This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

Exhaustive study of concept of liberation of soul (Mokṣa) in six systems of Hindu philosophy and other schools.

Reserach work on Hindu doctrines and philosophy.

Television advertisements depicting the use of electronic cigarettes have recently exposed minors to images of smoking behaviors. While these advertisements are currently legal, existing laws should be interpreted or expanded to ban the commercial depiction of smoking behaviors with any product that resembles a cigarette to shield minors from potentially influential advertising.

Amid the action of the 2013 Super Bowl aired the usual array of high-priced advertisements. Most ads were original. Some were unusual. One regional ad, however, seemed distantly familiar. The 30-second commercial promoted the NJOY King electronic cigarette1 to at least 10 million viewers in several major markets. It featured an attractive male model taking a drag from what looks like a cigarette. He then slowly blows smoke to the tune of Foreigner’s “Feels Like the First Time.” Of course, the (...) “smoke” does not come from burning tobacco. Rather, it is the water vapor produced by an e-cigarette as part of its nicotine delivery process. This, however, was not evident from the imagery. For those watching the broadcast, including thousands of minors, NJOY’s advertisement depicted what tobacco companies have not portrayed on television for decades: a person engaged in smoking behavior. (shrink)

Misophonia has been characterized as intense negative reactions to specific trigger sounds. However, recent research suggests high-level, contextual, and multisensory factors are also involved. We recently demonstrated that neurotypicals’ negative reactions to aversive sounds are attenuated when the sounds are synced with positive attributable video sources. To assess whether this effect generalizes to misophonic triggers, we developed a Sound-Swapped Video database for use in misophonia research. In Study 1, we created a set of 39 video clips depicting common trigger sounds (...) and a corresponding set of 39 PAVS temporally synchronized with the OVS videos. In Study 2, participants rated the 39 PAVS videos for their audiovisual match and pleasantness. We selected the 20 PAVS videos with best match scores for use in Study 3. In Study 3, a new group of participants observed the 20 selected PAVS and 20 corresponding OVS and judged the pleasantness or unpleasantness of each sound in the two contexts accompanying each video. Afterward, participants completed the Misophonia Questionnaire. The results of Study 3 show a robust attenuating effect of PAVS videos on the reported unpleasantness of trigger sounds: trigger sounds were rated as significantly less unpleasant when paired with PAVS with than OVS. Moreover, this attenuating effect was present in nearly every participant regardless of their score on the MQ. In fact, we found a moderate positive correlation between the PAVS-OVS difference and misophonia severity scores. Overall our results provide validation that the SSV database is a useful stimulus database to study how misophonic responses can be modulated by visual contexts. Here, we release the SSV database with the best 18 PAVS and 18 OVS videos used in Study 3 along with aggregate ratings of audio-video match and pleasantness. We also provide detailed instructions on how to produce these videos, with the hope that this database grows and improves through collaborations with the community of misophonia researchers. (shrink)

Since its inception in September 2010, the Network for Public Health Law has responded to hundreds of public health legal technical assistance claims from around the country. Based on a review of these data, a series of major trends in public health practice and the law are analyzed, including issues concerning: the Affordable Care Act, tobacco control, emergency legal preparedness, health information privacy, food policy, vaccination, drug overdose prevention, sports injury law, public health accreditation, and maternal breastfeeding. These and other (...) emerging themes in public health law demonstrate the essential role of law and practice in advancing the public's health. (shrink)

Public health law research reveals significant complexities underlying the use of law as an effective tool to improve health outcomes across populations. The challenges of applying public health law in practice are no easier. Attorneys, public health officials, and diverse partners in the public and private sectors collaborate on the front lines to forge pathways to advance population health through law. Meeting this objective amidst competing interests requires strong practice skills to shift through sensitive and sometimes urgent calls for action (...) to address known threats to the health of individuals and the community. It also necessitates objective, timely information and national and regional legal support. (shrink)

Treatise on Vedanta philosophy; includes interpretation in Hindi and Sanskrit.

Study of Vedāntakaustubha of Śrīnivāsācārya, commentary on Brahmasūtra of Bādarāyaṇa, work on Vedanta philosophy.

This paper will suggest that the work Alfred North Whitehead (1861-1947) provides a fruitful resource for understanding the philosophical development and validity of scientific concepts through an analysis of their socio-historical location. The paper will address two key elements of Whitehead’s thought. One element is "The Bifurcation of Nature" and the paper traces the influence that this conceptual compromise has had on philosophy and science through its reinforcement of the division between the natural and the social sciences. The second element (...) is the status of abstraction in thought and existence. The article will outline Whitehead’s argument that it is necessary to pay attention to the social environment which both enables and inhibits thought if historical epistemology is to develop novel yet analytically strong concepts. (shrink)

Annotation. "This trim publication satisfies a much-felt need among teachers of Indian philosophy, who badly want introductions to the several systems of classical Indian thought such as Professor Deutsch provides."--Journal of Asian Studies.

Text on fundamentals of Vedanta philosophy; includes Sanskrit commentary with Hindi Translation and English explanation.

Manual of the Advaita school in Indic philosophy.