral center. Patients All patients 18 years and older admitted to internal medicine services. Intervention Treatment by teaching internal medicine services vs. hospitalists. Treatment by locum hospitalists vs. employed hospitalists. Main Measures Primary outcome was adjusted length of stay and secondary outcomes included hospital cost, inpatient mortality, 30-day all-cause readmission, and 30-day mortality. Key Results A total of 1273 patients were admitted in the study period. The mean patient age was 61 ± 19 years, and the sample was 52% females. Teaching internal medicine physicians admitted 526 patients and non-teaching hospitalists admitted 747 patients. Being seen exclusively by teaching internal medicine physicians comports with a shorter adjusted hospital stay by 0.6 days (95% CI − 1.07 to − 0.22, P = .003) compared to non-teaching hospitalists. Adjusted length of stay was 1 day shorter in patients seen exclusively by locums compared to patients seen exclusively by employed services (95% CI − 1.6 to − 0.43, P < .001) with an adjusted average hospital cost saving of 1339 dollars (95% CI − 2037 to − 642, P < .001). There was no statistically significant difference in other outcomes. Conclusions Teaching internal medicine services care was associated with a shorter stay but not with increased costs, readmission, or mortality compared to non-teaching services. In contrary to the “expected,” patients treated by locums had shorter stays and decreased hospital costs but no increase in readmissions or mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-020-06578-4.

This study presents an experimental study of the effect of quenching temperature from the inter-critical region (a the standard high speed rotating beam test was adapted for this purpose. It was found that there is a direct relation between quenching temperature from the inter-critical region and fatigue life; the fatigue life can be increased up to 625% by increasing the quenching temperature to 850°C. This finding is important as it enhances much the ability of the AISI 1010 steel to resist fatigue failure.

There is growing evidence that implicates epigenetic modification in the pathogenesis of systemic sclerosis (SSc). The complexity of epigenetic regulation and its dynamic nature complicate the investigation of its role in the disease. We will review the current literature for factors that link epigenetics to SSc by discussing DNA methylation, histone acetylation and methylation, and non-coding RNAs (ncRNAs), particularly microRNA changes in endothelial cells, fibroblasts (FBs), and lymphocytes. These three cell types are significantly involved in the early stages and throughout the course of the disease and are particularly vulnerable to epigenetic regulation. The pathogenesis of SSc is likely related to modifications of the epigenome by environmental signals in individuals with a specific genetic makeup. The epigenome is an attractive therapeutic target; however, successful epigenetics-based treatments require a better understanding of the molecular mechanisms controlling the epigenome and its alteration in the disease.

Pancreaticopleural fistula (PPF) is a rare complication of pancreatitis that requires a high index of clinical suspicion as patients typically present with pulmonary symptoms related to the pleural effusion rather than pancreatitis. Diagnosis is made by detection of amylase in the pleural fluid. Magnetic resonance cholangiopancreatography can aid in visualizing the fistula. We present a case of massive left pleural effusion secondary to a PPF due to acute on chronic pancreatitis.

Urinothorax is the presence of urine in the pleural space. It can occur at any age and is more common in males. It typically results from obstructive uropathy but can also be caused by malignancy or trauma. Urinothorax is a rare cause of transudative pleural effusion and the only cause of low pH (pH

In this paper, we present the results and experience gained through the Energy Conservation Pilot Project in the Town of Salfeet/Palestine. Also, we describe five case studies of energy-efficient programs in five countries—Mexico, China, Philippines, Poland and Vietnam. The project was funded by the UNDP/GEF and executed within the framework of the cooperation between An-Najah National University, the UNDP/GEF, and Salfeet Municipality. The project aims mainly to draw the public attention towards the importance of energy conservation in reducing pollution as well as running cost. In fact, a major component of the project was the replacement of the incandescent lamps for about 40% of the residents of Salfeet (626 families), the 40–100 W lamps were replaced by 18 W compact florescent lamps (CFL). Each benefited family was given three to five CFL free of charge depending on number of persons per family. It is found that the total energy saved because of lamp-replacement in Salfeet is about 5,000 kWh/month, and the total emission saved of CO2 is about 5,792 kg as coal is burnt to generate electricity. Furthermore, the project has improved public awareness about energy conservation concepts and their positive impact on local and global climate changes.

In this paper, the displacement of a point on a rigid body which moves from one spatial position to another is considered by the concept of screw matrix. Since there are ∞3 possible screws to achieve such displacement, using Parkin's definition (measure) for pitch, one can represent this infinite set of screws as a 4-system of screws. This has been demonstrated by Huang and Roth by the use of screw triangle [1]. In this paper, however, without any assumption for the expression of pitch we ask the question that whether there exist different appropriate measure of pitch other than Parkin's such that all the available finite screws also form a 4-system. In fact by the use of screw matrix concept, a general expression of the pitch is derived so that the screws realize the stated displacement form a 4-system. It is shown that Parkin's pitch, plus an arbitrary constant, is the only appropriate measure of pitch. To arrive at this conclusion, a special coordinate system is selected. This selection of the coordinate system also makes it possible to yield several new geometrical properties of the set of ∞3 screws.

The interaction between the educational institutions and employers can be viewed as a chain of suppliers and customers. The final product of the educational institutions is qualified people or graduated students. The employers as a customer expect certain qualifications of the graduated students. The educational institutions should know what customer qualifications demands and be able to translate these demands into courses and the curriculum. In this paper, a real-time approach for determining the industry qualifications demand will be presented. The Industrial Engineering (IE) curriculum at An-Najah National University (NNU) have been assessed based on the industry qualifications demand and educational outcomes of Accreditation Board for Engineering and Technology (ABET).