Approche épistémologique et conceptuelle du rôle des émotions au sein de la rationalité

Les émotions ont été considérées en philosophie, et ce depuis l'Antiquité, tantôt comme des aides tantôt comme des obstacles aux décisions rationnelles. Les rapports entre émotions et décisions ne constituent donc pas donc un objet inédit de réflexion mais récemment cette question a été reprise et le champ théorique renouvelé. Des développements montrent que les émotions pourraient intégrer les raisonnements de manière constructive, et pas nécessairement comme des éléments perturbateurs et responsables d'erreurs. Il s'avère que malgré la complexité du phénomène émotionnel, et la diversité des conceptions à son égard, l'étude des impacts émotionnels dans les choix fait intervenir la distinction entre émotions positives et négatives de manière récurrente. La caractéristique permettant d'établir cette distinction se nomme la valence. D'apparence claire et pratique, elle comporte plusieurs difficultés importantes. En plus d'être un concept ambigu au sens variable d'une théorie à l'autre, la distinction simple qu'elle recoupe s'applique difficilement à certaines émotions plus complexes qui semblent mélanger des valences différentes. Face à ces problèmes, nous pensons qu'il n'est ni nécessaire ni souhaitable d'abandonner la notion de valence, mais qu'il convient plutôt de la réformer afin qu'elle puisse rendre compte avec plus de réalisme des émotions concrètes. D'une part, nous entendons apporter des clarifications sur ce concept central dans l'étude des émotions et de leur impact dans les choix et décisions; d'autre part, nous montrerons la nécessité de porter une attention renouvelée à la valence des émotions pour comprendre ces impacts avec plus de finesse et de précision.\ud ______________________________________________________________________________ \ud MOTS-CLÉS DE L’AUTEUR : Émotion, rationalité, heuristique, décision, affect, valence

Epistemological and conceptual study of the role of emotions within rationality

Les émotions ont été considérées en philosophie, et ce depuis l’Antiquité, tantôt comme des aides tantôt comme des obstacles aux décisions rationnelles. Les rapports entre émotions et décisions ne constituent donc pas donc un objet inédit de réflexion mais récemment cette question a été reprise et le champ théorique renouvelé. Des développements montrent que les émotions pourraient intégrer les raisonnements de manière constructive, et pas nécessairement comme des éléments perturbateurs et responsables d’erreurs. Il s’avère que malgré la complexité du phénomène émotionnel, et la diversité des conceptions à son égard, l’étude des impacts émotionnels dans les choix fait intervenir la distinction entre émotions positives et négatives de manière récurrente. La caractéristique permettant d’établir cette distinction se nomme la valence. D’apparence claire et pratique, elle comporte plusieurs difficultés importantes. En plus d’être un concept ambigu au sens variable d’une théorie à l’autre, la distinction simple qu’elle recoupe s’applique difficilement à certaines émotions plus complexes qui semblent mélanger des valences différentes. Face à ces problèmes, nous pensons qu’il n’est ni nécessaire ni souhaitable d’abandonner la notion de valence, mais qu’il convient plutôt de la réformer afin qu’elle puisse rendre compte avec plus de réalisme des émotions concrètes. D’une part, nous entendons apporter des clarifications sur ce concept central dans l’étude des émotions et de leur impact dans les choix et décisions; d’autre part, nous montrerons la nécessité de porter une attention renouvelée à la valence des émotions pour comprendre ces impacts avec plus de finesse et de précision.In philosophy, emotions have been studied throughout the centuries sometimes as helping to make good decisions, sometimes as hindering rationality. Thus, linking emotions and rationality is not something never tried before, but some recent developments have given a new extension to the question. Hypotheses of non-cognitive elements and non-computational ways of thinking that could guide reasoning and choice are searched for and studied. Emotions could be one of some new elements integrating choice in a constructive and not necessarily misguiding way.Despite the complexity of emotions and the diversity of their studies, a large part of the theoretical account of emotional impacts is structured by the recurrent distinction between positive and negative emotions known as their “valence.” Negative and positive emotions are thought to have distinct consequences on actions and choices which are studied and classified through this distinction. Valence seems to be a clear and practical distinction, but its shows several difficulties. Its meaning can be very different from one theory to the other, this notion being imprecise and ambiguous. We also found problems concerning the way this general and simple distinction applies to many emotions that seem to mix many valences. As we will show these problems do not constitute a reason to abandon this notion. We’ll see if it is possible to reform it and make it more realistic to take into account concrete emotions. We intend to make some clarifications on this central notion, and to underline the importance of a more comprehensive and specific study of valence to understand emotional impact at a finer and sharper level of analysis

Approche épistémologique et conceptuelle du rôle des émotions au sein de la rationalité

Les émotions ont été considérées en philosophie, et ce depuis l Antiquité, tantôt comme des aides tantôt comme des obstacles aux décisions rationnelles. Les rapports entre émotions et décisions ne constituent donc pas donc un objet inédit de réflexion mais récemment cette question a été reprise et le champ théorique renouvelé. Des développements montrent que les émotions pourraient intégrer les raisonnements de manière constructive, et pas nécessairement comme des éléments perturbateurs et responsables d erreurs. Il s avère que malgré la complexité du phénomène émotionnel, et la diversité des conceptions à son égard, l étude des impacts émotionnels dans les choix fait intervenir la distinction entre émotions positives et négatives de manière récurrente. La caractéristique permettant d établir cette distinction se nomme la valence. D apparence claire et pratique, elle comporte plusieurs difficultés importantes. En plus d être un concept ambigu au sens variable d une théorie à l autre, la distinction simple qu elle recoupe s applique difficilement à certaines émotions plus complexes qui semblent mélanger des valences différentes. Face à ces problèmes, nous pensons qu il n est ni nécessaire ni souhaitable d abandonner la notion de valence, mais qu il convient plutôt de la réformer afin qu elle puisse rendre compte avec plus de réalisme des émotions concrètes. D une part, nous entendons apporter des clarifications sur ce concept central dans l étude des émotions et de leur impact dans les choix et décisions; d autre part, nous montrerons la nécessité de porter une attention renouvelée à la valence des émotions pour comprendre ces impacts avec plus de finesse et de précision.In philosophy, emotions have been studied throughout the centuries sometimes as helping to make good decisions, sometimes as hindering rationality. Thus, linking emotions and rationality is not something never tried before, but some recent developments have given a new extension to the question. Hypotheses of non-cognitive elements and non-computational ways of thinking that could guide reasoning and choice are searched for and studied. Emotions could be one of some new elements integrating choice in a constructive and not necessarily misguiding way.Despite the complexity of emotions and the diversity of their studies, a large part of the theoretical account of emotional impacts is structured by the recurrent distinction between positive and negative emotions known as their valence. Negative and positive emotions are thought to have distinct consequences on actions and choices which are studied and classified through this distinction. Valence seems to be a clear and practical distinction, but its shows several difficulties. Its meaning can be very different from one theory to the other, this notion being imprecise and ambiguous. We also found problems concerning the way this general and simple distinction applies to many emotions that seem to mix many valences. As we will show these problems do not constitute a reason to abandon this notion. We ll see if it is possible to reform it and make it more realistic to take into account concrete emotions. We intend to make some clarifications on this central notion, and to underline the importance of a more comprehensive and specific study of valence to understand emotional impact at a finer and sharper level of analysis.AIX-MARSEILLE1-Bib.electronique (130559902) / SudocSudocFranceF

Mortality reduction by post-dilution online-haemodiafiltration : A cause-specific analysis

Background. From an individual participant data (IPD) meta-analysis from four randomized controlled trials comparing haemodialysis (HD) with post-dilution online-haemodiafiltration (ol-HDF), previously it appeared that HDF decreases all-cause mortality by 14% (95% confidence interval 25; 1) and fatal cardiovascular disease (CVD) by 23% (39; 3). Significant differences were not found for fatal infections and sudden death. So far, it is unclear, however, whether the reduced mortality risk of HDF is only due to a decrease in CVD events and if so, which CVD in particular is prevented, if compared with HD. Methods. The IPD base was used for the present study. Hazard ratios and 95% confidence intervals for cause-specific mortality overall and in thirds of the convection volume were calculated using the Cox proportional hazard regression models. Annualized mortality and numbers needed to treat (NNT) were calculated as well. Results. Besides 554 patients dying from CVD, fatal infections and sudden death, 215 participants died from 'other causes', such as withdrawal from treatment and malignancies. In this group, the mortality risk was comparable between HD and ol-HDF patients, both overall and in thirds of the convection volume. Subdivision of CVD mortality in fatal cardiac, non-cardiac and unclassified CVD showed that ol-HDF was only associated with a lower risk of cardiac casualties [0.64 (0.61; 0.90)]. Annual mortality rates also suggest that the reduction in CVD death is mainly due to a decrease in cardiac fatalities, including both ischaemic heart disease and congestion. Overall, 32 and 75 patients, respectively, need to be treated by high-volume HDF (HV-HDF) to prevent one all-cause and one CVD death, respectively, per year. Conclusion. The beneficial effect of ol-HDF on all-cause and CVD mortality appears to be mainly due to a reduction in fatal cardiac events, including ischaemic heart disease as well as congestion. In HV-HDF, the NNT to prevent one CVD death is 75 per year

Mortality reduction by post-dilution online-haemodiafiltration : A cause-specific analysis

Background. From an individual participant data (IPD) meta-analysis from four randomized controlled trials comparing haemodialysis (HD) with post-dilution online-haemodiafiltration (ol-HDF), previously it appeared that HDF decreases all-cause mortality by 14% (95% confidence interval 25; 1) and fatal cardiovascular disease (CVD) by 23% (39; 3). Significant differences were not found for fatal infections and sudden death. So far, it is unclear, however, whether the reduced mortality risk of HDF is only due to a decrease in CVD events and if so, which CVD in particular is prevented, if compared with HD. Methods. The IPD base was used for the present study. Hazard ratios and 95% confidence intervals for cause-specific mortality overall and in thirds of the convection volume were calculated using the Cox proportional hazard regression models. Annualized mortality and numbers needed to treat (NNT) were calculated as well. Results. Besides 554 patients dying from CVD, fatal infections and sudden death, 215 participants died from 'other causes', such as withdrawal from treatment and malignancies. In this group, the mortality risk was comparable between HD and ol-HDF patients, both overall and in thirds of the convection volume. Subdivision of CVD mortality in fatal cardiac, non-cardiac and unclassified CVD showed that ol-HDF was only associated with a lower risk of cardiac casualties [0.64 (0.61; 0.90)]. Annual mortality rates also suggest that the reduction in CVD death is mainly due to a decrease in cardiac fatalities, including both ischaemic heart disease and congestion. Overall, 32 and 75 patients, respectively, need to be treated by high-volume HDF (HV-HDF) to prevent one all-cause and one CVD death, respectively, per year. Conclusion. The beneficial effect of ol-HDF on all-cause and CVD mortality appears to be mainly due to a reduction in fatal cardiac events, including ischaemic heart disease as well as congestion. In HV-HDF, the NNT to prevent one CVD death is 75 per year

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed