University of Aruba

In temporal lobe epilepsy (TLE), locally reduced glucose metabolism (i.e., hypometabolism) is indicative of the epileptogenic onset zone (EZ). Here, we investigate the potential value of resting-state fMRI (rs-fMRI) for localizing the EZ with fluorodeoxyglucose positron emission tomography (FDG-PET) as ground truth. Twelve PET-positive patients (34.1 ± 13.1 y; 5 females) with unilateral drug-resistant TLE were included. FDG-PET and rs-fMRI were acquired simultaneously at a hybrid 3T PET-MR scanner. Hypometabolic regions were identified on the FDG-PET images by a nuclear medicine expert. The FDG-PET images were compared with a clinical FDG-PET control dataset with normal glucose uptake distribution. The output z-score maps were thresholded at z < -2 to produce a binary mask of the significantly hypometabolic regions. The hypometabolism masks were mirrored onto the contralateral hemisphere for the asymmetry comparison. Regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), and fractional ALFF (fALFF) were calculated from the rs-fMRI in conventional (0.01-0.1 Hz) and slow-3 (0.073-0.198 Hz) frequency bands. Asymmetry indices (AIs) were calculated using the ipsilateral and contralateral hypometabolic masks in the PET-positive subjects and assessed via the one-sample Wilcoxon test and Spearman correlation coefficients. The AIs of conventional fALFF were significantly lower in the hypometabolic zone (p < 0.05). A significant negative correlation was found between the AIs of FDG-PET and fALFF in the slow-3 band (r = -0.62; p < 0.05). Conventional and slow-3 band fALFF showed a potential to mimic the FDG-PET findings in terms of EZ localization. Further research with extended cohorts and histopathological validation is required to determine the clinical value.

Background:Many athletes experience pubalgia. Although much is known about ligament injuries in other joints, the importance of ligament injuries in the pubic joint remains understudied.Purpose:To determine the frequency of an inferior pubic ligament (IPL) injury on magnetic resonance imaging (MRI) in a population of athletes with isolated pubic-related groin pain and to compare this group with a control group of athletes with adductor-related groin pain to assess the clinical relevance and association of an IPL injury with pubic-related groin pain.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Inclusion criteria consisted of athletes with pubic-related groin pain. All included participants were given a standardized questionnaire, a clinical examination, and a MRI examination of the pelvis. All MRI scans were reviewed to assess the IPL and other pubic-related pathologies, including pubic bone marrow edema and adductor injuries. The prevalence of an IPL lesion in patients with pubic-related groin pain is reported with the 95% confidence interval (95% CI). A control group with adductor-related groin pain was retrospectively included for comparison. Group characteristics were compared using the Pearson χ2 test, Fisher exact test, and Mann-Whitney-Wilcoxon test. Risk factors of IPL injury were analyzed by logistic regression.Results:A total of 60 athletes were included (56 male, 4 female); 18% showed definite MRI signs of IPL injury. In addition, 15% showed an equivocal IPL abnormality. This resulted in an IPL lesion prevalence of 33% (95% CI, 23%-46%) in this group. Of the 20 athletes with an IPL injury, 18 were soccer players and 2 were track and field athletes. All were men. The median age was 30 years (IQR, 26-36). The risk of IPL lesion was significantly higher in patients with trauma (odds ratio, 8.76; 95% CI, 2.56-29.91; P < .001). No IPL lesions were observed in the control group of 28 athletes with adductor-related groin pain (P < .001).Conclusion:On the basis of MRI analysis, there is a relatively high frequency of IPL injuries (33%) in athletes with pubic-related groin pain in addition to pubic bone and adductor pathology. No IPL injuries (0%) were observed in a control group of athletes with adductor-related groin pain. Our findings support the consideration of IPL injury in the diagnostic workup of pubic-related groin pain, particularly in posttraumatic cases. Further research is needed to refine the diagnostic process and to better understand the implications of IPL injury for rehabilitation and return-to-play outcomes.

Insurance has been around for centuries. Traditionally, it has been purchased to protect the purchaser, namely, the insured. Over time, the insurance industry has developed an increasing number of products, so that at present one can purchase insurance to cover nearly every risk imaginable. The concept of mandatory or obligatory insurance is a fairly recent development. It traces its origins to the widespread use of the motor vehicle and also employment. Obligatory insurance is designed to protect certain classes of persons, such as workers and those who sustain injury and damage at the hands of others. In this article, the authors compare the current state of obligatory insurance in four democratic countries: the United States, Italy, Aruba and Poland. The aim of the article is to catalogue the similarities and differences in obligatory insurance in those four countries. The countries studied all have obligatory insurance designed to offer some degree of protection to workers injured on the job, and in the course and scope of their work, and to those involved in vehicular collisions. The other primary takeaway from our research is that, predictably, there is less obligatory insurance in the United States than in the other countries studied.

BackgroundThe geographic range of flaviviruses is expanding, as evidenced by the increase in dengue virus (DENV) cases and the recent emergence of Zika virus (ZIKV) in the Americas. Studying seroprevalence of flaviviruses in (hyper)endemic regions is challenging due to extensive antibody cross-reactivity. Over the past decade, Aruba and Curaçao have experienced DENV and ZIKV outbreaks, of which the magnitude and impact remain unclear due to the challenges of disentangling DENV from ZIKV (past) infection.MethodsHere, we study the potential utility of blood donors for monitoring the extent of circulation, on 2 Caribbean islands. We report a longitudinal cross-sectional study using randomly selected blood donor sera (n = 715) during the ZIKV outbreaks on Aruba and Curaçao (January 2016–July 2017). Flavivirus seroprevalence was estimated using a validated multiplex protein microarray containing NS1 proteins for 11 flaviviruses, in combination with confirmation virus neutralization tests on a selection of sera.ResultsIt was possible to disentangle ZIKV exposure from exposure to other flaviviruses. In Curaçao, the seroprevalence of ZIKV antibodies was 25% and significantly higher than the prevalence of antibodies attributable to ZIKV exposure in Aruba (8%). Flavivirus immunoglobulin G antibody (IgG) titers increased with age (P < .05),ConclusionsThis methodology allows estimation of ZIKV seroprevalence during and after the ZIKV outbreaks. This study shows the importance of including age in the interpretation of serology data. Furthermore, it gives insights into the complex antibody (background) patterns of flaviviruses over time, and highlights the utility of an existing voluntary blood donor program to monitor and respond to (flavivirus) outbreaks.

BackgroundStandardized patients (SPs) have been crucial in medical education, offering realistic patient interactions to students. Despite their benefits, SP training is resource-intensive and access can be limited. Advances in artificial intelligence (AI), particularly with large language models such as ChatGPT, present new opportunities for virtual SPs, potentially addressing these limitations.ObjectivesThis study aims to assess medical students’ perceptions and experiences of using ChatGPT as an SP and to evaluate ChatGPT’s effectiveness in performing as a virtual SP in a medical school setting.MethodsThis qualitative study, approved by the American University of Antigua Institutional Review Board, involved 9 students (5 females and 4 males, aged 22‐48 years) from the American University of Antigua College of Medicine. Students were observed during a live role-play, interacting with ChatGPT as an SP using a predetermined prompt. A structured 15-question survey was administered before and after the interaction. Thematic analysis was conducted on the transcribed and coded responses, with inductive category formation.ResultsThematic analysis identified key themes preinteraction including technology limitations (eg, prompt engineering difficulties), learning efficacy (eg, potential for personalized learning and reduced interview stress), verisimilitude (eg, absence of visual cues), and trust (eg, concerns about AI accuracy). Postinteraction, students noted improvements in prompt engineering, some alignment issues (eg, limited responses on sensitive topics), maintained learning efficacy (eg, convenience and repetition), and continued verisimilitude challenges (eg, lack of empathy and nonverbal cues). No significant trust issues were reported postinteraction. Despite some limitations, students found ChatGPT as a valuable supplement to traditional SPs, enhancing practice flexibility and diagnostic skills.ConclusionsChatGPT can effectively augment traditional SPs in medical education, offering accessible, flexible practice opportunities. However, it cannot fully replace human SPs due to limitations in verisimilitude and prompt engineering challenges. Integrating prompt engineering into medical curricula and continuous advancements in AI are recommended to enhance the use of virtual SPs.

Circulating tumor cells (CTCs) have emerged as a key biomarker in cancer detection and prognosis, and their molecular profiling is gaining importance in precision oncology. Liquid biopsies, which allow the extraction of CTCs, circulating tumor DNA (ctDNA) or cell-free DNA (cfDNA), have measurable advantages over traditional tissue biopsies, especially when molecular material is difficult to obtain. However, this method is not without limitations. Difficulties in differentiating between primary and metastatic lesions, uncertain predictive values and the complexity of the biomarkers used can prove challenging. Recently, high cell heterogeneity has been identified as the main obstacle to achieving high diagnostic accuracy. Because not all cells undergo epithelial-mesenchymal transition (EMT) at the same time, there is a large population of hybrid CTCs that express both epithelial and mesenchymal markers. Since traditional diagnostic tools primarily detect epithelial markers, they are often unable to detect cells with a hybrid phenotype; therefore, additional markers may be required to avoid false negatives. In this review, we summarize recent reports on emerging CTCs markers, with particular emphasis on their use in cancer diagnosis. Most of them, including vimentin, TWIST1, SNAI1, ZEB1, cadherins, CD44, TGM2, PD-L1 and GATA, hold promise for the detection of CTCs, but are also implicated in cancer progression, metastasis, and therapeutic resistance. Therefore, understanding the nature and drivers of epithelial-mesenchymal plasticity (EMP) is critical to advancing our knowledge in this field.

The morphology of a coral reef terrace is a key parameter in the interpretation and quantification of past sea-level changes, but it is directly influenced by local morphodynamic and hydrodynamic conditions. Spatial differences in terrace morphology t

BackgroundSelf-Directed Learning (SDL) is a theory of andragogy in which adult learners take their own initiative to identify and tailor their individual learning process and outcomes. In undergraduate medical education, SDL aims to develop medical students into lifelong learners. This study aims to estimate the overall effectiveness of self-directed learning compared to traditional didactic learning (TDL).MethodsWe performed a systematic review and meta-analysis according to the PRISMA statement. A systematic search was used across PubMed, Scopus, Embase and Google Scholar to identify peer-reviewed articles spanning from January 1, 2014, to May 30, 2024. Key words used were “self-directed learning” AND “undergraduate medical education.” Forest plots were generated with the Open Meta-analyst Software, comparing SDL and TDL.ResultsA total of 2,955 titles and abstracts were screened for eligibility, of which 95 articles met the eligibility criteria for full-text review. Following a more detailed screening, 19 articles met the criteria for inclusion in the systematic review and 14 articles met the criteria for inclusion in the meta-analysis. The systematic review included 2,098 students while the meta-analysis included 1,792 students. The overall mean difference for all studies was 2.399, 95% CI [0.121–4.678], and I2 = 98.56%.ConclusionSelf-directed learning compared to traditional didactic learning is an effective learning strategy in medical undergraduate education and has the potential to aid in students’ learning and improve their cognitive performance. Moreover, SDL nurtures qualities such as autonomy, curiosity, and self-regulation, which are essential for success in the ever-evolving field of medicine.

There is no consensus about the definition and classification of Sub-National Island Jurisdictions (SNIJs). This may conflate academic and policy analysis and misguide policies to advance development. We review existing definitions and classifications of SNIJs and systematically analyze the criteria used in different studies. Our study finds several inconsistencies in existing lists of entities labelled as SNIJs. This shows it may be helpful to arrive at common ground as to what might constitute an SNIJ. We suggest to define an SNIJ as a non-sovereign populated island territory that possesses some degree of autonomy in a partnership with a parent state. SNIJs have their own identity and culture, which are distinct from the parent state. They often are former colonies and may freely move towards independence. This definition can be used as a starting point for further analysis and of SNIJs that can help study them and design policies that address their challenges.