[The challenges and contributions of digital technology to improve the performance of the health system]. / Les enjeux et les apports du numérique pour un système de santé plus performant.

The digital transformation is already under way in our health system. The deployment of data-driven management and artificial intelligence supports the transition towards treatment methods oriented more towards chronic diseases. Understanding the ethical issues associated with this transformation is a key priority for the future of our health system.

Te-based glass fiber for far-infrared biochemical sensing up to 16 µm.

Chalcogenide glass fibers are very suitable to carry out mid-infrared spectroscopy by Fiber Evanescent Wave Spectroscopy (FEWS). Nowadays, selenide glasses are used for FEWS, but the reachable domain is limited in the infrared to typically 12 µm. Te-rich glasses, due to their heavy atomic weight, are better for far-infrared sensing but they crystallize easily and until now that was difficult to prepare operational optical fibers from such glasses. In this work, Te-Ge-AgI highly purified glasses have been prepared and successfully drawn into optical fiber. The minimum of attenuation is 3 dB/m around 10 µm, which is up to now the lowest value ever measured for Te-based fiber. Overall, such fibers open the sensing window up to 16 µm against 12 µm so far. Then, for the first time, tapered telluride fibers with different diameters at the sensing zone were obtained during the fiber drawing process. Chloroform and butter were used to test the fiber infrared sensing ability, and the sensitivity has been greatly enhanced as the sensing zone fiber diameter decreases. Finally, the new protocol of telluride glass preparation allows shaping them into efficient functional fibers, opening further in the mid-infrared which is essential for chemical spectroscopy.

Shaping of looped miniaturized chalcogenide fiber sensing heads for mid-infrared sensing.

Chalcogenide glass fibers are promising photonic tools to develop Fiber Evanescent Wave Spectroscopy (FEWS) optical sensors working in the mid-infrared region. Numerous pioneering works have already been carried out showing their efficiency, especially for bio-medical applications. Nevertheless, this technology remains confined to academic studies at the laboratory scale because chalcogenide glass fibers are difficult to shape to produce reliable, sensitive and compact sensors. In this paper, a new method for designing and fabricating a compact and robust sensing head with a selenide glass fiber is described. Compact looped sensing heads with diameter equal to 2 mm were thus shaped. This represents an outstanding achievement considering the brittleness of such uncoated fibers. FEWS experiments were implemented using alcoholic solutions as target samples showing that the sensitivity is higher than with the routinely used classical fiber. It is also shown that the best compromise in term of sensitivity is to fabricate a sensing head including two full loops. From a mechanical point of view, the breaking loads of the loop shaped head are also much higher than with classical fiber. Finally, this achievement paves the way for the use of mid-infrared technology during in situ and even in vivo medical operations. Indeed, is is now possible to slide a chalcogenide glass fiber in the operating channel of a standard 2.8 mm diameter catheter.

From selenium- to tellurium-based glass optical fibers for infrared spectroscopies.

Chalcogenide glasses are based on sulfur, selenium and tellurium elements, and have been studied for several decades regarding different applications. Among them, selenide glasses exhibit excellent infrared transmission in the 1 to 15 µm region. Due to their good thermo-mechanical properties, these glasses could be easily shaped into optical devices such as lenses and optical fibers. During the past decade of research, selenide glass fibers have been proved to be suitable for infrared sensing in an original spectroscopic method named Fiber Evanescent Wave Spectroscopy (FEWS). FEWS has provided very nice and promising results, for example for medical diagnosis. Then, some sophisticated fibers, also based on selenide glasses, were developed: rare-earth doped fibers and microstructured fibers. In parallel, the study of telluride glasses, which can have transmission up to 28 µm due to its atom heaviness, has been intensified thanks to the DARWIN mission led by the European Space Agency (ESA). The development of telluride glass fiber enables a successful observation of CO2 absorption band located around 15 µm. In this paper we review recent results obtained in the Glass and Ceramics Laboratory at Rennes on the development of selenide to telluride glass optical fibers, and their use for spectroscopy from the mid to the far infrared ranges.

Forming glasses from Se and Te.

Despite being close neighbors on the Periodic Table, selenium and tellurium present a totally different abilities to form glasses. Se is a very good glass former, and gives rise to numerous glass compositions which are popular for their transparency in the infrared range and their stability against crystallization. These glasses can be shaped into sophisticated optical devices such as optical fibers, planar guides or lenses. Nevertheless, their transparencies are limited at about 12 microm (depending on the thickness of the optical systems) due to the relatively small mass of the Se element. On the other hand, tellurium is heavier and its use in substitution for Se permits to shift the IR cutoff beyond 20 microm. However, the semimetallic nature of Te limits its glass formation ability and this glass family is known to be unstable and consequently has found application as phase change material in the Digital Versatile Disk (DVD) technology. In this paper, after a review of selenide glasses and their applications, it will be shown how, in a recent past, it has been possible to stabilize tellurium glasses by introducing new elements like Ga or I in their compositions.

Fiber evanescent wave spectroscopy using the mid-infrared provides useful fingerprints for metabolic profiling in humans.

Fiber evanescent wave spectroscopy (FEWS) explores the mid-infrared domain, providing information on functional chemical groups represented in the sample. Our goal is to evaluate whether spectral fingerprints obtained by FEWS might orientate clinical diagnosis. Serum samples from normal volunteers and from four groups of patients with metabolic abnormalities are analyzed by FEWS. These groups consist of iron overloaded genetic hemochromatosis (GH), iron depleted GH, cirrhosis, and dysmetabolic hepatosiderosis (DYSH). A partial least squares (PLS) logistic method is used in a training group to create a classification algorithm, thereafter applied to a test group. Patients with cirrhosis or DYSH, two groups exhibiting important metabolic disturbances, are clearly discriminated from control groups with AUROC values of 0.94+/-0.05 and 0.90+/-0.06, and sensibility/specificity of 8684% and 8787%, respectively. When pooling all groups, the PLS method contributes to discriminate controls, cirrhotic, and dysmetabolic patients. Our data demonstrate that metabolic profiling using infrared FEWS is a possible way to investigate metabolic alterations in patients.

[Effects of the Internet on the dissemination of medical information: some thoughts on applied ethics]. / Diffusion des informations médicales à l'épreuve des usages de l'Internet: quelques réflexions d'éthique et de déontologie appliquée.

Learned and professional societies as well as health authorities must attempt to provide free access to their databases for physicians, by a simple repertory of key words and, if necessary, by portals. Although information available for physicians may not be intended to be secret, it often requires some professional training to be interpreted appropriately. The principles of the Code of Medical Ethics, as transcribed in the Public Health Code, apply to all forms and media of information and communication. In public spaces, readers must be guaranteed that information written by physicians corresponds to the state of the art, that it is not advertising or self-promotion or commercial, that it was developed by a process ensuring quality, and that it distinguishes clearly between a popularized description of scientific data and what remains uncertain because research is on-going. The public should be informed about the source of the information they see, the editorial quality of the site, and any potential financial dependence or conflicts of interest. According to the medical association, prudence is recommended for physicians who moderate chat-rooms and discussion lists. List moderation, like any other type of medical activity, must not be improvised; it requires prudence, thought, and training.

Planar waveguide obtained by burying a Ge22As(20Se58 fiber in As2S3 glass.

We demonstrate the possibility of fabricating an infrared transmitting waveguide by burying fiber in chalcogenide glasses. Two highly mature chalcogenide glasses are used for these experiments. GASIR glass from Umicore IR Glass, Olen, Belgium, with the composition of Ge(22)As(20)Se(58) is used to draw fibers that are then buried in an As(2)S(3) glass substrate. The glasses we used are compatible, and we obtained a high quality interface. We performed a transmission test with a CO(2) laser at 9.3 microm. The potential for extremely low loss planar waveguides is discussed.

Glasses for seeing beyond visible.

Conventional glasses based on oxides have a transparency limited by phonon absorption in the near IR region and have a limited interest for analyzing information located far beyond the visible. The IR spectral domain is nevertheless of prime interest, since it covers fundamental wavelength ranges used for thermal imaging as well as molecular vibrational signatures. Besides spectacular advances in the field of IR detectors, the main significant progresses are related to the development of IR glass optics, such as lenses or IR optical fibres. The field of IR glasses is almost totally dominated by glasses formed from heavy atoms such as the chalcogens S, Se and Te. Their transparency extends up to 12, 16 and 28 microm for sulfide-, selenide- and the new generation of telluride-based glasses, respectively. They cover the atmospheric transparency domains, 3-5 and 8-13 microm, respectively, at which the IR radiation can propagate allowing thermal imaging and night-vision operations through thick layers of atmosphere. The development of new glass compositions will be discussed on the basis of structural consideration with the objective of moulding low-cost lenses for IR cameras used, for instance, in car-driving assistance. Additionally, multimode, single-index, optical fibres operating in the 3 to 12 microm window developed for in situ remote evanescent-wave IR spectroscopy will also be mentioned. The detection of molecular IR signatures is applied to environmental monitoring for investigating the pollution of underground water with toxic molecules. The extension of this technique to the investigation of biomolecules in three different studies devoted to liver tissues analysis, bio-film formation, and cell metabolism will also be discussed. Finally we will mention the developments in the field of single-mode fibres operating around 10 mum for the Darwin space mission, which is aiming at discovering, signs of biological life in telluric earth-like exoplanets throughout the universe.

Selenium-tellurium sequences in binary glasses as depicted by 77Se and 125Te NMR.

Some resolved solid state (77)Se NMR spectra are presented in the Te(x)Se(1-x) vitreous system at ambient temperature. They exhibit three different kinds of Se lines assigned to the following Se atom neighborhoods: Se-Se-Se, Se-Se-Te, and Te-Se-Te. Different models were considered to describe the way the Se and Te atoms are linked into the chains: clustering process, homogeneous distribution, random distribution. Finally, thanks to the measurements of the relative intensities of the lines, it appears that Se and Te atoms are mainly randomly distributed with a small preference for heteropolar bonds. The (125)Te spectra are also shown but their resolution is too weak to be informative concerning the vitreous network.