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Unintentional leaks (ULs) are frequent adverse effects in CPAP-treated patients. We previously published a novel methodology for analyzing the determinants of UL using polysomnography. We now propose a simplified recording system using a type 3 polygraphic device (Somnolter; Nomics S.A.).(1) To describe individual UL determinants provided by the Somnolter software in automatic-CPAP-treated OSA patients; (2) To subsequently describe the clinical consensus of four physicians on how to manage each individual UL situation.Somnoler recordings performed under nasal automatic-CPAP were automatically analyzed with APIOS software. For each polygraphic recording, APIOS provided the OR and the CIs for potential determinants of UL: mouth opening, CPAP pressure, body position, and mandibular oscillation. Based on these results, each of four physicians was asked to choose one of four strategies: (1) increase or decrease therapeutic pressure; (2) change nasal mask for oro-nasal mask/chinstrap; (3) favor a nonsupine or supine position; (4) no action for individual leak management. Subsequently, a meeting was held to determine a consensus choice for each individual case.Seventy-eight consecutive patients underwent home-polygraphy with Somnolter. Fifty recordings were analyzed (16 females; 65 [57-75] years of age; BMI = 31.1 [27.4-35.3]). Individual diagnosis of UL was routinely feasible. The determinants of UL were heterogeneous in the population, and diagnosis of UL was not feasible in 10 patients. Based on the results from this analysis, we established consensus leak management strategies at the individual level. The average Cohen κ coefficient for the four raters was 0.58. Pressure modification was proposed in 36% of patients, no action in 24%, installation of a facial mask/chinstrap in 22%, and positional treatment in 18%.The use of type 3 polygraphy for characterizing leak determinants in patients treated with nasal automatic-CPAP is feasible in routine practice. Leak determinants are patient specific. Interrater concordance for determining individual leak management strategies demonstrated a "fair" level of agreement.ClinicalTrials.gov; No.: NCT03381508; URL: www.clinicaltrials.gov).

Aims Sleep-disordered breathing (SDB) is a highly prevalent co-morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril-valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin-converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. Methods and results The ENTRESTO-SAS trial is a 3-month, multicentric, prospective, open-label real-life cohort study. Patients eligible for sacubitril-valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin-converting enzyme inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea-Hypopnoea Index with a power of 90% at an alpha risk of 5%. Conclusions In the context of the SERVE-HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO-SAS trial whether sacubitril-valsartan could improve the outcome of SDB in CHF patients.

Introduction Les signes d’insuffisance cardiaque droite sont frequents dans l’evolution de la bronchopneumopathie chronique obstructive (BPCO) avec emphyseme sans que les mecanismes en cause soit clairement precises. Notre hypothese de travail est que l’emphyseme en majorant la pression intrathoracique provoque une dysfonction diastolique cardiaque droite a l’exercice en limitant l’expansion ventriculaire. Ainsi, une reduction d’emphyseme pourrait ameliorer la fonction diastolique ventriculaire droite. Methodes Lors du screening des patients BPCO avec emphyseme severe adresses pour une reduction endoscopique d’emphyseme, une evaluation hemodynamique invasive classique et avec un catheter a conductance permettant d’obtenir des boucles Pression/Volume au repos, a l’exercice et durant un test de lever de jambe, etait realise en cas de suspicion d’hypertension pulmonaire. Cette exploration etait repetee apres reduction d’emphyseme. La precharge, la fonction diastolique, la contractibilite, la fonction systolique, la postcharge et le couplage ventriculo-arteriel etaient ainsi enregistrees. Le critere de jugement principal est la compliance ventriculaire apres reduction d’emphyseme qui se traduit par une diminution de la pente relation pression volume telediastolique. Nous ne presentons ici que des donnees preliminaires. Resultats Nous avons pu obtenir la caracterisation hemodynamique de cinq patients dont trois ont eu une evaluation avant et apres reduction d’emphyseme. Concernant notre critere de jugement principal nos resultats preliminaires montrent une diminution de la pente relation pression volume telediastolique de respectivement 0,85 % et 0,95 % chez les deux patients ayant eu une reduction d’emphyseme versus une augmentation de 0,25 % chez le patient controle. Nos resultats secondaires montrent qu’apres reduction d’emphyseme on observe une augmentation de l’index cardiaque a l’effort rapporte a la valeur de repos (+ 55,4 % en post reduction versus + 3,4 % en pre reduction), du volume telediastolique (+ 28,5 % en post reduction versus − 2,3 % en pre reduction) tout en annulant l’augmentation de pression telediastolique a l’effort. Nous n’observons pas d’amelioration de la fonction systolique ni du couplage ventriculo-arteriel. Conclusion Ces premieres donnees permettent d’evaluer grâce a la technique de reference l’hemodynamique des patients BPCO avec emphyseme severe. Nos Resultats preliminaires vont dans le sens d’une amelioration de la fonction diastolique cardiaque droite par augmentation de compliance apres reduction d’emphyseme.

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

International audience; Few- and single-layer MoS2 host substantial densities of defects. They are thought to influence the doping level, the crystal structure, and the binding of electron-hole pairs. We disentangle the concomitant spectroscopic expression of all three effects, and identify to which extent they are intrinsic to the material or extrinsic to it, \textit{i.e.} related to its local environment. We do so by using different sources of MoS2 --- a natural one and one prepared at high pressure and high temperature --- and different substrates bringing varying amounts of charged impurities, and by separating the contributions of internal strain and doping in Raman spectra. Photoluminescence unveils various optically-active excitonic complexes. We discover a defect-bound state having a low binding energy of 20 meV, that does not appear sensitive to strain and doping, unlike charged excitons. Conversely, the defect does not significantly dope or strain MoS2. Scanning tunneling microscopy and density functional theory simulations point to substitutional atoms, presumably individual nitrogen atoms at the sulfur site. Our work shows the way to a systematic understanding of the effect of external and internal fields on the optical properties of two-dimensional materials.

Backgrounds As a consequence of the increased mortality observed in the SERVE-HF study, many questions concerning the safety and rational use of ASV in other indications emerged. The aim of this study was to describe the clinical characteristics of ASV-treated patients in real-life conditions. Methods The OTRLASV-study is a prospective, 5-centre study including patients who underwent ASV-treatment for at least 1 year. Patients were consecutively included in the study during the annual visit imposed for ASV-reimbursement renewal. Results 177/214 patients were analysed (87.57% male) with a median (IQ25–75) age of 71 (65–77) years, an ASV-treatment duration of 2.88 (1.76–4.96) years, an ASV-usage of 6.52 (5.13–7.65) hours/day, and 54.8% were previously treated via continuous positive airway pressure (CPAP). The median Epworth Scale Score decreased from 10 (6–13.5) to 6 (3–9) (p p 45% in 92.7% of patients. Associated comorbidities/etiologies were cardiac in nature for 75.7% of patients (neurological for 12.4%, renal for 4.5%, opioid-treatment for 3.4%). 9.6% had idiopathic central-sleep-apnea. 6.2% of the patients were hospitalized the year preceding the study for cardiological reasons. In the 6 months preceding inclusion, night monitoring (i.e. polygraphy or oximetry during ASV usage) was performed in 34.4% of patients, 25.9% of whom required a subsequent setting change. According to multivariable, logistic regression, the variables that were independently associated with poor adherence (ASV-usage ≤4 h in duration) were TECSA group versus CSA group (p = 0.010), a higher Epworth score (p = 0.019) and lack of a night monitoring in the last 6 months (p Conclusions In real-life conditions, ASV-treatment is often associated with high cardiac comorbidities and high compliance. Future research should assess how regular night monitoring may optimize devices settings and patient management. Trial registration The OTRLASV study is registered on ClinicalTrials.gov (Identifier: NCT02429986) on 1 April 2015.

International audience; Embodied cognition studies have shown motor resonance during action language processing, indicating that linguistic representations are at least partially multimodal. However, constraints of this activation linked to linguistic and extra-linguistic context, function and timing have not yet been fully explored. Importantly, embodied cognition binds social and physical contexts to cognition, suggesting that more ecologically valid contexts will yield more valid measures of cognitive processing. Herein, we measured cortical motor activation during language processing in a fully immersive Cave automatic virtual environment (CAVE). EEG was recorded while participants engaged in a Go/No-Go task. They heard action verbs and, for Go trials, performed a corresponding action on a virtual object. ERSP (event-related spectral perturbation) was calculated during verb processing, corresponding to the pattern of power suppression (event-related desynchronization-ERD) and enhancement (event-related synchronization-ERS) relative to the reference interval. Significant ERD emerged during verb processing in both the µ (8-13 Hz) and beta band (20-30 Hz) for both Go and No-Go trials. µ ERD emerged in the 400-500 msec time window, associated with lexical-semantic processing. Greater µ ERD emerged for Go compared to No-Go trials. The present results provide compelling evidence in a naturalistic setting of how motor and linguistic processes interact.

Background Whereas telemedicine usage is growing, the only clinical algorithm for Continuous Positive Airway Pressure (CPAP) adherence management is that stipulated by the 2013 American Thoracic Society (ATS). The capacity of the latter to predict non-adherence in long-term CPAP-treated patients has not been validated. Methods Patients from the prospective real-life InterfaceVent study (NCT03013283, study conducted in an adult cohort undergoing at least 3 months of CPAP) and eligible for ATS algorithm usage were analysed. The residual device Apnea–Hypopnea-Index (AHIflow) and High Large Leak (HLL) thresholds proposed in the ATS algorithm were evaluated for predicting adherence (i.e. AHIflow > 10/h, HLLs 95th > 24 L/min for ResMed® devices and ResMed® nasal mask, HLLs 95th > 36 l/min for ResMed® devices and ResMed® oronasal masks, HLLs > 1 h for Philips® devices and HHLs > 60 l/min for Fisher & Paykel® devices). Adherence was defined according to the 2013 ATS algorithm (i.e. CPAP use > 4 h/j for at least 70% of days). Results 650/1484 patients eligible for ATS algorithm usage were analysed (15.38% non-adherent, 74% male with a median (IQ25–75) age of 68 (61–77) years, a body mass index of 30.8 (27.7–34.5) kg/m2, an initial AHI of 39 (31–55) events/h, and CPAP-treatment-duration of 5.1 (2.2–7.8) years). Logistic regression analysis demonstrated no significant relationship between the ATS proposed AHIflow or HLL thresholds and non-adherence. Complementary ROC curve analysis failed to determine satisfactory AHIflow and HLL thresholds. Conclusion When managing non-adherence in long-term CPAP-treated patients, our data do not validate absolute AHIflow or HLL thresholds in general. Trial registration The INTERFACE-VENT study is registered on ClinicalTrials.gov (Identifier: study (NCT03013283).

We study the adsorption of atomic hydrogen on graphene by combining scanning tunneling microscopy experiments and first principle calculations. Our results reveal the existence of a physisorption channel over the graphene layer, dominated by van der Waals forces and thus homogeneous over the whole atomic lattice, where atomic hydrogen can move freely. Such physisorption channel is essential to understand the final configuration of hydrogen atoms chemisorbed on graphene. We find that ~95% of chemisorbed H atoms form non-magnetic dimers even for very dilute concentrations (

BACKGROUND AND OBJECTIVES French Polynesia, where dengue virus (DENV) has been present for a long time, experienced two successive outbreaks of Zika (ZIKV) and chikungunya viruses (CHIKV) between 2013 and 2015. To avoid the transmission of these viruses by transfusion, nucleic acid testing (NAT) has been in place for DENV since 2013 and for ZIKV and CHIKV during epidemics. The objective was to compare the estimated risk of viraemic blood donation with NAT results and to discuss the impact on the prevention of transfusion-related infectious risk. MATERIALS AND METHODS The average risks of viraemic blood donation were estimated per year for DENV, and during the epidemic periods for ZIKV and CHIKV, using the Biggerstaff and Petersen model based on the incidence rate, the mean length of viraemia and the frequency of asymptomatic infection. The estimated risks were compared with the number of viraemic blood donations detected by NAT. RESULTS According to the different assumptions, risks estimates ranged from 11·2 to 53·1/100 000 donations for DENV, 746 to 1924/100 000 for ZIKV and 1083 /100 000 for CHIKV. When compared to the number of donations collected during the study periods, these estimates match NAT results (5 blood donors reactive for DENV, 42 for ZIKV and 34 for CHIKV). CONCLUSION The risks of viraemic blood donation were related to the viral incidence in the general population and concordant with NAT results. These findings suggest that the screening may be optimized by a targeted NAT implementation based on incidence data.

International audience; Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial.Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions.Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology.Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 ± 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: κ = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: κ = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: κ = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% CI, 38–82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases.Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA

International audience

International audience; By means of scanning tunneling microscopy and spectroscopy, we investigate the electronic properties oflead islands (width 5–100 nm, thickness 5–25 monolayers) deposited by molecular beam epitaxy on twistedgraphene layers grown on SiC(000-1). We find that elastic scattering processes govern the local density ofstates probed at the surface of the Pb islands, inducing (i) the well-known quantum well states due to electronconfinement in the direction perpendicular to the surface and (ii) spatial in-plane periodic modulations relatedto quasiparticle interferences off the island edges. Through a quantitative analysis of these effects, comparedwith ab initio calculations for a two-dimensional Pb slab, we conclude that the lead islands grown on the surfaceof graphene can be considered as freestanding from the point of view of their electronic structure, leaving thesurrounding graphene layer unperturbed. Accordingly, low bias tunneling spectra show evidence of a sizableinterface resistance. Nevertheless, we suggest that the transparency of the interface, which can be estimated fromits resistance, is good enough to induce superconductivity within the underlying graphene layer by proximityeffect with the Pb islands.

Objectif Pour expliquer la surmortalite cardiovasculaire associee a la Ventilation Auto-Asservie (VAA) de l’etude SERVE-HF, il a ete evoque que les reglages de la VAA auraient induit une hyperventilation. Les objectifs de cette etude sont de decrire: – les reglages de la VAA et, – la ventilation minute (VM) en fonction de l’algorithme de la VAA (VAA-volume ResMed® et VAA-debit Philips®). Methodes Etude « vie reelle » transversale multicentrique incluant des patients traites par VAA depuis plus de 1 an, aucune consigne de reglage n’etant donnee aux 8 experts investigateurs. L’analyse des donnees est realisee: – en fonction du diagnostic initial du SAS (central, obstructif, emergent sous traitement), – en fonction de 5 clusters non supervises (partitionnement en K moyennes). Resultats 177 patients sont analyses avec une mediane (IQ25–75) d’IAH initial de 50 (38-62)/h, une duree de VAA de 2.88 (1.76–4,96) ans, 61,58 % traites par VAA-volume. Seule l’analyse basee sur les 5 clusters permet de mettre en evidence des differences entre clusters et/ou type de machine: – reglage d’une pression expiratoire (EPAP) fixe plus faible dans le groupe des patients obstructifs et a fraction d’ejection ventriculaire gauche reduite, – l’usage plus frequent de l’auto-EPAP chez les patients non cardiopathes, – des VM differents entre clusters, ces differences variant en fonction du type de VAA, – un risque d’hyperventilation quel que soit le cluster et le type de VAA. Conclusion Dans l’attente des etudes en cours, il serait prudent de telesuivre les donnees de VM des patients sous VAA.

International audience

Summary Background The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified. Methods We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk. Findings The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62–70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0–8) per 10 000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34–191) per 10 000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data. Interpretation Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus. Funding Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.

For the last 25 years, scientists have demonstrated the capabilities of Scanning Tunneling Microscopy (STM) to visualize in real space the response of a two-dimensional electron gas to atomic-scale impurities. The analysis of the Friedel oscillations surrounding the impurities yields valuable information regarding the elastic scattering properties, the band structure, the doping level and the symmetry of the electronic states in the two-dimensional host system. We will address in this article the use of this technique for probing the electronic properties of graphene, the star two-dimensional compound of the last decade. In particular, we will emphasize how this technique can be pushed up to unravel the electronic pseudospin, a distinctive degree of freedom of graphene's Dirac fermions.

Welding residual stresses have been always seen as a threat to the integrity of structures and components during service loadings. However residual stresses could partially or even totally relax under thermal or mechanical external loads if the sum of residual stresses and load stresses exceeds the material yield strength. If the stable portion of residual stresses after relaxation is still significant, care must be taken that residual stresses, similar to mean stresses, could shift the applied stress range. Accordingly, for a reliable structural integrity assessment an accurate insight into the stable residual stress field is essential. A three-dimensional FE model was implemented in software ABAQUS in order to study the relaxation and redistribution of welding residual stresses in a bead on tube weld under multiaxial mechanical loading. The predefined field of residual stress was initially calculated through a welding simulation in software SYSWELD. To verify the numerical simulations, a couple of tubular samples made of steel S355J2H were TIG welded and then mechanically loaded at different applied load levels. The surface residual stresses were measured by means of x-ray diffraction (XRD) in the as-welded condition and also after applying the mechanical loads for further comparisons. Pure torsion and multiaxial tension-torsion loading conditions in the form of quasi-static loading-unloading were investigated experimentally. The predicted welding residual stress relaxation conforms well the measurement results. The accordance between the numerical and experimental relaxation results confirmed the validity of the FE model. The validated model was then used to evaluate numerically the behavior of residual stresses under cyclic torsion loading with regard to the influence of the used material model. Based on the results, for such a material, the major relaxation occurs during the first cycle due to the monotonic yielding but further relaxation may take place in the upcoming cycles due to the accumulation of plastic strains.

International audience; We report scanning tunneling microscopy/spectroscopy (STM/STS) investigations of the bandbendingin the vicinity of charged point defects and edges of monolayer MoSe$_2$ and mono- andtrilayer WSe$_2$ films deposited on graphitized silicon carbide substrates. By tracing the spatialevolution of the structures of the STS spectra, we evaluate the magnitude and the extent of theband-bending to be equal to few hundreds milielectronvolts and several nanometres, respectively.With the aid of a simple electrostatic model, we show that the spatial variation of the Coulombpotential close to the film edges can be well reproduced by taking into account the metallic screeningby graphene. Additionally, the analysis of our data for trilayer WSe$_2$ provides reasonable estimationsof its dielectric constant ($\epsilon_{WSe}$$_2$ = 20) and of the magnitude of the charge trapped at the defect site(Q = $+e$).

International audience; Van der Waals heterojunctions composed of graphene and transition metal dichalcogenides have gain much attention because of the possibility to control and tailor band structure, promising applications in two-dimensional optoelectronics and electronics. In this report, we characterized the van der Waals heterojunction MoSe$_2$/few-layer graphene with a high-quality interface using cutting-edge surface techniques scaling from atomic to microscopic range. These surface analyses gave us a complete picture of the atomic structure and electronic properties of the heterojunction. In particular, we found two important results: the commensurability between the MoSe$_2$ and few-layer graphene lattices and a band-gap opening in the few-layer graphene. The band gap is as large as 250 meV, and we ascribed it to an interface charge transfer that results in an electronic depletion in the few-layer graphene. This conclusion is well supported by electron spectroscopy data and density functional theory calculations. The commensurability between the MoSe$_2$ and graphene lattices as well as the band-gap opening clearly show that the interlayer interaction goes beyond the simple van der Waals interaction. Hence, stacking two-dimensional materials in van der Waals heterojunctions enables us to tailor the atomic and electronic properties of individual layers. It also permits the introduction of a band gap in few-layer graphene by interface charge transfer.

Van der Waals heterojunctions composed of graphene and transition metal dichalcogenides have gain much attention because of the possibility to control and tailor band structure, promising applications in two-dimensional optoelectronics and electronics. In this report, we characterized the van der Waals heterojunction MoSe

Mandibular movement tests have demonstrated potential as screening tools for polysomnography candidates http://ow.ly/iu2430fZk2u

International audience; Much is known about how different spatial reference frames continually interact to support spatial navigation, but less explored is whether it is more crucial to process object-to-object information or egocentric heading information for effective orientation in a cluttered environment. To address this question, we evaluated the possible influence on spatial performance of an interactive aerial view of different scale (small vs. large) comprising an arrow indicating participants' egocentric heading. Results revealed that the presence of a small interactive aerial view including a visualized larger arrow facilitated the retrieval of stored spatial layout. These data are consistent with recent studies revealing the role of retrosplenial cortex in translating between different spatial reference frames, and may contribute to elucidate the continuous synchronization between the inter-object direction information in the environment with respect to egocentric current heading. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Single photon emitters can form at the interfaces between layers of WSe2. Crystal structure imperfections in solids often act as efficient carrier trapping centres, which, when suitably isolated, act as sources of single photon emission. The best known examples of such attractive imperfections are well-width or composition fluctuations in semiconductor heterostructures1,2 (resulting in the formation of quantum dots) and coloured centres in wide-bandgap materials such as diamond3,4,5. In the recently investigated thin films of layered compounds, the crystal imperfections may logically be expected to appear at the edges of commonly investigated few-layer flakes of these materials exfoliated on alien substrates. Here, we report comprehensive optical micro-spectroscopy studies of thin layers of tungsten diselenide (WSe2), a representative semiconducting dichalcogenide with a bandgap in the visible spectral range. At the edges of WSe2 flakes (transferred onto Si/SiO2 substrates) we discover centres that, at low temperatures, give rise to sharp emission lines (100 μeV linewidth). These narrow emission lines reveal the effect of photon antibunching, the unambiguous attribute of single photon emitters. The optical response of these emitters is inherently linked to the two-dimensional properties of the WSe2 monolayer, as they both give rise to luminescence in the same energy range, have nearly identical excitation spectra and have very similar, characteristically large Zeeman effects. With advances in the structural control of edge imperfections, thin films of WSe2 may provide added functionalities that are relevant for the domain of quantum optoelectronics.

We have investigated the electronic properties of two-dimensional (2D) transition metal dichalcogenides (TMDs), namely trilayer WSe2 and monolayer MoSe2, deposited on epitaxial graphene on silicon carbide, by using scanning tunneling microscopy and spectroscopy (STM/STS) in ultra-high vacuum. Depending on the number of graphene layers below the TMD flakes, we identified variations in the electronic dI/dV(V) spectra measured by the STM tip: the most salient feature is a rigid shift of the TMD spectra (i.e. of the different band onset positions) towards occupied states by about 120 mV when passing from bilayer to monolayer underlying graphene. Since both graphene phases are metallic and present a work function difference in the same energy range, our measurements point towards the absence of Fermi-level pinning for such van der Waals 2D TMD/Metal heterojunctions, following the prediction of the Schottky-Mott model.

French Polynesia and the French Territories of the Americas (FTAs) have experienced outbreaks of Zika virus (ZIKV) infection. These territories used similar sentinel syndromic surveillance to follow the epidemics. However, the surveillance system only takes into account consulting patients diagnosed with ZIKV disease, while non-consulting cases, as well as asymptomatic cases, are not taken into account. In the French territories under study, the ratio of consulting to non-consulting patients was found to likely be as low as 1/3 to 1/4, and rough estimates of the ZIKV asymptomatic infections indicated a lower rate than previously reported (i.e., not more than half). Keywords: Zika virus, Sentinel surveillance, Asymptomatic infections, Pacific islands, Caribbean region, Vector-borne infections

Aims Sleep‐disordered breathing (SDB) is a highly prevalent co‐morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril–valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin‐converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. Methods and results The ENTRESTO‐SAS trial is a 3‐month, multicentric, prospective, open‐label real‐life cohort study. Patients eligible for sacubitril–valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin‐converting enzyme inhibitor, a beta‐blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality‐of‐life and SDB questionnaires). The primary outcome is the change in the Apnoea–Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea–Hypopnoea Index with a power of 90% at an alpha risk of 5%. Conclusions In the context of the SERVE‐HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO‐SAS trial whether sacubitril–valsartan could improve the outcome of SDB in CHF patients.

International audience; Although discrete auditory stimuli have been found useful for emergency braking, the roleof continuous speed-related auditory feedback has not been investigated yet. This pointmay though be of importance in electric vehicles in which acoustic cues are drasticallychanged. The present study addressed this question through two experiments. In experi-ment 1, 12 usual drivers were exposed to naturalistic auditory feedback mimicking thoseissued from electric cars, while facing dynamic visual scenes in a 3D driving simulator.After being passively travelled up to a sustained constant speed, subjects had to stop theircar in front of a traffic light that unexpectedly turned to red. Modifications of the speed-related auditory feedback did not impact braking initiation and regulation. In experiment2, synthesized auditory feedback based on the Shepard-Risset glissando was provided to anew sample of 15 usual drivers in the same task. Pitch variations of this acoustic stimulus,although not scaled to an absolute speed, were manipulated as a function of visual speedchanges. Changing the mapping between pitch variations of the synthesized auditory feed-back and visual speed changes induced adjustments on braking which depended on accel-eration/deceleration feedback. These findings stressed the importance of the acousticcontent and its dynamics for car speed control.

Implementing smart grids is central to the transition to a low-carbon economy, and DSOs are key players in this transition. A far-reaching change-one could say a revolution-in power systems is indeed ongoing; designing and implementing smart grids is not an option but an absolute necessity. If we do not do it, or if we do it too slowly, we will face major problems. To prepare, European DSOs are massively investing in R&D and demonstration projects in cooperation with the information communications technology (ICT) industry, acquiring the knowledge and skills needed to adapt and lead. Smart grids have the potential to benefit the whole value chain, but the market model must be defined. Whatever the preferred model, DSOs will have a key role to play as market enablers. DSOs will be responsible for setting up the playing field for retailers and aggregators so that it works for the benefit of customers. DSOs will increasingly act as local system operators. Well-organized active distribution system management will make it possible to reduce the investments needed to host renewable energy sources and electric vehicle charging stations and will guarantee security and quality of supply. Enhancing the “smartness” of distribution grids is not free of charge. It will require significant capex on the DSO side, while the benefits from those investments will accrue throughout the entire value chain. The development of business models, with the strong support of policy makers and regulators, is necessary to ensure that all parties share the risks, costs, and benefits of smart grids. Bringing smart grids from vision to reality will only happen if smart regulation is introduced. Last but not least, a key objective of European DSOs is to make sure that the new solutions that will be implemented are designed to benefit all customers.

International audience; The Zika virus crisis exemplified the risk associated with emerging pathogens and was a reminder that preparedness for the worst-case scenario, although challenging, is needed. Herein, we review all data reported during the unexpected emergence of Zika virus in French Polynesia in late 2013. We focus on the new findings reported during this outbreak, especially the first description of severe neurological complications in adults and the retrospective description of CNS malformations in neonates, the isolation of Zika virus in semen, the potential for blood-transfusion transmission, mother-to-child transmission, and the development of new diagnostic assays. We describe the effect of this outbreak on health systems, the implementation of vector-borne control strategies, and the line of communication used to alert the international community of the new risk associated with Zika virus. This outbreak highlighted the need for careful monitoring of all unexpected events that occur during an emergence, to implement surveillance and research programmes in parallel to management of cases, and to be prepared to the worst-case scenario.

Introduction Peu de donnees sur l’usage de la Ventilation Auto-Asservie (VAA) en vie reelle existent. Dans ce contexte post SERVE-HF, les cliniciens sont dans l’attente de nouvelles donnees. Le but de cette etude est de decrire les caracteristiques cliniques des patients traites actuellement en conditions de vie reelle par VAA. Methodes L’etude OTRLASV (NCT02429986) est une etude prospective observationnelle multicentrique concernant des patients traites par VAA depuis au moins 1 an. Les donnees sont collectees consecutivement lors des consultations annuelles imposees pour le renouvellement de la prise en charge de la VAA, chacun des 5 centres restant ouvert 14 mois (1ere inclusion en mars 2015 pour le premier centre, derniere inclusion en decembre 2016 pour le dernier centre, 11 patients de phenotype SERVE-HF sont exclus). Resultats Au total, 177 patients sont inclus dans l’analyse finale (87,57 % d’hommes avec une mediane (IQ 25–75) d’âge de 71 (65–77) ans, une duree de traitement par VAA de 2,88 (1,76–4,96) annees, une utilisation de la VAA de 6,52 (5,1–7,6) heures/jour, 54,8 % des patients ayant ete prealablement traites par CPAP). La mediane de score d’Epworth est passee de 10 (6–13,5) a 6 (3–9) sous VAA (p 45 % dans 92,6 % des cas), neurologique dans 12,4 % des cas, renale dans 4,5 % des cas, 3,4 % des patients consomment des opiaces (14,12 % avec deux comorbidites). Au total, 13,5 % des patients presentaient une forme centrale idiopathique. Seulement 6,21 % des patients sont hospitalises pour raison cardiologique l’annee precedant leur inclusion. Le delai entre la derniere consultation cardiologique et l’inclusion dans l’etude est de 183 (70–365) jours, 97,97 % des patients ont beneficie d’une echocardiographie avec un delai de 263 (116–529) jours avant inclusion dans l’etude. Dans les 6 derniers mois precedant l’inclusion, 31 % des patients ont beneficie d’une polygraphie (PV) ou d’une oxymetrie (oxy) ayant conduit a une modification des reglages (9 patients) ou de l’interface (7 patients). Ce suivi cardiologique ou PV/oxy ne dependant pas de la date de mise en place de la VAA, il est peu probable qu’il ait pu etre influence par les resultats de l’etude SERVE-HF. Conclusion En conditions de vie reelle, a la difference des derniers essais randomises publies, la VAA est associee a une tres bonne observance et un suivi PV/oxy frequent.

Between October, 2013, and April, 2014, French Polynesia experienced the largest Zika virus outbreak ever described at that time. During the same period, an increase in Guillain-Barré syndrome was reported, suggesting a possible association between Zika virus and Guillain-Barré syndrome. We aimed to assess the role of Zika virus and dengue virus infection in developing Guillain-Barré syndrome.In this case-control study, cases were patients with Guillain-Barré syndrome diagnosed at the Centre Hospitalier de Polynésie Française (Papeete, Tahiti, French Polynesia) during the outbreak period. Controls were age-matched, sex-matched, and residence-matched patients who presented at the hospital with a non-febrile illness (control group 1; n=98) and age-matched patients with acute Zika virus disease and no neurological symptoms (control group 2; n=70). Virological investigations included RT-PCR for Zika virus, and both microsphere immunofluorescent and seroneutralisation assays for Zika virus and dengue virus. Anti-glycolipid reactivity was studied in patients with Guillain-Barré syndrome using both ELISA and combinatorial microarrays.42 patients were diagnosed with Guillain-Barré syndrome during the study period. 41 (98%) patients with Guillain-Barré syndrome had anti-Zika virus IgM or IgG, and all (100%) had neutralising antibodies against Zika virus compared with 54 (56%) of 98 in control group 1 (p0.0001). 39 (93%) patients with Guillain-Barré syndrome had Zika virus IgM and 37 (88%) had experienced a transient illness in a median of 6 days (IQR 4-10) before the onset of neurological symptoms, suggesting recent Zika virus infection. Patients with Guillain-Barré syndrome had electrophysiological findings compatible with acute motor axonal neuropathy (AMAN) type, and had rapid evolution of disease (median duration of the installation and plateau phases was 6 [IQR 4-9] and 4 days [3-10], respectively). 12 (29%) patients required respiratory assistance. No patients died. Anti-glycolipid antibody activity was found in 13 (31%) patients, and notably against GA1 in eight (19%) patients, by ELISA and 19 (46%) of 41 by glycoarray at admission. The typical AMAN-associated anti-ganglioside antibodies were rarely present. Past dengue virus history did not differ significantly between patients with Guillain-Barré syndrome and those in the two control groups (95%, 89%, and 83%, respectively).This is the first study providing evidence for Zika virus infection causing Guillain-Barré syndrome. Because Zika virus is spreading rapidly across the Americas, at risk countries need to prepare for adequate intensive care beds capacity to manage patients with Guillain-Barré syndrome.Labex Integrative Biology of Emerging Infectious Diseases, EU 7th framework program PREDEMICS. and Wellcome Trust.

We detected an unusual increase in congenital cerebral malformations and dysfunction in fetuses and newborns in French Polynesia, following an epidemic of Zika virus (ZIKV), from October 2013 to March 2014. A retrospective review identified 19 cases, including eight with major brain lesions and severe microcephaly, six with severe cerebral lesions without microcephaly and five with brainstem dysfunction without visible malformations. Imaging revealed profound neurological lesions (septal and callosal disruption, ventriculomegaly, abnormal neuronal migration, cerebellar hypoplasia, occipital pseudocysts, brain calcifications). Amniotic fluid was drawn from seven cases at gestation weeks 20 to 29. ZIKV RNA was detected by RT-PCR and infectious ZIKV isolates were obtained in four of five microcephalic, but not in two non-microcephalic cases with severe brain lesions. Medical termination of pregnancy was performed in eleven cases; two cases with brainstem dysfunction died in the first months of life; six cases are alive, with severe neurological impairment. The results show that four of seven tested fetuses with major neurological injuries were infected with ZIKV in utero. For other non-microcephalic, congenital abnormalities we were not able to prove or exclude ZIKV infection retrospectively. The unusual occurrence of brain malformations or dysfunction without microcephaly following a ZIKV outbreak needs further studies.

Introduction Les traitements medicaux de l’emphyseme ont une efficacite limitee. L’objectif de cette etude est d’evaluer l’efficacite, la securite et le cout de la reduction volumique par spirales endobronchiques dans le traitement de l’emphyseme severe. Methodes Etude multicentrique randomisee (1:1) de superiorite comparant la reduction volumique par spirales ( n = 50) au traitement medical standard seul ( n = 50) avec un suivi pendant un an. Le critere d’evaluation principal est l’amelioration du test de marche de six minutes a six mois (comparaison intergroupe du pourcentage de patients ayant une augmentation d’au moins 54 m de la distance parcourue). Les criteres secondaires sont les modifications a 6 et 12 mois de la fonction respiratoire, de la dyspnee, de la qualite de vie, la mortalite et le cout global. Resultats Soixante et onze hommes et 29 femmes, d’âge moyen de 62 ans ont ete inclus. A 6 mois, une amelioration du test de marche de 6 minutes de plus de 54 m etait observee chez 16 patients (32 %) dans le groupe spirales contre 8 patients (16 %) dans le groupe temoin ( p = 0,03). Les modifications a 6 et 12 mois dans le groupe spirales et le groupe temoin etaient respectivement de +9 % [IC 95 %, +4 ; +14] et +8 % [+3 ; +13] vs –3 % [–6 ; +1] et –3 % [–8 ; +2] pour le VEMS ( p p p Conclusion La reduction volumique par spirales est associee a une augmentation des capacites a l’exercice a 6 mois et a une amelioration de la fonction respiratoire et de la qualite de vie a 6 et 12 mois.

International audience; Designing multimodal virtual environments promises revolutionary advances in interacting with computers in the near future. In this paper, we report the results of an experimental investigation on the possible use of surround-sound systems to support visualization, taking advantage of increased knowledge about how spatial perception and attention work in the human brain. We designed two auditory-visual cross-modal experiments, where noise bursts and light-blobs were presented synchronously, but with spatial offsets. We presented sounds in two ways: using free field sounds and using a stereo speaker set. Participants were asked to localize the direction of sound sources. In the first experiment visual stimuli were displaced vertically relative to the sounds, in the second experiment we used horizontal offsets. We found that, in both experiments, sounds were mislocalized in the direction of the visual stimuli in each condition (ventriloquism effect), but this effect was stronger when visual stimuli were displaced vertically, as compared to horizontally. Moreover we found that the ventriloquism effect is strongest for centrally presented sounds. The analyses revealed a variation between different sound presentation modes. We explain our results from the viewpoint of multimodal interface design. These findings draw attention to the importance of cognitive features of multimodal perception in the design of virtual environment setups and may help to open new ways to more realistic surround based multimodal virtual reality simulations.

After an 18-year absence, dengue virus serotype 3 reemerged in the South Pacific Islands in 2013. Outbreaks in western (Solomon Islands) and eastern (French Polynesia) regions were caused by different genotypes. This finding suggested that immunity against dengue virus serotype, rather than virus genotype, was the principal determinant of reemergence.

De par sa forte prevalence, sa chronicite et son impact social, la peur des hauteurs ou acrophobie represente un domaine de recherche important. La therapie comportementale par exposition a la realite virtuelle (TERV) a demontre son efficacite clinique dans le traitement de cette pathologie. Le but de cette etude TEP etait de caracteriser le metabolisme cerebral des patients atteints d’acrophobie et d’etudier l’impact de la TERV sur ce metabolisme cerebral et les modifications associees de connectivite. Methodes Dix-huit patients atteints d’acrophobie, inclus dans l’etude CTRLSTRESS (financee par la Mission pour l’Interdisciplinarite du CNRS), ont eu une TEP au 18F-FDG cerebrale, sensibilisee par une exposition concomitante a la peur du vide par realite virtuelle, avant traitement par TERV. Parmi eux, 9 patients ont de nouveau ete testes en TEP sensibilisee par realite virtuelle apres traitement. La reponse clinique a la TERV a ete evaluee par une echelle visuelle analogique (EVA) et le test comportemental d’evitement (TCE). Des comparaisons de cartes statistiques a l’aide du logiciel SPM ont ete realisees entre les patients et 18 sujets temoins sains apparies selon l’âge et le sexe (p 178). La connectivite metabolique a ete evaluee par analyse de correlation interregionale (p 84). Resultats L’echelle EVA et le test TCE ont ete significativement ameliores chez les patients apres TERV (p = 0,02). Avant TERV, les patients atteints d’acrophobie presentaient une diminution du metabolisme des regions temporales internes bilaterales en comparaison aux sujets sains. Apres TERV, les patients presentaient une augmentation de metabolisme dans les gyri superieurs frontaux et le gyrus precentral gauche, et une augmentation de la connectivite metabolique entre ce meme gyrus precentral gauche et les regions occipitales (coefficient de correlation avant et apres traitement de respectivement 0,24, p = 0,34 et 0,73, p = 0,03). Conclusion Cette etude montre l’implication du systeme limbique chez les patients atteints d’acrophobie. Par ailleurs, l’efficacite de la TERV dans cette pathologie semble liee a une augmentation de la connectivite au sein du systeme visuo-moteur, potentielle cible pour de futurs travaux de rehabilitation chez ces patients.

The early stages of the graphitization of the 6H-SiC(000 1 ) (3×3) surface in an Ultra-High Vacuum (UHV) are investigated by means of scanning tunneling microscopy (STM). Different kinds of graphitic islands are found on the surface. One kind (called G_ 3×3) consists of a single graphene-like carbon plane covering the initial (3×3) reconstructed substrate surface. We observe a broad distribution of rotation angles between the substrate and the carbon plane revealed by superstructures of different directions and periods. Low bias images show that the graphene structure is preserved close to the Fermi level. The data indicate a weak substrate-graphene coupling for the G_ 3×3 islands.

The distribution network is being challenged bythe increasing capacity of Distributed Generation (DG),end-users embracing smart grid technologies to offer their flexibility,the continuous growth of the peak load in most European countries,the expected increase of Electric Vehicles (EVs) to hit the road by 2020 along with public charging stations. All of these evolving and new uses of electricity increase the complexity of the management of the distribution system. Current trends impose challenges that impact the ability of the DSO to carry out his responsibilities: develop, operate, and maintain the network in order to deliver high-quality services to grid users and other stakeholders of the electric power system, while ensuring safety of people, assets most efficient use and system security incooperation with TSOs. DSOs need to evolve from its former “fit and forget” approach towards an Active Distribution System Management approach to ensure the fulfilment of DSOs’ core responsibilities by taking advantage of the opportunities brought by smart grid technologies. The exploration of these opportunities could lead to the provision of new regulated services, the facilitation of electricity markets, the empowerment of the end-customers and the creation of sustainable public policies for the cost-efficient integration of renewables. This evolution will allow DSOs to provide an adequate Quality of Service (QoS) and to enhance the Security of Supply (SoS) in a cost-efficient way.

International audience; Outbreaks of Salmonella enterica serotype Enteritidis infections associated with eggs occurred in French Polynesia during 2008-2013. Molecular analysis of isolates by using clustered regularly interspaced short palindromic repeat polymorphisms and multilocus variable-number tandem-repeat analysis was performed. This subtyping made defining the epidemic strain, finding the source, and decontaminating affected poultry flocks possible.

The effect of electron doping on the van Hove singularities (vHs) which develop in twisted graphene bilayers (tBLs) is studied for a broad range of rotation angles $\ensuremath{\theta}\phantom{\rule{0.28em}{0ex}}(1.{5}^{\ensuremath{\circ}}l\ensuremath{\theta}l{15}^{\ensuremath{\circ}})$ by means of scanning tunneling microscopy and spectroscopy. Bilayer and trilayer graphene islands were grown on the 6H-SiC(000-1) $(3\ifmmode\times\else\texttimes\fi{}3)$ surface, which results in tBLs doped in the ${10}^{12}\phantom{\rule{4pt}{0ex}}{\mathrm{cm}}^{\ensuremath{-}2}$ range by charge transfer from the substrate. For large angles, doping manifests in a strong asymmetry of the positions of the upper (in empty states) and lower (in occupied states) vHs with respect to the Fermi level. The splitting of these vHs energies is found essentially independent of doping for the whole range of $\ensuremath{\theta}$ values, but the center of theses vHs shifts towards negative energies with increasing electron doping. Consequently, the upper vHs crosses the Fermi level for smaller angles (around ${3}^{\ensuremath{\circ}}$). The analysis of the data performed using tight-binding calculations and simple electrostatic considerations shows that the interlayer bias remains small $(l100\phantom{\rule{0.28em}{0ex}}\mathrm{mV})$ for the doping level resulting from the interfacial charge transfer $(\ensuremath{\simeq}5\ifmmode\times\else\texttimes\fi{}{10}^{12}\phantom{\rule{0.28em}{0ex}}{\mathrm{cm}}^{\ensuremath{-}2})$.