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BACKGROUND: The use of physician satisfaction scores to evaluate emergency medicine physicians’ performance and compensation is controversial. Prior studies have shown that the clinical environment may influence scores. This study compared satisfaction scores for the same physician at different emergency departments (ED). Differences in their individual score may indicate the ED environment could be as important as the physician’s interaction. METHODS: Press Ganey satisfaction scores were obtained for physicians at three EDs—Grand Strand, South Strand and North Strand—between July 2018 and June 2019. Included physicians worked at all 3 facilities and had at least 6 patient satisfaction surveys at each site. The Press Ganey scale ranges from 1–5, with 1 as “very poor” and 5 as “very good”. Using top-box methodology, the total physician score was generated from the average of 4 questions: courtesy, keeping patients informed, patient comfort and listening. We utilized descriptive statistics to compare scores for all physicians at each of the 3 sites. In addition, each physician’s top box scores were averaged by site for analysis (two-way ANOVA) to determine if individual physician scores varied in different EDs. RESULTS: Fourteen physicians met inclusion criteria. Physicians at the main ED had an average total score of 73.37 ± 6.08 (SD) versus 76.5 ± 8.87 and 85.09 ± 7.75 at the 2 free standing EDs. Two-way ANOVA showed that the Press Ganey scores were significantly different for individual physicians between the newer free-standing ED and either the main ED or the other free-standing ED, p

AIM: The purpose of this study was to characterize a novel, non-thiazolidinedione (TZD) peroxisome proliferator-activated receptor (PPAR)gamma agonist, RWJ-348260, via both in vitro and in vivo approaches. METHODS: The in vitro PPARgamma activities of RWJ-348260 were assessed in PPARgamma-GAL4 co-transfection assay, PPARgamma receptor binding assay, aP2 gene induction assay and preadipocyte differentiation assay. The in vivo efficacy of the compound was determined in rodent genetic diabetes models [ob/ob mouse, db/db mouse and Zucker diabetic fatty (ZDF) rat] following multiple days of oral administration. RESULTS: RWJ-348260 selectively activated PPARgammain vitro. In vivo, RWJ-348260 produced significant decreases in plasma glucose, HbA1c, insulin and triglyceride levels. RWJ-348260 also dose-dependently improved oral glucose tolerance. In db/db mice, the compound up-regulated PPARgamma target genes in white adipose tissues. RWJ-348260 produced a lower extent of hepatocyte lipid deposition and a smaller increase in liver weight compared to rosiglitazone in db/db mice. While RWJ-348260 effectively normalized hyperglycaemia and dyslipidaemia, it did not change haematocrit, transaminase, alkaline phosphatase, total bilirubin levels or liver weights in ZDF rats. CONCLUSIONS: RWJ-348260 is a potent PPARgamma agonist with efficacious antidiabetic activity in diabetic animal models. The compound has an improved side-effect profile compared to rosiglitazone.

Topiramate (TPM) is a novel neurotherapeutic agent. Clinical studies reported that TPM treatment reduced body weight and decreased fasting blood glucose levels in obese patients with or without type 2 diabetes. It is unclear whether the blood glucose-normalizing phenomenon observed during TPM treatment is a primary effect or the consequence of reduced food intake and weight loss. In the present studies, we chronically treated female Zucker diabetic fatty (ZDF) rats (fed with a diabetogenic diet) and db/db mice with TPM (30-300 mg/kg/day) to examine the effect of TPM on hyperglycaemia and its relationship with food intake and body weight gain. Our data showed that TPM treatment markedly reduced blood glucose levels in both ZDF rats and db/db mice without a significant reduction in body weight gain. Pair-fed db/db mice treated with the vehicle alone did not exhibit a significant decrease in blood glucose levels compared with mice fed ad libitum. TPM treatment increased glucose-stimulated insulin release by 2-3-fold during an oral glucose tolerance test in both ZDF rats and db/db mice. We also observed a 1.4-fold increase of pancreatic insulin content and heightened insulin immunostaining in pancreatic beta cells in db/db mice treated with TPM. Our data suggest that the antidiabetic effect of TPM is independent of the changes in body weight gain and food intake. Improved glucose-induced insulin release may, in part, underlie the mechanisms by which TPM ameliorates the hyperglycaemia.

This paper postulates that larger more complicated organisms cannot be comprehended completely. Some of their important internal characteristics and dynamics are indeterminate. Certain external conditions and occurrences vitally affecting them cannot be predicted or treated as random events. The internal functioning of complex organisms and their interaction with the external environment cannot therefore be formulated analytically with the completeness, precision, and reliability required for truly comprehensive planning and decision-making. Limitations of rational and collective action by people are also involved in what comprehensive planning can and cannot accomplish, and how it is best conducted.

In this article the significance and requirements of monitoring outdoor noise pollution in urban environments are discussed. Potentialities and limitations of using the regular telephone network for this purpose are identified. A system of noise monitoring is described which uses single telephone lines and existing electronic and data processing components. This system provides a technically and economically feasible means of enforcing local legislation controlling noise from aircraft overhead and from other outdoor sources, and of analyzing needs and trends with respect to such sounds over time.

City planning is an established activity, field of knowledge, and profession. Except for river basin development and specific functional programs, regional planning is presently limited as an organized endeavor. Civil engineers will continue their roles relating to the design and construction of certain physical facilities; but greater knowledge of the dynamics of urban-regional organisms and subsystem analysis will be necessary for effective participation as the scope of planning broadens and deepens. The current focus is on comprehensive planning which analyzes and projects all major elements in shaping the city or region in accordance with trends and objectives. This calls for improved techniques of synthesizing disparate interdependent variables, projecting into the future, formulating sound subjective judgments, and systems design. Together with other engineers and professions, the civil engineer is a potential candidate for directorial positions in comprehensive or master planning; these require graduate education in city or regional planning, or acquiring equivalent knowledge through university extension, self-education, or expanded civil engineering curricula.

Use of commercial helicopters in cities is expanding rapidly. Continued growth in this use and the development of other means of aerial travel could create a new set of city planning problems. Advance analysis of the complex questions involved in widespread urban air traffic would reduce its potentially disruptive effects and possibly prevent a period of serious metropolitan confusion. It would provide a better basis for the decisions relating to urban air travel made by city planning commissions today and for those likely to arise in the future.

(1957). Planning and Operations Research. Journal of the American Institute of Planners: Vol. 23, No. 4, pp. 168-175.

Corporate planning has expanded as an organized staff activity in business, but little is known concerning either its operating characteristics or its practitioners as a group. Results of a recent sample survey represent the best information now available.

Many professional fields are now involved directly in different applications of planning: architecture, economics, engineering, geography, business and governmental management, mathematics and operations research, military and physical planning, sociology. Such recent intellectual advances as information and decision theory, game and communication theory, symbolic logic, mathematical and other simulation, queueing theory, linear programming, or the psychology of groups are being applied successfully to planning problems. From a synthesis of these professional and intellectual activities, a theory, principles, and methodology of comprehensive planning are likely to develop. This substantive body of knowledge will become an important field of study.

A number of concepts and conditions in current city planning are questioned: the grand master plan delusion; planning after the fact; intermittent master planning; the illusion of complete study; avoiding the critical problems; trying to do everything; sematic confusion; conflicts of role and organization; unrealistic derivation of goals and objectives; failure of city planning in the general public interest; deficiencies of planning personnel; inadequacies of theory and research; underestimating fundamental difficulties of the city planning endeavor.