Background: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of subsequent stroke is uncertain. Methods: Electronic databases were searched for observational studies reporting subsequent stroke during a minimum follow-up of 1 year in patients with TIA or minor stroke. Unpublished data on number of stroke events and exact person-time at risk contributed by all patients during discrete time intervals of follow-up were requested from the authors of included studies. This information was used to calculate the incidence of stroke in individual studies, and results across studies were pooled using random-effects meta-analysis. Results: Fifteen independent cohorts involving 129794 patients were included in the analysis. The pooled incidence rate of subsequent stroke per 100 person-years was 6.4 events in the first year and 2.0 events in the second through tenth years, with cumulative incidences of 14% at 5 years and 21% at 10 years. Based on 10 studies with information available on fatal stroke, the pooled case fatality rate of subsequent stroke was 9.5% (95% CI, 5.9 – 13.8). Conclusions: One in five patients is expected to experience a subsequent stroke within 10 years after a TIA or minor stroke, with every tenth patient expected to die from their subsequent stroke.

The popularity of a vegan diet is growing worldwide. Data analysed from the 2018 NZ Attitudes and Values study showed that 1.1% of New Zealanders followed a vegan diet(1). Though there are potential nutrient deficiencies in a vegan diet, it is generally accepted that a vegan diet, with its emphasis on a variety of vegetables, fruit, grains, legumes, and pulses, has greater metabolic benefits than a Western-style diet high in red meat and processed foods and lower in plants(2). This observational cross-sectional study aimed to explore the dietary intake (4-day food diary) and metabolic health status (including anthropometry, blood pressure, lipids, body fat percentage, omega-3 index and glycaemic control) of adults who had been consuming a vegan diet for 2+ years. Participants (N = 212) were predominantly female (N = 155) with a mean (SD) age of 39.5 (12.4) years. Mean cardiometabolic markers of systolic and diastolic blood pressure, BMI, waist circumference, HbA1c, total cholesterol, LDL-cholesterol, HDL-cholesterol, Chol:HDL ratio and triglycerides were all below the thresholds for disease risk. Omega-3 index results <4% placed most participants (86.3%) in the high-risk category for heart disease. Many female participants (71%) had >30% body fat, compared to 5.3% of males. With reference to the AMDR (total fat 20-35%, carbohydrate 45-65% and protein 15-25%), the intake of total fat was at the upper end (males 34.4%, females 35.9%), carbohydrate was at the lower end (males 46.2%, females 44.7%), and protein was below the lower end (males 14.9%, females 14.2%). Saturated fat intakes ranged from 4.0-65.9 g/d, with a mean (SD) of 24.9 (10.5) g/d for males and 20.2 (9.9) g/d for females. The mean (SD) dietary fibre intake was much higher than the AI set by the Ministry of Health of 25g/d for females and 30g/d for males, at 55.0 (17.8) g/d for males and 43.4 (12.8) g/d for females, ranging from 10.9-133.9g/d. This is the first New Zealand study to examine the metabolic health and dietary intake of adult vegans. The results of cardiometabolic health markers indicate that the vegan diet confers cardioprotective benefits. However, the low Omega-3 index of most participants is concerning, which warrants longitudinal research to assess the level of risk conferred by a low Omega-3 index result in a population with no other cardiometabolic risk factors. The findings of the present study may help guide the growing New Zealand vegan community towards a nutritionally optimal vegan diet.

Background: Sex differences in treatment response to intravenous thrombolysis (IVT) are poorly characterized. We compared sex-disaggregated outcomes in patients receiving IVT for acute ischemic stroke in the Alteplase compared to Tenecteplase (AcT) trial, a Canadian multicentre, randomised trial. Methods: In this post-hoc analysis, the primary outcome was excellent functional outcome (modified Rankin Score [mRS] 0-1) at 90 days. Secondary and safety outcomes included return to baseline function, successful reperfusion (eTICI≥2b), death and symptomatic intracerebral hemorrhage. Results: Of 1577 patients, there were 755 women and 822 men (median age 77 [68-86]; 70 [59-79]). There were no differences in rates of mRS 0-1 (aRR 0.95 [0.86-1.06]), return to baseline function (aRR 0.94 [0.84-1.06]), reperfusion (aRR 0.98 [0.80-1.19]) and death (aRR 0.91 [0.79-1.18]). There was no effect modification by treatment type on the association between sex and outcomes. The probability of excellent functional outcome decreased with increasing onset-to-needle time. This relation did not vary by sex (pinteraction 0.42). Conclusions: The AcT trial demonstrated comparable functional, safety and angiographic outcomes by sex. This effect did not differ between alteplase and tenecteplase. The pragmatic enrolment and broad national participation in AcT provide reassurance that there do not appear to be sex differences in outcomes amongst Canadians receiving IVT.

Humpback whales (Megaptera novaeangliae) exhibit maternally driven fidelity to feeding grounds, and yet occasionally occupy new areas. Humpback whale sightings and mortalities in the New York Bight apex (NYBA) have been increasing over the last decade, providing an opportunity to study this phenomenon in an urban habitat. Whales in this area overlap with human activities, including busy shipping traffic leading into the Port of New York and New Jersey. The site fidelity, population composition and demographics of individual whales were analysed to better inform management in this high-risk area. Whale watching and other opportunistic data collections were used to identify 101 individual humpback whales in the NYBA from spring through autumn, 2012–2018. Although mean occurrence was low (2.5 days), mean occupancy was 37.6 days, and 31.3% of whales returned from one year to the next. Individuals compared with other regional and ocean-basin-wide photo-identification catalogues (N = 52) were primarily resighted at other sites along the US East Coast, including the Gulf of Maine feeding ground. Sightings of mother-calf pairs were rare in the NYBA, suggesting that maternally directed fidelity may not be responsible for the presence of young whales in this area. Other factors including shifts in prey species distribution or changes in population structure more broadly should be investigated.

Soldier operational performance is determined by their fitness, nutritional status, quality of rest/recovery, and remaining injury/illness free. Understanding large fluctuations in nutritional status during operations is critical to safeguarding health and well-being. There are limited data world-wide describing the effect of extreme climate change on nutrient profiles. This study investigated the effect of hot-dry deployments on vitamin D status (assessed from 25-hydroxyvitamin D (25(OH)D) concentration) of young, male, military volunteers. Two data sets are presented (pilot study, n 37; main study, n 98), examining serum 25(OH)D concentrations before and during 6-month summer operational deployments to Afghanistan (March to October/November). Body mass, percentage of body fat, dietary intake and serum 25(OH)D concentrations were measured. In addition, parathyroid hormone (PTH), adjusted Ca and albumin concentrations were measured in the main study to better understand 25(OH)D fluctuations. Body mass and fat mass (FM) losses were greater for early (pre- to mid-) deployment compared with late (mid- to post-) deployment (P<0·05). Dietary intake was well-maintained despite high rates of energy expenditure. A pronounced increase in 25(OH)D was observed between pre- (March) and mid-deployment (June) (pilot study: 51 (sd 20) v. 212 (sd 85) nmol/l, P<0·05; main study: 55 (sd 22) v. 167 (sd 71) nmol/l, P<0·05) and remained elevated post-deployment (October/November). In contrast, PTH was highest pre-deployment, decreasing thereafter (main study: 4·45 (sd 2·20) v. 3·79 (sd 1·50) pmol/l, P<0·05). The typical seasonal cycling of vitamin D appeared exaggerated in this active male population undertaking an arduous summer deployment. Further research is warranted, where such large seasonal vitamin D fluctuations may be detrimental to bone health in the longer-term.

Replacement phenomena in amblygonite–montebrasite in rare-element pegmatites from the Karibib-Usakos area, Namibia, have been investigated using the electron microprobe. The first African occurrence and analysis of the very rare mineral natromontebrasite NaAl(PO4)(OH,F) is reported from the Daheim pegmatite. In the Okatjimukuju pegmatite, montebrasite has been replaced by a number of phases including crandallite CaAl3(PO4)2(OH)5·H2O and brazilianite NaAl3(PO4)2(OH)4. In one example, montebrasite has been almost completely replaced by brazilianite which has also been found to contain not only crandallite but also its solid solution analogues: goyazite SrAl3(PO4)2(OH)5·H2O and gorceixite BaAl3(PO4)2(PO3OH)(OH)6. Apatite is common at the contacts with montebrasite and associated minerals and texturally is intimately intergrown with crandallite, goyazite and gorceixite at Okatjimukuju. The occurrence of these minerals offers insight into the chemistry of post-magmatic fluids in these pegmatites.

Euhedral crystals of the low-temperature mineral lansfordite, MgCO3 · 5H2O, have been prepared from saturated magnesium bicarbonate solutions at temperatures below 10°C. The crystals are monoclinic P21/a with a = 12.4758(7), b = 7.6258(4), c = 7.3463(6)Å, β = 101.762(6)°, V = 684.24Å3, Dcalc. = 1.693 g cm−3, Dobs. = 1.70(1) g m−3. At room temperature, the crystals slowly effloresce to produce pseudomorphs of nesquehonite, MgCO3 · 3H2O. Dehydration is complete at 300°C, with decarbonation taking place in the interval to 560°C. A new X-ray powder diffraction pattern is presented, and details of the infra-red absorption spectrum are discussed.

We have analysed a rare occurrence of orange-brown manganotantalite lamellae (visible in hand specimen), intergrown with microlite [(Ca,Na)2(Ta,Nb)2(O,OH,F)7], aggregates of ferrotapiolite, bismuth minerals and apatite to understand more about the mechanisms of crystal growth and secondary modification in Ta-rich minerals. The intergrowth occurs within amblygonite/montebrasite nodules near the quartz core of the highly fractionated rare-metal Li/Be/Ta pegmatite at Rubicon, Karibib, Namibia. Electron microprobe analyses show that manganotantalite lamellae are variable in composition. Primary microlite (Ta2O5 82%, 1.97 Ta a.p.f.u.) forms the matrix mineral between the lamellae. Textural relations suggest an exsolution origin for the lamellae. Manganotantalite is represented by three generations: (1) primary late magmatic; (2) disequilibrium exsolution lamellae; and (3) subsolidus replacement. Crystallization commenced with primary microlite and likely simultaneous intergrowth between ferrotapiolite and a first generation of late-magmatic primary manganotantalite with low Ta (1.1—1.5 a.p.f.u.). On cooling this was followed by exsolution of manganotantalite lamellae, generation (2) with low—medium Ta (1.27—1.7 a.p.f.u.). The replacement of microlite by a highly fractionated late-stage melt rich in Mn2+, Ca2+ with low Na+ finally produces a third generation (3) of manganotantalite with high Ta (1.72—1.99 a.p.f.u.) at the contact with microlite. Native bismuth and bismutite cut across microlite and pseudomorph lamellae as a final hydrothermal replacement. Apatite is ubiquitous at the contact with amblygonite. The stability field of microlite may be extended by incorporation of CaTa2O6-rynersonite and Ca2Ta2O7 — idealized, components in solid solution. However, rynersonite-CaTa2O6 with distorted octahedra has some structural templates which are similar to the structure of pyrochlore (microlite). Hence, via the perovskite/pyrochlore analogy, hypothetical exsolution of manganotantalite-type structures may occur from a microlite (pyrochlore) host by solid-state diffusion via metastable rynersonite-type intermediates. Such a mechanism has the potential to explain the crystallographically controlled intergrowth textures and the compositional heterogeneity.