Controlled education of patients after stroke (ceops)-nurse-led multimodal and long-term interventional program involving a patient''s caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial

International audienceBACKGROUND: Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment, but necessary to prevent recurrence and improve patients' quality of life. To involve a referent nurse and a caregiver from the patient's social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family. The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up, and an interventional program directed to the patient and a caregiving member of their social circle, as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke.METHODS: The design is a randomized, controlled, clinical trial conducted in the French Stroke Unit of the Strokavenir network. In total, 410 patients will be recruited and randomized in optimized follow up or usual follow up for 2 years. In both group, patients will be seen by a neurologist at 6, 12 and 24 months. The optimized follow up will include follow up by a nurse from the vascular neurology department, including therapeutic follow up, and a training program on secondary prevention directed to the patient and a caregiving member of their social circle. After discharge, a monthly telephone interview, in the first year and every 3 months in the second year, will be performed by the nurse. At 6, 12 and 24 month, the nurse will give the patient and caregiver another training session. Usual follow up is only done by the patient's general practitioner, after classical information on secondary prevention of risk factors during hospitalization. The primary outcome measure is blood pressure measured after the first year of follow up. Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been randomized. Secondary endpoints are associated mortality, morbidity, recurrence, drug side-effects and medico-economic analysis.CONCLUSIONS: The result of this trial is expected to provide the benefit of a nurse-led optimized multimodal and long-term interventional program for management of risk factors after stroke, personalizing the role of the nurse and including the patient's caregiver.BACKGROUND: ClinicalTrials.gov, NCT 02132364. Registered on 7 May 2014. EUDRACT, A 00473-40

Carbon-rich dust in comet 67P/Churyumov-Gerasimenko measured by COSIMA/Rosetta

International audienceCometary ices are rich in CO2, CO and organic volatile compounds, but the carbon content of cometary dust was only measured for the Oort Cloud comet 1P/Halley, during its flyby in 1986. The COmetary Secondary Ion Mass Analyzer (COSIMA)/Rosetta mass spectrometer analysed dust particles with sizes ranging from 50 to 1000 mu m, collected over 2 yr, from 67P/Churyumov-Gerasimenko (67P), a Jupiter family comet. Here, we report 67P dust composition focusing on the elements C and O. It has a high carbon content (atomic C/Si = 5.5(-1.2)(+1.4) on average) close to the solar value and comparable to the 1P/Halley data. From COSIMA measurements, we conclude that 67P particles are made of nearly 50 per cent organic matter in mass, mixed with mineral phases that are mostly anhydrous. The whole composition, rich in carbon and non-hydrated minerals, points to a primitive matter that likely preserved its initial characteristics since the comet accretion in the outer regions of the protoplanetary disc

Choice of Initial Brain Imaging in Patients with Suspected Acute Stroke: STROKE69, a Population-Based Study

International audienceBackground: In patients with suspected stroke, brain imaging is recommended in the acute phase for appropriate management and treatment. Both computed tomography (CT) and magnetic resonance imaging (MRI) are considered reasonable choices for initial brain imaging. When both techniques are available, choosing one or the other might be associated with specific factors related either to patients, stroke symptoms, and severity or management organization. Methods: The study was performed within the STROKE 69 database, a population-based cohort of all adult patients with suspected stroke admitted in one of the emergency departments (ED), primary stroke center, or stroke center of the Rhône County, from November 2015 to December 2016. Patients were included if they were admitted within 24 h following either symptom onset or last known normal. To identify factors potentially associated with the choice of initial brain imaging, a multivariate logistic regression was performed. Results: Among the 3,244 patients with suspected stroke enrolled in the STROKE69 cohort, 3,107 (95.8%) underwent brain imaging within the first 24 h after admission. Among those 74.6% underwent CT as initial imaging while 25.4% had an MRI. In multivariate analyses, several factors were associated with a lower probability of having an MRI as initial brain imaging versus CT. These were either patient characteristics: older age (>80 years old, OR 0.39 [95% CI 0.28–0.54]), preexisting disability (OR 0.55 [95% CI 0.36–0.84]), use of anticoagulants (OR 0.52 [95% CI 0.33–0.81]), stroke characteristics: stroke of unknown onset (OR 0.42 [95% CI 0.31–0.58]) or factors associated with overall management: onset-to-door time (>6 h, OR 0.38 [95% CI 0.23–0.60]), initial admission to ED (OR 0.02 [95% CI 0.02–0.04]) or intensive care unit (OR 0.01 [95% CI 0.001–0.08]), personal transport (OR 0.66 [95% CI 0.45–0.96]), and admission during working hours (OR 0.65 [95% CI 0.51–0.84]). Conclusions: Besides CT or MRI availability, a number of other parameters could influence the choice of first imaging in case of stroke suspicion. These are related to patient characteristics, type of stroke symptoms, and type of organization

Global Composition of Cometary Dust Particles from 67P/Churyumov-Gerasimenko as deduced from the COSIMA/Rosetta Instrument

International audienc

Global Composition of Cometary Dust Particles from 67P/Churyumov-Gerasimenko as deduced from the COSIMA/Rosetta Instrument

International audienc

Nitrogen-to-carbon atomic ratio measured by COSIMA in the particles of comet 67P/Churyumov–Gerasimenko

International audienceThe COmetary Secondary Ion Mass Analyzer (COSIMA) on board the Rosetta mission has analysed numerous cometary dust particles collected at very low velocities (a few m s(-1)) in the environment of comet 67P/Churyumov-Gerasimenko (hereafter 67P). In these particles, carbon and nitrogen are expected mainly to be part of the organic matter. We have measured the nitrogen-to-carbon (N/C) atomic ratio of 27 cometary particles. It ranges from 0.018 to 0.06 with an averaged value of 0.035 +/- 0.011. This is compatible with the measurements of the particles of comet 1P/Halley and is in the lower range of the values measured in comet 81P/Wild 2 particles brought back to Earth by the Stardust mission. Moreover, the averaged value found in 67P particles is also similar to the one found in the insoluble organic matter extracted from CM, CI and CR carbonaceous chondrites and to the bulk values measured in most interplanetary dust particles and micrometeorites. The close agreement of the N/C atomic ratio in all these objects indicates that their organic matters share some similarities and could have a similar chemical origin. Furthermore, compared to the abundances of all the detected elements in the particles of 67P and to the elemental solar abundances, the nitrogen is depleted in the particles and the nucleus of 67P as was previously inferred also for comet 1P/Halley. This nitrogen depletion could constrain the formation scenarios of cometary nuclei

Assessment of Factors Associated With Community-Acquired Extended-Spectrum β-Lactamase–Producing <i>Escherichia coli</i> Urinary Tract Infections in France

International audienceIMPORTANCE Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is considered a leading pathogen contributing to the global burden of antimicrobial resistance. OBJECTIVE To better understand factors associated with the heterogeneity of community-acquired ESBL-producing E coli urinary tract infections (UTIs) in France. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study performed from January 1 to December 31, 2021, was based on data collected via PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a nationwide clinical laboratory surveillance system in France. Strains of E coli isolated from community urine samples from January 1 to December 31, 2019, from 59 administrative departments of metropolitan France were included. MAIN OUTCOMES AND MEASURES Quasi-Poisson regression models were used to assess the associations between several ecological factors available on government and administration websites between 2010 and 2020 (demographic population structure, living conditions, baseline health care services, antibiotic consumptions, economic indicators, animal farming density, and environmental characteristics) and the number of ESBL-producing E coli strains isolated from urine samples of individuals with community-acquired UTI in 2019