Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative

BACKGROUND AND OBJECTIVES: There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide. METHODS: We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression. RESULTS: We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36). DISCUSSION: Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs

Response function of single crystal synthetic diamond detectors to 1-4 MeV neutrons for spectroscopy of D plasmas

A Single-crystal Diamond (SD) detector prototype was installed at Joint European Torus (JET) in 2013 and the achieved results have shown its spectroscopic capability of measuring 2.5 MeV neutrons from deuterium plasmas. This paper presents measurements of the SD response function to monoenergetic neutrons, which is a key point for the development of a neutron spectrometer based on SDs and compares them with Monte Carlo simulations. The analysis procedure allows for a good reconstruction of the experimental results. The good pulse height energy resolution (equivalent FWHM of 80 keV at 2.5 MeV), gain stability, insensitivity to magnetic field, and compact size make SDs attractive as compact neutron spectrometers of high flux deuterium plasmas, such as for instance those needed for the ITER neutron camera