Search

The concept of patient centricity has spread for several years in hospitals where, under the expression patient-centered care (PCC), it contributes to introducing a marketing logic in a new environment. However, beyond the intention to transform the patient as an object into a patient as a subject, this concept remains difficult to define. A review of the literature shows a diversity of approaches that are echoed in practice. This article draws on the economies of worth to examine how these conceptions collide but also reconcile. It relies on the study of an emblematic case, the orthopedic surgery department of a large Parisian public hospital (3 weeks of observation and 43 interviews). The research shows that PCC is built sequentially in a shared experience involving patients, caregivers, and management. The article defines PCC as a marketing device resulting from compromises between different conventions and provides evolution scenarios.

Purpose To evaluate sphere concentration delivered to tumor and non-tumor tissue using voxel-based dosimetry as it relates to treatment, pathologic outcomes, and adverse events.Methods A retrospective, single-center analysis of patients (n = 57) with solitary HCC who were treated with Y90 radiation segmentectomy with Y90 glass microsphere infusion (TheraSphere; Boston Scientific, Marlborough, MA, USA) from 2020 to 2022 was performed. Post-treatment dosimetry was evaluated using Mirada DBx Build 1.2.0 Simplicit90Y dosimetry software. Voxel-based dosimetry and MIRD formula were utilized to calculate sphere concentration to tumor and non-tumor tissue. Time to progression (TTP), treatment response, pathologic response, and adverse events were studied.Results Fifty-seven patients with solitary tumors were analyzed with a median tumor diameter of 3.4cm (range 1.2-6.8cm). The median tumor absorbed dose was 692Gy (range, 256-1332Gy) with a median perfused treatment volume of 113mL (range, 33.6-442mL). Median sphere activity (SA) at time of delivery was 1428Bq (range, 412-2589Bq). Using voxel-based dosimetry and the MIRD formula, median tumor sphere concentration was 12,339 spheres/mL (range, 2,689 − 37,649 spheres/mL). Sphere concentration to tumor exhibited a weak, inverse correlation with perfused treatment volume (R2 = 0.25). However, tumor sphere concentration and non-tumor sphere concentration exhibited a direct, positive correlation (R2 = 0.72). Of the 52 tumors with post-treatment imaging, objective response was noted in 50 patients (96%) and complete response in 41 patients (79%). 98% of all treated tumors demonstrated a durable response at 2 years. The median time to progression for all patients was not reached with a 2-year progression rate of 11%. Multivariate analysis demonstrated target dose as the only statistically significant variable associated with TTP (p = 0.033). 14 patients underwent liver transplant. Median tumor necrosis was 99% (range, 80–100%).Conclusion Voxel-based dosimetry following Y90 radioembolization can be utilized to measure sphere concentration into tumor and non-tumoral tissue. Higher SA allows increased tumor absorbed dose with limited sphere/mL tumor capacity.

International audience; Patient-centered care (PCC) in French hospitals has become highly topical. As it challenges people's roles and positions in the health care system, it generates tensions that can produce paradoxes when elements perceived as contradictory are both present and persistent. However, the actors most often learn to deal with them. The aim of this research is to examine how actors cope with the paradoxes created by PCC. Linking the theory of paradox to the concepts of situated action and object agency, this paper studies the orthopedics department of a major PCC public hospital in Paris based on shadowing, interviews and secondary documents. It highlights three ways in which technical objects play a key role in managing belonging, learning, organizing and performing paradoxes generated by PCC: enactment, mediation and interpretive flexibility. It thus extends the dynamic equilibrium model of organizing in the theory of paradox developed by Smith and Lewis (2011).

In this study, we are interested in examining whether providing reputational information about targets' competence will affect how much people transfer to excited and calm targets in an economic game (Trust Game). We expect that competence reputation will exert a weaker effect on transfers compared to trustworthiness reputation (which was manipulated in a prior study). In addition, we predict that East Asians will transfer more to calm than excited targets, whereas European Americans will not differ in the amount they transfer to calm versus excited targets. European Americans in the U.S. (N = 100) and Taiwanese (N = 100) will be recruited for this study.

In this study, we are interested in examining whether providing information about targets' social reputation will affect how much people transfer to excited and calm targets in an economic game (Trust Game). Based on preliminary data, we predict that across groups, participants will transfer more to targets who have higher vs. lower reputation. In addition, we predict that East Asians will transfer more to calm than excited targets regardless of target reputation. European Americans in the U.S. (N = 100) and Taiwanese (N = 100) will be recruited for this study.

Recent work demonstrated that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Notably, this racial bias in pain perception seems to arise, at least in part, from disruptions in configural face processing. Differential engagement of configural processing has also been implicated as a core mechanism supporting other more basic social perceptual biases, like the cross-race effect (e.g., a tendency to show reduced memory for other-race faces; Hancock & Rhodes, 2008; Rhodes et al., 2009) and the out-group homogeneity effect (e.g., a related tendency to show diminished perceptual sensitivity to different faces from a racial out-group; Hughes et al., 2019). In recent pilot work adapting the Hughes et al. (2019) task, we’ve demonstrated that perceivers show a basic perceptual insensitivity to identity changes on Black (vs. white faces) as well as a more specific insensitivity to variability in pain expressions on Black (vs. white faces). Moreover, racial bias in identity sensitivity is positively correlated with racial bias in pain sensitivity. Here, we again assess whether perceptual insensitivity to a) identity and b) pain in Black (versus white) faces are correlated with each other. Moreover, we seek to confirm that a blunting in perceptual insensitivity to pain on Black (vs. white) faces in a previous study was a consequence of an order effect (such that completing the identity sensitivity task first affected responses in the pain sensitivity task).

Recent work demonstrated that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Notably, this racial bias in pain perception seems to arise, at least in part, from disruptions in configural face processing. Differential engagement of configural processing has also been implicated as a core mechanism supporting other more basic social perceptual biases, like the cross-race effect (e.g., a tendency to show reduced memory for other-race faces; Hancock & Rhodes, 2008; Rhodes et al., 2009) and the out-group homogeneity effect (e.g., a related tendency to show diminished perceptual sensitivity to different faces from a racial out-group; Hughes et al., 2019). Here, we assess whether perceptual insensitivity to a) identity and b) pain in Black (versus white) faces are correlated with each other.

G. Recent work demonstrated that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Notably, this racial bias in pain perception seems to arise, at least in part, from disruptions in configural face processing. Differential engagement of configural processing has also been implicated as a core mechanism supporting other more basic social perceptual biases, like the cross-race effect (e.g., a tendency to show reduced memory for other-race faces; Hancock & Rhodes, 2008; Rhodes et al., 2009) and the out-group homogeneity effect (e.g., a related tendency to show diminished perceptual sensitivity to different faces from a racial out-group; Hughes et al., 2019). Here, we seek to establish a direct association between racial bias in pain perception and the cross-race effect.

D. Recent work demonstrated that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Racial bias in pain perception arises from disruptions in configural face processing, cannot be explained by low-level stimulus features, persists even when identical expressions of pain are rendered on computer-generated targets, and predicts biases in treatment above and beyond explicit stereotypes and prejudice. That said, the automaticity of this bias remains unclear. If the bias depends on the conscious and deliberate application of explicit knowledge and stereotypes, we’d predict that the bias would be reduced under conditions of cognitive load. That said, one previous investigation we conducted demonstrated that cognitive load did not influence the magnitude of racial bias in pain perception. Here, we conduct a second replication of this previous paradigm once again using photographs of real individuals as stimuli (as opposed to computer-generated faces). We also employ additional screening criteria to ensure that participants included in the analyses are engaging with the load manipulation appropriately. Note that this is a reposting of a previous pre-registration (https://osf.io/dj689) which includes the addition of exclusion criteria that were accidentally left off of the original preregistration document.

We examine neural bases of racial bias in pain perception and treatment. For further details, see preregistration document.

Recent work demonstrated that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Racial bias in pain perception arises from disruptions in configural face processing, cannot be explained by low-level stimulus features, persists even when identical expressions of pain are rendered on computer-generated targets, and predicts biases in treatment above and beyond explicit stereotypes and prejudice. However, within a medical context, judgments of pain are rarely made in the absence of other diagnostic information such as a patient’s report of their subjective pain level. That said, real-world disparities in pain care for Black Americans persist in medical contexts despite self-reported pain experience. This may suggest that although self-reported pain may be considered in judgements of patient pain, it does not entirely eliminate bias in pain care, perhaps due to the persistence of a perceptual bias. A previous investigation manipulated both target race and self-report but used a) larger windows of self-report (4-6 vs. 8-10 for ambiguous and high self-report, respectively), b) a non-clinical pain context (e.g., experimental pain stimulations), and c) a treatment measure that was comparable in scale to the pain self-report scale itself, which might have led participants to simply match their treatment recommendations to the self-report values. Here, we test if racial bias in pain perception is robust to information about self-reported pain experience in a task that a) compares between two specific self-report values (4 vs. 7; where a 7/10 in terms of pain experience would still qualify as severe, uncontrolled pain), b) a clinical pain context (specifically, targets will be described as patients in dealing with pain during physical therapy after orthopedic surgery), and c) a more ecologically valid treatment measure.

Recent work demonstrated that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Notably, this racial bias in pain perception seems to arise, at least in part, from disruptions in configural face processing. Differential engagement of configural processing has also been implicated as a core mechanism supporting other more basic social perceptual biases, like the cross-race effect (e.g., a tendency to show reduced memory for other-race faces; Hancock & Rhodes, 2008; Rhodes et al., 2009) and the out-group homogeneity effect (e.g., a related tendency to show diminished perceptual sensitivity to different faces from a racial out-group; Hughes et al., 2019). In recent pilot work adapting the Hughes et al. (2019) task, we’ve demonstrated that perceivers show a basic perceptual insensitivity to identity changes on Black (vs. white faces) as well as a more specific insensitivity to variability in pain expressions on Black (vs. white faces). Moreover, racial bias in identity sensitivity is positively correlated with racial bias in pain sensitivity. Finally, a serial mediation model (with identity sensitivity preceding pain sensitivity consecutively) demonstrated that these factors facilitate the influence of target race on treatment. Here, we again assess whether perceptual insensitivity to a) identity and b) pain in Black (versus white) faces are correlated with each other. Moreover, we seek to confirm the serial mediation we observed previously, using a more ecologically valid set of stimuli in our treatment task.

Recent work demonstrates that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Racial bias in pain perception arises from disruptions in configural face processing, cannot be explained by low-level stimulus features, persists even when identical expressions of pain are rendered on computer-generated targets, and predicts biases in treatment above and beyond explicit stereotypes and prejudice. That said, the speed with which painful expressions are processed is somewhat unclear, and further, the automaticity of this bias is as of yet uncertain. Are differences in evaluations of Black and White facial expressions of pain evident under minimal presentation conditions, or does this bias require more time (and deliberation) to emerge?

Cet article se situe dans le champ du controle organisationnel. Partant de l’inscription ancienne de la dialectique liberte-controle dans les sciences sociales et de son investigation dans les organisations post-bureaucratiques, il s’interesse aux formes de controle dans les entreprises qualifiees de liberees. Pour rendre compte de ce phenomene, il s’appuie sur l’etude de deux cas emblematiques : l’entreprise de services industriels, Chrono Flex, et le biscuitier Poult. L’article s’attache a reperer les formes de controle et, par l’analyse des situations observees, a identifier des arrangements entre formes de controle, ainsi que les roles d’acteurs mediateurs, porteurs de ces arrangements. Les resultats montrent en particulier que le controle hierarchique n’a pas ete totalement supprime, mais qu’il a plutot ete renouvele en combinaison avec d’autres formes de controle deja decrites par la litterature.

Purpose: To quantify eye lens dose in interventional radiology and assess whether neck dosimeter is a good surrogate to evaluate eye lens dosimetry. Methods: Radiation exposure was prospectively measured in 9 interventional radiologists between May and October 2017. Standard Hp(0,07) thermoluminescent dosimeters (TLDs) were worn at the neck outside the lead apron, and 2 dedicated eye lens Hp(3) TLDs were placed just above the eyes, one midline and another at the outer edge of the left eye. Correlations between eye lens and neck TLD doses were assessed with Pearson coefficient, and linear regression was used to predict eye lens dose from neck TLD values. Results: Eye lens dose without eye protection was 0.18 ± 0.11 (mean ± standard deviation; 0.08-0.41) mSv per workday and 35.3 ± 6.6 mSv (16.3-82.9) annually (200 workdays/year). Five (56%) radiologists exceeded the 20 mSv annual eye lens dose limit. Eye lens doses from left and central TLDs were 12.46 ± 3.02 and 9.29 ± 3.38 mSv, respectively ( P = .027). Mean eye lens (left and central) and neck TLD doses were 10.87 ± 2.67 and 16.56 ± 5.67 mSv, respectively ( P = .008). Pearson correlation coefficient between both eye lens TLD and between mean eye lens TLD and neck TLD doses were 0.91 and 0.92, respectively. Average of eye lens dose was 0.0179 + (0.5971 × neck dose). Conclusion: Full-time interventional radiologists are likely to suffer from deterministic radiation effects to the eye lens, especially on the left side. Neck TLD significantly overestimates eye lens dose. However, eye lens doses are highly correlated with neck doses and may be predicted from the neck TLD values.

International audience; Les outils de la RSE foisonnent et pourtant, s’agissant du social, leurs effets paraissent très modestes. Les auteurs s’interrogent en conséquence sur les fonctions réelles de ces outils, inscrivant leur analyse dans le cadre de la théorie des opérations, que G. Simondon appelle allagmatique, et des travaux de l’école française des outils de gestion. Il en ressort que des effets, correspondant à des fonctions implicites de ces outils, expliquent leur prégnance.