Vécu des situations à risque d’erreur en réanimation : une étude qualitative auprès des médecins et infirmiers

Intensive care units are considered as services with a high risk of error. More and more studies have measured the incidence and impact of errors in intensive care units, but few of them are centered on the impact of the risk of error for professionals. This study focuses on the perception of the risk of error, how it is experienced, and the way in which professionals cope with it. Forty professionals (20 physicians, 20 nurses) participated in clinical interviews. We transcribed recordings and analysed the data using a phenomenological approach. The risk of error is omnipresent in intensive care units. For nurses with less than one years experience, the risk of error is associated with important manifestations of anxiety. On the contrary, for doctors and nurses who have worked for more than one year in ICU, their experience and the relationship of cooperation built with colleagues gives them a feeling of control over risky situations. Our results show that it is important to take into account the risk of error in order to better target the support and training for the ICU professionals.     

Facing temptation: The neural correlates of gambling availability during sports picture exposure

Nowadays, sports betting has become increasingly available and easy to engage in. Here we examined the neural responses to stimuli that represent sporting events available for betting as compared to sporting events without a gambling opportunity. We used a cue exposure task in which football (soccer) fans (N = 42) viewed cues depicting scheduled football games that would occur shortly after the scanning session. In the “betting” condition, participants were instructed to choose, at the end of each block, the game (and the team) they wanted to bet on. In the “watching” condition, participants chose the game they would prefer to watch. After the scanning session, participants completed posttask rating questionnaires assessing, for each cue, their level of confidence about the team they believed would win and how much they would enjoy watching the game. We found that stimuli representing sport events available for betting elicited higher fronto-striatal activation, as well as higher insular cortex activity and functional connectivity, than sport events without a gambling opportunity. Moreover, games rated with more confidence towards the winning team resulted in greater brain activations within regions involved in affective decision-making (ventromedial prefrontal cortex), cognitive inhibitory control (medial and superior frontal gyri) and reward processing (ventral and dorsal striatum). Altogether, these novel findings offer a sensible simulation of how the high availability of sports betting in today’s environment impacts on the reward and cognitive control systems. Future studies are needed to extend the present findings to a sample of football fans that includes a samilar proportion of female and male participants.     

A validity and reliability study of assessment and screening for sustained withdrawal reaction in infancy: The Alarm Distress Baby scale

Sustained withdrawal behavior in infancy is an important alarm signal to draw attention to both organic and relationship disorders. A withdrawal scale, the Alarm Distress Baby scale (ADBB), for infants between 2 and 24 months of age was built. This article describes the construction of the scale and the assessment of its psychometric properties. The ADBB has good content validity, based on the advice of seven experts. The scale has good criterion validity: first, as a measure of the infant's withdrawal reaction, with a very good correlation between nurse and pediatrician on the ADBB (r_s = 0.84), and second, as a screening procedure for detecting the developmental risk of the infant. The cutoff score of 5 with a sensitivity of 0.82 and a specificity of 0.78 was determined to be optimal for screening purposes. The scale has good construct validity, with good convergent validity with both the Spitz (1951) and the Herzog & Rathbun (1982) lists of symptoms of infant depression (r_s = 0.61 and 0.60, respectively). Exploratory factor analysis showed two different factors, consistent with the scale's construct. Reliability was satisfactory with good internal consistency for both subscales (the Cronbach α = 0.80 for the first subscale and 0.79 for the second) and for the global scale (α = 0.83). The test‐retest procedure showed good stability over time (r_s = 0.90 and 0.84 for the two different raters). The scale could be used in different clinical settings, provided a sufficient level of social stimulation is given to the infant in a relatively brief period of time. The scale can be used by nurses and psychologists or by medical doctors after a short period of training. © 2001 Michigan Association for Infant Mental Health.     

The ethical and legal aspects of palliative sedation in severely brain-injured patients: a French perspective

The 2011 Varsity Medical Debate, between Oxford and Cambridge Universities, brought students and faculty together to discuss the waiving of patents for antiretroviral therapies in the developing world. With an estimated 29.5 million infected by Human Immunodeficiency Virus (HIV) in low- and middle-income countries and only 5.3 million of those being treated, the effective and equitable distribution of anti-retroviral therapy (ART) is an issue of great importance. The debate centred around three areas of contention. Firstly, there was disagreement about whether patents were the real barrier to the access of anti-retroviral therapy in the developing world. Secondly, there were differing views on the effectiveness of a patent pool. Thirdly, concerns were raised over the impact of waiving patents on research to produce new and better anti retro-viral drugs.     

Toward a neurophenomenology as an account of generative passages: a first empirical case study

This paper analyzes an explicit instantiation of the program of neurophenomenology in a neuroscientific protocol. Neurophenomenology takes seriously the importance of linking the scientific study of consciousness to the careful examination of experience with a specific first-person methodology. My first claim is that such strategy is a fruitful heuristic because it produces new data and illuminates their relation to subjective experience. My second claim is that the approach could open the door to a natural account of the structure of human experience as it is mobilized in itself in such methodology. In this view, generative passages define the type of circulation which explicitly roots the active and disciplined insight the subject has about his/her experience in a biological emergent process.     

THE SYMBOLIC BODY AND THE SYMBOLIC SYMPTOM

The differential analysis of the symbolic expression and of the symbolic symptom enlightens the relation between body, language and symbol. The displacement and condensation, which explain the symptom, involve a bodily perception of a symbolic nature. Consequently, Freud tends to interpret the symbol according to the symptom formation, as opposed to J. Lacan, who equates displacement with metonymy, and condensation with metaphor. The author, in analyzing the similarities and differences, interprets the symptom as a desymbolization, which presupposes a presymbolic perception, which phenomenology has thematized. However, it is language which structures this perception as symbolic, and which introduces the symbolic finality; which the psychological dynamisms do not have by their own selves.     

Beyond left and right: Automaticity and flexibility of number-space associations

Close links exist between the processing of numbers and the processing of space: relatively small numbers are preferentially associated with a left-sided response while relatively large numbers are associated with a right-sided response (the SNARC effect). Previous work demonstrated that the SNARC effect is triggered in an automatic manner and is highly flexible. Besides the left-right dimension, numbers associate with other spatial response mappings such as close/far responses, where small numbers are associated with a close response and large numbers with a far response. In two experiments we investigate the nature of this association. Associations between magnitude and close/far responses were observed using a magnitude-irrelevant task (Experiment 1: automaticity) and using a variable referent task (Experiment 2: flexibility). While drawing a strong parallel between both response mappings, the present results are also informative with regard to the question about what type of processing mechanism underlies both the SNARC effect and the association between numerical magnitude and close/far response locations.     

Message Exchange Games in Strategic Contexts

When two people engage in a conversation, knowingly or unknowingly, they are playing a game. Players of such games have diverse objectives, or winning conditions: an applicant trying to convince her potential employer of her eligibility over that of a competitor, a prosecutor trying to convict a defendant, a politician trying to convince an electorate in a political debate, and so on. We argue that infinitary games offer a natural model for many structural characteristics of such conversations. We call such games message exchange games, and we compare them to existing game theoretic frameworks used in linguistics—for example, signaling games—and show that message exchange games are needed to handle non-cooperative conversation. In this paper, we concentrate on conversational games where players’ interests are opposed. We provide a taxonomy of conversations based on their winning conditions, and we investigate some essential features of winning conditions like consistency and what we call rhetorical cooperativity. We show that these features make our games decomposition sensitive, a property we define formally in the paper. We show that this property has far-reaching implications for the existence of winning strategies and their complexity. There is a class of winning conditions (decomposition invariant winning conditions) for which message exchange games are equivalent to Banach- Mazur games, which have been extensively studied and enjoy nice topological results. But decomposition sensitive goals are much more the norm and much more interesting linguistically and philosophically.